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BACKGROUND: Colonoscopy does miss some lesions that may be later diagnosed as post-colonoscopy colorectal cancers (PCCRCs). We evaluated the rate of PCCRCs in a cohort of our patients. METHODS: The data of patients diagnosed with first primary colorectal cancers (CRCs) between July 2014 and June 2017 were analyzed. Colorectal cancers were considered to be missed if they occurred among patients who have had an index colonoscopy between 7 and 36 months prior to their diagnosis. The incidence of missed lesions and the distribution of such lesions in the large bowel are presented. RESULTS: In the study, 399 of the total 541 patients whose CRCs were diagnosed by colonoscopy were included. The median age of the patients (213 males and 186 females) was 75.3 (32.4-82.1) years. Seven patients with diagnosis of primary CRCs had undergone index colonoscopy between 7 and 36 months prior to their diagnostic colonoscopy. Therefore, the PCCRC rate in this cohort was 1.8% (7/399 × 100). The mean time interval between the false negative colonoscopy (index colonoscopy) and diagnostic colonoscopy was 18.7 (9.1-34.9) months. Missed CRCs were located in the ascending (2), transverse (1), descending (1), and sigmoid colon (2) and in the rectum (1). CONCLUSION: Our PCCRC rate was 1.8%, which is lower than the usually reported rate.

The fecal immunochemical test (FIT) is a common colorectal cancer screening modality in the USA but often is not followed by diagnostic colonoscopy. We investigated the efficacy of patient navigation to increase diagnostic colonoscopy after positive FIT results and determined persistent barriers to follow-up despite navigation in a large, academic healthcare system. The study cohort included all health system outpatients with an assigned primary care provider, a positive FIT result between 12/01/2016 and 06/01/2019, and no documentation of colonoscopy after positive FIT. Two non-clinical patient navigators engaged patients and providers to encourage follow-up, offer solutions to barriers, and assist with colonoscopy scheduling. The primary intervention endpoint was completion of colonoscopy within 6 months of navigation. We documented reasons for persistent barriers to colonoscopy despite navigation and determined predictors of successful follow-up after navigation. There were 119 patients who received intervention. Of these, 37 (31.1%) patients completed colonoscopy at 6 months. In 41/119 (34.5%) cases, the PCP did not recommend colonoscopy, most commonly due to a normal colonoscopy prior to the positive FIT (19, 46.3%). There were 41/119 patients (34.5%) that declined colonoscopy despite the patient navigator and the PCP order. Male sex and younger age were significant predictors of follow-up (aOR = 2.91, 95%CI, 1.18-7.13; aOR = 0.92, 95%CI, 0.87-0.99). After implementation of patient navigation, diagnostic colonoscopy was completed for 31.1% of patients with a positive FIT result. However, navigation also highlighted persistent multilevel barriers to follow-up. Future work will develop targeted solutions for these barriers to further increase FIT follow-up rates in our health system.

Putut Bayupurnama,1 Neneng Ratnasari,1 Fahmi Indrarti,1 Catharina Triwikatmani,1 Sutanto Maduseno,1 Siti Nurdjanah,1 Felix W Leung2 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, Universitas Gadjah Mada/Dr Sardjito General Hospital, Yogyakarta, Indonesia; 2Sepulveda Ambulatory Care Center, VAGLAHS and David Geffen School of Medicine at UCLA, Los Angeles, CA, USACorrespondence: Putut Bayupurnama Division of Gastroenterology and Hepatology, Internal Medicine Department, Faculty of MedicineUniversitas Gadjah Mada/Dr.Sardjito Hospital, Yogyakarta, IndonesiaEmail pututby@yahoo.comObjective: A colonoscopy study in sedated patients with air insufflation showed that right-lateral starting position (RLP) improved abdominal discomfort and reduced cecal intubation time. The aim of this study was to determine if RLP vs left-lateral starting position (LLP) may produce similar results in unsedated patients examined with a modified-water immersion (m-WI) method.Methods: Consecutive patients for diagnostic colonoscopy meeting the inclusion criteria were randomized. Patients and colonoscopist were unblinded. The m-WI method entailed suction during insertion not only for fecal debris evacuation but also to facilitate passage through difficult or angulated colonic flexures. Water was infused as needed when any difficulty was encountered during insertion. A bowel visualization scale (BVS) (0=totally blurred visualization; 1=blurred lumen visualization; 2=small fecal debris with clear mucosa visualization; 3= clear visualization) was used to evaluate the interference of fecal debris with cecal intubation rate and time.Results: A total of 142 patients (72 in RLP and 70 in LLP) were enrolled. The respective pain score, visual analog scale, (VAS) and cecal intubation rate were not significantly different. The cecal intubation time was nearly significantly different (13.4± 4.5 min vs 11.7± 5.4 min; p=0.054) and was significantly different in the constipation subgroup (16.0± 3.5 min vs 8.6± 3.8 min; p=0.001). The cecal intubation time based on BVS showed significant difference between RLP and LLP in Scale 2 (13.9± 4.6 min vs 10.3± 4.2 min; p=0.003) and Scale 2 and 3 combined (13.2± 4.3 min vs 10.6± 4.8 min; p=0.01), respectively.Conclusion: RLP did not improve the pain score, and LLP showed better performance in unsedated m-WI colonoscopy patients (ClinicalTrial.gov, NCT03489824).Keywords: unsedated colonoscopy, colonoscopy starting position, water immersion

After 2 screen-setting studies showing high sensitivity for colorectal cancer and advanced precancerous lesions, multitarget stool DNA testing was endorsed by the US Preventative Services Task Force as a first-line colorectal cancer screening test. Uptake has increased exponentially since approval by the US Food and Drug Administration and Centers for Medicare and Medicaid Services. Adherence to testing is approximately 70%. Patients with positive results have high diagnostic colonoscopy completion rates in single-center studies. The positive predictive value for colorectal neoplasia in postapproval studies is high. Next-generation test prototypes show promise to extend specificity gains while maintaining high sensitivity.

BACKGROUND The optimal strategy for colonic polyps not amenable to traditional endoscopic polypectomy is unknown. Endoscopic step up is a promising strategy for definitive treatment. OBJECTIVE The purpose of this study was to determine whether endoscopic step up leads to improved outcomes and decreased costs compared with planned colectomy for endoscopically unresectable colon polyps. DESIGN This was a retrospective review of a prospective database. SETTING The study was conducted at a tertiary referral center. PATIENTS Consecutive patients referred for endoscopically unresectable colon polyps 15 to 50 mm in size were included. INTERVENTIONS Patients underwent planned colectomy or endoscopic step up at the surgeon's discretion. Endoscopic step up began with diagnostic colonoscopy in the operating room. If the polyp was amenable to endoscopic removal, endoscopic mucosal resection or endoscopic submucosal dissection was performed with progression to combined endoscopic-laparoscopic surgery or laparoscopic colectomy, as indicated. MAIN OUTCOME MEASURES The primary outcome was 30-day adverse events. We also examined length of stay, hospital charges, insurer payments, and polyp recurrence. RESULTS A total of 52 patients underwent planned colectomy (48 laparoscopic), and 38 underwent endoscopic step up (28 endoscopic mucosal resection, 2 endoscopic submucosal dissection, 6 combined endoscopic-laparoscopic surgery, and 2 colectomy). Compared with planned colectomy, endoscopic step-up patients had fewer complications (13% vs 33%; p = 0.03) and shorter length of stay (median, 0 vs 4 d; p < 0.001). There was 1 readmission in the endoscopic step-up group and 5 in the planned colectomy group. Endoscopic step-up patients had lower hospital costs ($4790 vs $13,004; p < 0.001) and insurer payments ($2431 vs $19,951; p < 0.001). One-year polyp recurrence-free survival was 84% (95% CI, 67%-93%) in endoscopic step-up patients. All of the recurrences were benign

Colorectal cancer (CRC) is the third most common malignancy in the industrial western world and the second cause of cancer death. Its evolution is slow; therefore it constitutes a favourable disease for the application of prevention methods. To show the diagnostic process of CRC (colonoscopy or surgery), highlight clinicopathological features associated with diagnosis (tumour stage and size, symptoms, etc) and record certain patient characteristics. This study included patients from the prefecture of Drama Greece, who were initially diagnosed with CRC. They were divided into three groups: those who underwent a screening colonoscopy, those who underwent a colonoscopy due to symptoms (diagnostic colonoscopy) and those who were subjected to emergent surgery. Sex, age, symptoms, surgery type, tumour size, stage at diagnosis and habits were investigated. The study included 52.6% (n=118) male and 47.4% (n=106) female patients. The mean age was 74.6 years. The group of screening colonoscopy included 5.8% of patients, the group of diagnostic colonoscopy 87% and the group of emergent surgery 7.2% of patients. Stage I CRC, with the most favourable prognosis, was diagnosed more frequently in the group of screening colonoscopy than in those of diagnostic colonoscopy and emergent surgery (38.5%, 4.6% and 0% respectively). At least 61.5%, 52.3% and 81.25% of each group respectively had never undergone a screening colonoscopy. Nearly 95% of the patients were diagnosed after symptom development and had more advanced disease. The contribution of colonoscopy in prompt CRC diagnosis (asymptomatic tumours) is crucial and well-organised screening programs should be applied in the general population.

Postcolonoscopy colorectal cancer (PCCRC) can arise from missed cancers, missed premalignant lesions, incomplete resection, and new cancers with an accelerated route to cancer.1.

Although initiatives have been largely spread throughout Europe, almost all population-based FIT screening programmes were implemented relatively recently, lowering possibilities to already observe...

Introduction: Evidence suggests that colorectal cancer (CRC) screening using guaiac faecal occult blood tests (gFOBT) reduces the CRC burden by facilitating timely removal of adenomas. Yet, the faecal immunochemical test (FIT) is being implemented in many countries. The aim of this study was to analyse the risk of having adenomas detected when invited for FIT-based screening as compared to those not yet invited. Material and Methods: The study was designed as a register-based retrospective cohort study. The potential for prevention was estimated as number of individuals who had no adenomas, non-advanced adenomas, and advanced adenomas detected per 1000 invited/not yet invited individuals and the relative risk (RR) of each of the three outcomes. Results: A total of 1,359,340 individuals were included, 29.6% of whom had been invited and 70.4% had not yet been invited to participate in CRC screening. Compared with the not yet invited population, the invited group had a RR of no adenomas of 2.28 (2.22–2.34) and a RR of advanced adenomas of 7.41 (6.93–7.91). The RR of colonoscopy was 2.93 (2.87–2.99) for the invited population compared with the not yet invited population. Conclusion: The RR of having a colonoscopy was three times higher among those invited compared to those not yet invited for CRC screening and twice as often those who had been invited compared to those not yet invited had no adenomas detected. Still, the risk of advanced adenomas was more than seven times higher among the invited population, indicating that the screening programme holds great potential for reducing the CRC burden. Abbreviations: CI: Confidence interval; CRC: Colorectal cancer; FIT: Faecal immunochemical test; ICD: International Classification of Disease; RR: Relative risk.

AIM: to evaluate the efficacy, safety and drug tolerance of «Colokit» for bowel cleansing before colonoscopy.PATIENTS AND METHODS: an open prospective non-randomised study of the quality of bowel cleansing was carried out in 30 patients (17 females, aged 26-72 years), who underwent diagnostic colonoscopy after using «Сolokit» (Mayoly Spindler, France) using two different regimes (recommended and alternative).RESULTS: the quality of the bowel cleansing was significantly better in patients after «Colokit» use in recommended regime vs alternative regime. No difference in subjective assessment of patients’ comfort during bowel preparation was found in both regimes. CONCLUSION: the «Colokit» agent provides good preparation and patients’ comfort and can be recommended for the bowel cleansing before colonoscopy.

INTRODUCTION We evaluated the off-label use of multitarget stool DNA (mt-sDNA) testing in the primary care setting. METHODS We reviewed all mt-sDNA orders between July 1, 2018, and June 30, 2019, to determine the frequency of off-label mt-sDNA orders. RESULTS Nine hundred two patients with mt-sDNA orders were evaluated, of which 160/902 patients (17.7%) met at least 1 criterion for off-label mt-sDNA order. Increasing age was associated with off-label order (Odds Ratio [OR] 2.32 [95% CI, 1.86-2.89] for every 10-year increase in age, P < 0.0001). On multivariate analysis, increased age (OR 1.04 [1.02-1.06], P = 0.001) and need for diagnostic colonoscopy (OR 2.9 [1.01-8.34], P = 0.048) were associated with a positive mt-sDNA result. DISCUSSION Off-label mt-sDNA testing is common, and further efforts are needed to educate patients and providers on appropriate use of mt-sDNA for colorectal cancer screening.

ObjectivesLittle has been reported on the yield and characteristics of colorectal neoplasia detected by the two-sample faecal immunochemical test (FIT), particularly the difference between subjects with two-positive results on the two-sample FIT and those with one-positive results. We aimed to assess risk stratification among patients with positive two-sample FIT to prioritise colonoscopy.DesignA retrospective cross-sectional study.SettingA single-centre, representative endoscopy clinic in Japan.ParticipantsConsecutive patients who underwent colonoscopy were enrolled. Indications for colonoscopy included two-positive results on the two-sample FIT (FIT (+/+)), one-positive results on the two-sample FIT (FIT (+/−)), and other reasons (non-FIT group, including presence of symptoms, screening or surveillance).Primary and secondary outcome measuresPrimary outcomes were detection rates of colorectal cancers, including in situ (all cancers) and invasive cancers, based on the indications for colonoscopy. Secondary outcomes were cancer features, such as location, size, T stage and histological subtype.ResultsOf the 8724 patients, 264 underwent colonoscopy following FIT (+/+), 1018 following FIT (+/−) and 7442 for reasons other than positive FIT. Detection rates of all (and invasive) cancers in the FIT (+/+), FIT (+/−) and non-FIT groups were 12.1% (8.3%), 1.9% (0.3%) and 0.4% (0.2%), respectively. The cancer detection rates were much higher in the FIT (+/+) group than in the FIT (+/−) group, which in turn had higher rates than the non-FIT group. Moreover, the FIT (+/+) group showed more advanced T stages on tumour, node, metastasis (TNM) classification (Tis/T1/T2/T3/T4: 10/7/4/10/1) than the FIT (+/−) group (16/1/2/0/0, pConclusionsTwo-positive results for two-sample FIT showed a much higher yield for more advanced colorectal cancers than the one-positive result. High priority for diagnostic colonoscopy should be assigned to patients with two-positive-FIT results.

AIM: The object of this work was to study how National Health Service hospitals in England and Wales aimed to maintain effective and safe colorectal cancer (CRC) services during the first peak of the COVID-19 pandemic (April 2020). METHOD: A national survey was performed among all 148 hospitals providing CRC services. Information was collected about changes in referrals, diagnostic, staging and therapeutic procedures, as well as whether there was access to a 'cold site' (a hospital facility free of COVID-19). Clinicians in each hospital were also asked to give the 'single most important lesson learned' about keeping services safe and effective. RESULTS: Full responses were received from 123 (83%) hospitals, and information about 'cold sites' was available for 146 (99%). Eighty hospitals (54%) had access to a 'cold site' and this was increased in regions with higher COVID-19 infection rates (p

More recent endoscopic developments have created highly innovative techniques and new technology for replacing surgical procedures such as tumor resections, myotomies and bypassing malignant stenoses. A number of new ideas and technologies around endoscopic tools are emerging to improve diagnostic accuracy and therapeutic efficacy of procedures. This chapter will focus on a few of these new endoscopic tools for special indications such as the camera cap for additional cameras in diagnostic colonoscopy, an external additional working channel connected to the scope for additional instruments, a multi-size bouginage system, and several 3D-printed prototypes of endoscopic manipulator systems. The term “Endoneering” stands for a combination of endoscopy and engineering, which was coined to characterize the new cooperation between engineers and endoscopists, which is very fruitful in developing interventional endoscopy.

Colonoscopy is routinely used for the diagnosis and treatment of colorectal diseases. Bowel perforation is a rare but severe complication that significantly increases the morbidity and mortality. Tension pneumothorax is an uncommon complication of colonic perforation. We present a case of the successful treatment of a patient with tension pneumothorax, following colonoscopy, by using tube thoracostomy and Hartman-type resection of the rectosigmoid junction and proximal sigmoid. Surgeons, anesthesiologists, and endoscopists should consider the possibility of pneumothorax as a rare complication of colonoscopy. Early detection and urgent treatment is the key to successful management.

Background and Aim During this COVID‐19 pandemic, Taiwan is one of the few countries where fecal immunochemical test and endoscopic activity for colorectal cancer screening keeps ongoing. We aimed to investigate how screening uptake and colonoscopy rate were affected in one of the biggest screening hubs in Northern Taiwan. Methods We conducted a prospective observational study tracing and analyzing the screening uptake and the trend of compliance to diagnostic colonoscopy in fecal immunochemical test‐positive subjects in the National Taiwan University Hospital screening hub since the outbreak of COVID‐19 and compared it with that of the corresponding periods in the past 3 years. Cancellation and rescheduling rates of colonoscopy and related reasons were also explored. Results Screening uptake during December 2019 to April 2020 was 88.8%, which was significantly lower than that in the corresponding period of the past 3 years (91.2–92.7%, P for trend

Colonoscopy is a low-risk procedure performed for screening and diagnostic purposes. About 15 million colonoscopies were carried out in the United States in 2012 with this number projected to increase. Injury to the spleen as a complication of colonoscopy is still a rather rare occurrence. We report a case of significant splenic injury, American Association of Surgery for Trauma (AAST) grade III with hemoperitoneum, in a patient following diagnostic colonoscopy, managed conservatively without the need for invasive or salvage surgical procedure.

INTRODUCTION Faecal calprotectin is a highly sensitive non-invasive marker of intestinal inflammation that has evidence-based roles in outpatient diagnosis and management of inflammatory bowel disease. This study aimed to examine indications for faecal calprotectin (FCP) in a tertiary inpatient population, and its role in inpatient management and subsequent investigations. METHODS An electronic database was used to identify all patients over the age of 18 years who had faecal calprotectin performed during a hospital admission over a three year period from March 2016 to the end of March 2019. Electronic records and case notes were reviewed with follow up to March 2020, seeking indication for testing, health care units requesting, and subsequent investigations and treatment resulting from FCP. RESULTS Over a three year period 111 faecal calprotectin inpatient results were identified. There were three changes in management based on the FCP result that led to further investigations that did not lead to any clinically significant pathology. There was no observable difference in the number of colonoscopies performed based on FCP level. The numerical FCP value was associated with clinically significant findings on colonoscopy. Negative predictive value of faecal calprotectin level (

Introduction Fecal immunochemical testing (FIT) is the most commonly used colorectal cancer (CRC) screening tool worldwide and accounts for 10% of all CRC screening in the United States. Potential vulnerabilities for patients enrolled to facilities within the military health system have recently come to light requiring reassessment of best practices. We studied the impact of a process improvement initiative designed to improve the safety and quality of care for patients after a positive screening FIT given previously published reports of poor organization performance. Methods During a time of increased utilization of nonendoscopic means of screening, we assessed rates of colonoscopy completion and time to colonoscopy after positive FIT after a multi-faceted process improvement initiative was implemented, compared against an institutional control period. The interventions included mandatory indication labeling at the time of order entry, as well as utilization of subspecialty nurse navigators to facilitate rapid follow-up even the absence of a referral from primary care. Results Preintervention, 34.8% of patients did not have appropriate follow-up of a positive FIT. Those that did had a variable and prolonged wait time of 140.1 ± 115.9 days. Postintervention, a standardized order mandating test indication labeling allowed for proactive gastroenterology involvement. Colonoscopy follow-up rate increased to 91.9% with an average interval of 21.9 ± 12.3 days. Conclusion The addition of indication labels and patient navigation after positive screening FIT was associated with 57.1% absolute increase in timely diagnostic colonoscopy. Similar highly reliable systems-based solutions should be adopted for CRC screening, and further implementation for other preventative screening interventions should be pursued.

Ganglioneuromas are slow-growing hamartomatous tumors that are rarely found in the colon. There are three subtypes of ganglioneuromas: polypoid ganglioneuroma, ganglioneuromatous polyposis, and diffuse ganglioneuromatosis. They are differentiated depending on their endoscopic and histological characteristics. Patients with colonic ganglioneuroma may present with nonspecific symptoms; however, they are usually asymptomatic. We present a case of hematochezia, where an ascending colon ganglioneuroma was found incidentally on diagnostic colonoscopy. We will explain how to distinguish the three subtypes of ganglioneuroma on colonoscopy and will mention the genetic disorders associated with them. We will also discuss the treatment of ganglioneuromas.

AIM: to evaluate the effectiveness of bowel cleansing before colonoscopy using enteral nutrition agent «Nutridrink» as the single nutrient. MATERIALS AND METHODS: a prospective comparative study included 150 patients (83 females, aged 20-65 years), who underwent diagnostic colonoscopy. To assess the quality of bowel cleansing the Likert scale was used. Subjective assessment of patients' comfort was performed by patients on a 10-point visual scale (from 0 - «excellent» to 10 - «extremely negative»). RESULTS: the quality of colon cleansing before colonoscopy was significantly better in patients who got enteral nutrition, especially in comparison with patients with standard protein diet. Subjective assessment of comfort during cleansing was better in the group of patients who used Nutridrink as the only source of nutrition as well. CONCLUSION: use of enteral nutrition as a part of bowel cleansing before colonoscopy can replace the protein diet.

To determine whether monitored anesthesia care (MAC) results in shorter colonoscopy time. A retrospective chart review from electronic medical records at Sentara Norfolk General Hospital was performed of all patients seen by the Eastern Virginia Medical School Department of Surgery who underwent a screening or diagnostic colonoscopy from December 2015 to July 2017. The primary end point is procedure time, with secondary end point of sedation time. There is a statistically significant difference in time to cecum between moderate sedation (MOD) and MAC (P = 0.002). Operator perceived difficulty is statistically associated with increased time to cecum (P < 0.0001). Time to cecum between MOD and MAC over the levels of difficulty was not significant (P = 0.403). A subanalysis looking at time to cecum between MOD and MAC for each level of difficulty showed a significant effect when difficulty was described as no difficulty. There is a statistically significant difference in time to scope insertion between MOD and MAC (P < 0.0001). Our data show that, taken as a conglomerate, the procedure and sedation time is shorter in MAC than in MOD. The use of MAC is associated with decrease time to scope insertion and overall time to cecum.

Summary of Event: A 2 cm-sized colonic perforation occurred during diagnostic colonoscopy. Endoscopic closure was performed immediately using detachable snare and conservative management with intravenous antibiotics was followed for several days. However, abdominal computed tomography showed huge abscess and its connection to the sigmoid colon. The patient underwent segmental colectomy, which revealed the incomplete closure of perforated lesion with severe serosal fibrotic change. Teaching Point: Endoscopic treatment of large-sized colonic perforations should be undertaken with caution since the possibility of incomplete closure is high. For large-sized colonic perforations, early surgical treatment should be preferentially considered over endoscopic treatment.

OBJECTIVE. Colonoscopy accuracy in detecting colorectal neoplasia is critical for colorectal cancer prevention but has been shown to be operator- and technology-dependent. This article will discuss several recent improvements in the technique and technology of colonoscopy. CONCLUSION. More rigorous training and retraining programs, active monitoring of endoscopist technique and outcomes, and exclusion of poorly performing endoscopists are urgently needed to improve the ultimate efficacy of colorectal cancer screening programs.

Objective. To analyze the observations of the toothed neoplastic tumors (TNT), using determination of their occurrence rate and peculiarities of morphological structure. Маterials and methods. Results of morphological investigation were analyzed, concerning material, obtained during diagnostic colonoscopy (DCS) with biopsy, conducted in 376 patients. Results. In 289 (77.0%) patients of 376 there were revealed 1058 colorectal superficial neoplastic tumors (CSNT). Іndex of detection of CSNT (quantity of diagnosed CSNT in relation to general quantity of the patients examined) have constituted 2.81. Of 376 patients TNT was diagnosed in 157 (42%) (95% confidence interval (CІ) 32.6-53.5), papillary-tubular neoplastic tumors (PTNT) - in 248 (66%) (95% CІ 58.2-70.8), while in 116 (31%) patients were observed simultaneously PTNT and TNT (95% CІ 28.6-42.7). Among 1058 CSNT were diagnosed 672 (63.5%) PTNT and 386 (36.5%) TNT, thus TNT was revealed trustworthily less frequently, than PTNT (р < 0.01; the odds ratio 2.69). Among 386 TNT were diagnosed 95 (24.6%) hyperplastic polyps, 144 (37.2%) TNT on a wide base, 74 (19.4%) conventional and 73 (18.8%) nonclassified. Conclusion. TNT constitutes a prevalent colorectal pathology. DCS with excision of TNT is еffective method of prophylaxis of colorectal cancer.

Intussusception in adult is a rare clinical entity. The clinical presentation of adult intussusception is often nonspecific. Majority of the cases have been reported as chronic, consistent with partial obstruction. We report a case of a 53‑year‑old male, who presented with chronic diarrhea and vague abdominal discomfort. He was incidentally detected to have colocolic intussusception secondary to colonic lipoma during diagnostic colonoscopy.

A 39-year-old woman underwent a preoperative diagnostic colonoscopy for cervical cancer. A 3-mm neuroendocrine tumor (NET) was incidentally detected in the rectum. The NET was observed via 7 colonoscopies over 10 years while giving priority to treating the cervical cancer. Complete cervical cancer remission was confirmed at the 10-year follow-up examination; therefore, endoscopic treatment for the NET was subsequently performed. The NET showed almost no change in either size or morphology over the 10-year period. This case illustrates the possible very-slow progression of a small NET, suggesting its benign behavior.

BACKGROUND: How clinical teams function varies across sites and may affect follow-up of abnormal fecal immunochemical test (FIT) results. AIMS: This study aimed to identify the characteristics of clinical practices associated with higher diagnostic colonoscopy completion after an abnormal FIT result in a multi-site integrated safety-net system. METHODS: We distributed survey questionnaires about tracking and follow-up of abnormal FIT results to primary care team members across 11 safety-net clinics from January 2017 to April 2017. Surveys were distributed at all-staff clinic meetings and electronic surveys sent to those not in attendance. Participants received up to three reminders to complete the survey. RESULTS: Of the 501 primary care team members identified, 343 (68.5%) completed the survey. In the four highest performing clinics, nurse managers identified at least two team members who were responsible for communicating abnormal FIT results to patients. Additionally, team members used a clinic-based registry to track patients with abnormal FIT results until colonoscopy completion. Compared to higher-performing clinics, lower-performing clinics more frequently cited competing health issues (56% vs. 40%, p=0.03) and lack of patient priority (59% vs. 37%, p

Colonoscopies are effective in finding early stage colorectal cancer (CRC), which when found in a timely manner, dramatically improve survival rates. A significant number of at-risk patients are still not screened. We investigated the utility of a blood-based protein assay to assess for CRC in patients with elevated risk on the quality of preventive care delivered by board-certified primary care physicians (PCPs) in the United States.We report on the results of a 3-part, longitudinal, randomized controlled trial. Part 1 assessed physicians' ability to identify simulated patients at risk for CRC and found PCPs missed colonoscopy referrals for high-risk patients ~40% of the time. Part 2 randomized PCPs into control and intervention arms and demonstrated that a novel blood-based protein assay increased referral rates for a diagnostic colonoscopy when caring for simulated patients. Part 3, reported herein, compares real-world colonoscopy rates of actual patients cared for by control versus intervention physicians. Part 3 was executed to confirm whether the use of the assay demonstrated the same utility in their real world, high-risk patients as found in part 2 using simulated patients.In the simulations, physicians with access to the assay were significantly more likely to order diagnostic colonoscopies. Similarly, in real-world practice, patients were also more likely to be referred for a diagnostic colonoscopy (odds ratio, 4.57; 95% confidence interval, 1.19-17.57).An increase in CRC risk, as indicated by the assay in simulated and real-life patients, was associated with a higher likelihood of appropriate patients being referred to diagnostic colonoscopy.