Introduction

Colonoscopy is the standard modality for colorectal cancer (CRC) screening and surveillance by means of an examination that achieves cecal intubation without patient pain or complications^[1]. According to related literatures, patients with a history of abdominal or pelvic surgery, usually associate with lumen adhesion or normal intestinal structure changes, which lead to a more difficult colonoscopy. In addition, abdominal pain during the colonoscopy may result in incomplete operation or refusal of a second colonoscopy, causing serious impact on the diagnosis of colonoscopy and adenoma detection rate (ADR), thus reducing the quality of colonoscopy^[2-3]. At present, the type of colonoscope have been demonstrated to influence the colonoscopy performance. For example, ultrathin colonoscopes are of greater utility for passing strictures and severe angulations. While variable stiffness colonoscopes may be useful for negotiating tortuous recto-sigmoid junctions^[4]. Until now, the value of colonoscope for reducing pain of patients, especially on patients with a history of abdominal or pelvic surgery and without sedation, have not been investigated completely. Thus, we conduct a randomized controlled trial to investigate the efficacy of different types of colonoscope for reducing pain during non-sedated colonoscopy.

Aims & Methods

The purpose of this randomized controlled study was to compare application characteristcs of CF-H290I and PCF-Q260JI colonoscope in non-sedated patients with a history of abdominal or pelvic surgery, thus helping endoscopists to use different types of colonoscopy more effectively and scientifically. From August 2022 to October 2022, a total of 397 patients in the Affiliated Wuxi People's Hospital of Nanjing Medical University were randomly allocated to the CF-H290I (n = 198) or PCF-Q260JI (n = 199) colonoscope groups by using a computer-generated system. We compared cecal intubation time, patient satisfaction of examination, adenoma detection rate (ADR), discomfort associated with colonoscopy including abdominal distension or pain and patient acceptance of next colonoscopy between the CF-H290I group (high-definition system) and the PCF-Q260JI group (high-resolution system).

Results

Among 397 subjects, 198 were performed with the CF-H290I and 199 with the PCF-Q260JI. The patients satisfaction of colonoscopy was higher with the PCF-Q260JI group than CF-H290I group［8.91（1.09）vs 8.51（1.44）, P ＜0.01］, and there was less chance for discomfort associated with colonoscopy［23（11.6%）vs 41（20.7%）, P= 0.013］, patients’ acceptance of next colonoscopy in PCF-Q260JI group was more than CF-H290I group［168（84.4%） vs 149（75.3%）, P = 0.023］. Compared with PCF-Q260JI colonoscope group, CF-H290I colonoscope group had shorter cecal intubation time (unit: s)［256.09（155.70）vs 315.64（171.64）, P =0.004］. No statistically difference was found in the adenoma detection rate (ADR) between the two groups ［63（31.7%）vs 81（40.9%）, P= 0.055］.There were no complications such as perforation or bleeding in both groups.

Conclusion

For patients with a history of abdominal or pelvic surgery, PCF-Q260JI colonoscope was superior with respect to reducing patients’ pain and improving patient acceptance of non-sedated colonoscopy. This study was approved by the Clinical Research Ethics Committee of Wuxi People’s Hospital and was registered in the Chinese Clinical Trial Registry（ChiCTR2200063092）.

References

[1] Shaukat A, Kahi CJ, Burke CA, et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol. 2021 Mar 1;116(3):458-479. Doi: 10.14309/ajg.0000000000001122.
[2] Anderson JC, Messina CR, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001 Nov;54(5):558-62. Doi: 10.1067/mge.2001.118950.
[3] Kim WH, Cho YJ, Park JY, et al. Factors affecting insertion time and patient discomfort during colonoscopy. Gastrointest Endosc. 2000 Nov;52(5):600-5. Doi: 10.1067/mge.2000.109802.
[4] Sato K, Ito S, Kitagawa T, Hirahata K, et al. A prospective randomized study of the use of an ultrathin colonoscope versus a pediatric colonoscope in sedation-optional colonoscopy. Surg Endosc. 2017 Dec;31(12):5150-5158. Doi: 10.1007/s00464-017-5581-2.
[5] ten Broek RP, Issa Y, van Santbrink EJ, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013 Oct 3;347:f5588. Doi: 10.1136/bmj.f5588.

Introduction

Unexplained chronic abdominal pain remains a frequent and often frustrating diagnostic challenge in clinical practice. When initial investigations such as colonoscopy and gastroscopy are inconclusive, small bowel capsule endoscopy (SBCE) provides a non-invasive means to evaluate the small intestine, a part of the gastrointestinal tract that is otherwise difficult to examine. This study explores the effectiveness of SBCE in uncovering underlying causes in patients with unexplained chronic abdominal pain.

Aims & Methods

We aimed to determine the diagnostic yield of SBCE in patients presenting with unexplained chronic abdominal pain and to identify predictive factors for positive findings. This was a retrospective analysis of prospectively collected data from all consecutive patients who underwent SBCE in our tertiary referral center in Greece between March 1, 2003, and April 30, 2025. We included patients who underwent SBCE following negative colonoscopy and gastroscopy. A positive diagnostic yield was defined as the detection of lesions capable of explaining the patient’s symptoms. Predictive factors for positive findings were evaluated using multivariate analysis.

Results

During the study period a total of 11.201 patients were subjected to SBCE and among them 1398(12.4%) patients underwent the test for the investigation of chronic abdominal pain (men/women: 694/704, mean age ± SD: 52.6±27.3 years). Positive findings were detected in 241 patients, leading to a diagnostic yield of 17.2%. The most common findings were inflammatory lesions that were seen in 176 (73.0%) patients[erosions from non-steroidal anti-inflammatory drugs n=75,erosions or ulcers from Crohn’s disease n=97, erosions from radiation enteritis, n =4]while 47 (19.5%) patients had tumor/mass lesions, 9 (3.7%) patients had ischemic colitis, 6 (2.5%) patients had parasites and 3 (1.2%) patients had small bowel strictures. By multivariate analysis, predictive factors for positive findings were elevated C-reactive protein (CRP) (OR=2.73, p<0.0001) and failure to intubate the terminal ileum during colonoscopy (OR=1.40 p=0.03).

Conclusion

The diagnostic yield of SBCE in patients with unexplained chronic abdominal pain is relatively low. Patients with elevated CRP or those in whom the terminal ileum was not examined during colonoscopy are those who will benefit most from the test.

Introduction

The 6-minute withdrawal time for colonoscopy is widely considered the standard of care. However, there may not be appropriate if the 6-minute is equally divided into various colon segments. Since the adenoma detection in each colon segment is not the same, there may be differences with the withdrawal time in different colon segments.

Aims & Methods

Our objective was to evaluate the relationships between adenoma detection rate (ADR) and respective withdrawal time in different colon segments. Outpatients, age range 18-75 years, undertaking complete colonoscopy were enrolled in this study from November 2019 to November 2020 in the digestive endoscopy center. The entire colon was divided into four different segments: ascending colon, transverse colon, descending colon and rectosigmoid colon. The respective withdrawal time and ADR in each colon segment were recorded respectively.

Results

A total of 586 outpatients (279 males, 307 females) enrolled in this study and the general ADR was 38.2%. The positive withdrawal time (adenomas detected) was longer than negative withdrawal time (non-adenomas detected) (334.04±24.21 secs vs 303.65±5.20 secs, t=1.26, P<0.001). ADR in ascending colon, transverse colon, descending colon and rectosigmoid colon were respectively 30.5%, 2.9%, 3.1% and 7.5%. While all of their positive withdrawal time were longer than negative withdrawal time (94.34±33.76 secs vs 70.40±41.84 secs, t=3.31, P=0.001; 85.40±49.76 secs vs 71.66±36.87 secs, t=1.95, P=0.025; 80.29±39.85 secs vs 69.73±35.96 secs, t=1.40, P=0.016;100.95±55.92 secs vs 80.96±42.87 secs, t=3.61; P<0.001, respectively). The withdrawal time threshold in the ascending colon, transverse colon, descending colon, rectosigmoid colon determined by receiver operating characteristic (ROC) curve were 77s, 61s, 56s and 109s, respectively. In the ascending colon, ADR was significantly higher (47.0% vs 33.1%, P < 0 .001) when the colonoscopy withdrawal time was ≥77s. When the withdrawal time was ≥61s in the transverse colon (42.7% vs 32.7%, P = 0.013), ≥59s in the descending colon (42.3% vs 29.9%, P=0.004) and ≥109s in rectosigmoid colon (52.2% vs 33.9%, P < 0 .001), ADR was also significantly higher. After adjusting for age, sex and BMI, Logistic regression analysis showed that withdrawal time ≥ 77s in the ascending colon (OR, 1.796; 95% CI, 1.273-2.532; P < 0 .001), ≥ 61s in the transverse colon (OR, 1.535; 95% CI, 1.094-2.155; P = 0.013), ≥56s in the descending colon (OR, 1.722; 95%CI, 1.193-2.486; P =0.004) and ≥109s in the rectosigmoid colon (OR, 2.134; 95% CI, 1.446-2.350; P < 0.001) were independent risk factors for the increase of ADR.

Conclusion

ADR and withdrawal time are all various in individual colon segments. During the operation of colonoscopy, withdrawal time in the ascending colon may be shortened appropriately. The adenomas in the rectosigmoid colon are more likely to be detected and do not take longer withdrawal times. We need to choose the appropriate time according to different colon segments.

References

[1] Sung H, Ferlay J, Siegel R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians 2021;71(3): 209-249.
[2] Shaukat A, Kahi C J, Burke C A, et al. ACG clinical guidelines: colorectal cancer screening 2021. Official journal of the American College of Gastroenterology ACG 2021;116(3): 458-479.
[3] Xi Y, Xu P. Global colorectal cancer burden in 2020 and projections to 2040. Transl Oncol 2021;14(10):101174.
[4] Araghi M, Soerjomataram I, Bardot A, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. The lancet Gastroenterology & hepatology 2019;4(7): 511-518.
[5] Siegel RL, Torre LA, Soerjomataram I, et al. Global patterns and trends in colorectal cancer incidence in young adults. Gut 2019;68(12):2179-2185.
[6] Kaminski MF, Robertson DJ, Senore C, et al. Optimizing the Quality of Colorectal Cancer Screening Worldwide. Gastroenterology 2020;158(2):404-417.
[7] Lee JK, Jensen CD, Levin TR, et al. Long-term Risk of Colorectal Cancer and Related Deaths After a Colonoscopy With Normal Findings. JAMA Intern Med 2019;179(2):153-160.
[8] Ladabaum U, Dominitz JA, Kahi C, et al. Strategies for colorectal cancer screening. Gastroenterology 2020;158(2):418-432.

Introduction

Capsule endoscopy (CE) is an important non-invasive diagnostic modality for the evaluation of small bowel and colon. However, in patients with gastrointestinal tract anatomy altered by surgical interventions, there can be a higher risk of incomplete examination of small bowel and colon.

Aims & Methods

The aim of our study was to evaluate the rate of complete examination and diagnostic yield of CE, in patients with previous gastrointestinal surgery, as well as the impact of endoscopic placement of CE using the AdvanCE device.
Retrospective, cohort study, including patients submitted to CE of the small bowel or colon, detailing patients with previous gastrointestinal surgeries and with endoscopic placement of CE.

Results

A total of 642 patients was included, 17 with previous gastrointestinal surgery (2.6%), from which 9 with gastric bypass and Y-de-Roux (with 3 having esophagojejunostomy and 6 gastrojejunostomy), 3 patients with Bilroth II, 2 with Bilroth I e 3 patients with sleeve gastrectomy.
Endoscopic placement of CE was performed at the discretion of the responsible gastroenterologist and occurred in 8 patients (1.2%). It was 13.3 times more likely to be performed in patients with previous gastrointestinal surgery (11.8% vs 1.0%, p=0.017).
In patients without endoscopic placement of CE, the rate of complete examination of the gastrointestinal tract, adequate bowel preparation and diagnostic yield was comparable between those with and without previous gastrointestinal surgery: 86.7% vs 85.3% (p=1.000), 73.3% vs 78.1% (p=0.751) e 40% vs 38% (p=0.875), respectively.
In patients with gastrointestinal surgery, the rate of complete examination of the gastrointestinal tract was comparable between patients with and without endoscopic placement of CE: 50.0% vs 86.7% (p=0.331). The rate of complete examination of the gastrointestinal tract, adequate bowel preparation and diagnostic yield was not influenced by the different types of surgery, considering patients with gastric bypass vs Y-de-Roux vs Bilroth II: 75.0% vs 80.0% vs 66.7% (p=0.915), 50.0% vs 60.0% vs 66.7% (p=0.902) e 25.0% vs 20.0% vs 66.7% (p=0.363), respectively.

Conclusion

CE is effective, even in patients with previous gastrointestinal surgery, with diagnostic yield and rate of complete examination of the gastrointestinal tract similar to other patients, regardless of the type of surgery. Endoscopic placement of CE with AdvanCE device does not seem to improve outcomes in patients with previous gastrointestinal surgery.

Introduction

Small bowel mucosal pathologies are a diagnostic challenge to clinicians. Video Capsule endoscopy (VCE) is currently the study of choice for the evaluation of the small intestine. Data on the effects of bowel preparation on mucosal visualization and diagnostic yields is scant. Most published studies suggest that bowel preparation methods (2-litre vs. 4-litre) are not superior.

Aims & Methods

This retrospective cross-sectional study analyzed data from 2018 to 2023. The main investigator reassessed all VCEs using 3-6 frames per second, single-image viewing. A nursing officer closely supervised the bowel preparation, adhering to unit protocols. The small intestine was divided into proximal and distal small intestines depending on the small intestinal transit time, and mucosal visualization was assessed according to the Brotz scoring system. Statistical significance was determined by Fisher’s exact (F) test and Chi-square (X2) test. A value of <0.05 was considered as significant.

Results

The sample size was 705, with a mean age of 56.9 (SD=18.2). 60.6% (n=427) were males. 39.3% had overt GI bleeding, 36.0% had occult GI bleeding, 16.3% had abdominal pain, 4.3% had chronic diarrhoea and 4.0 % had loss of weight as the indication for VCE. The mean gastric transit time was 01:13:52 ± 01:28:14 (hr.min.sec.), and the small intestine transit time mean was 05:12:59 ± 01:58:24 (hr.min.sec.). 38.3% consumed 59g x 2 PEG preparation in 2L of water; 11.9% consumed 59g x 3 PEG preparation in 3L of water; and 49.6% consumed 59g x 4 PEG preparation in 4L of water before VCE, followed by 6 hours of fasting. Mucosal visualization in the distal small intestine was significantly associated with the amount of PEG used, with 3×59 in 3 L of water accounting for a significantly higher percentage (32.1%) of adequate visualization (X2=11.82, p=0.003).However there was no significant association between the amount of PEG used and proximal bowel visualization (X²=5.38, p=0.068). The amount of PEG administered significantly influenced transit times (F=5.781, p=0.003). A post hoc Tukey test revealed that the use of 4x59g of PEG in 4L of water significantly increased small intestinal transit time compared to lower doses.
The diagnostic yield was 65.6%. 34.4% had P0 lesions, 21.1% had P1 lesions, and 44.5% had P2 lesions. 26.8% had vascular lesions (17.2% in the proximal and 5.6% in the distal and 3.0% in both proximal and distal small intestine), 32.6% had inflammatory lesions (15.4% in the proximal, 15.1% in the distal, and 2.1% in both proximal and distal small intestine), worm infestation 1.1%, and malignancies 2.4%, which were among the most common findings. Ulcers, the most common inflammatory lesion (22.3%), equally affected the proximal (10.2%) and distal (10.9%) small intestines. Additionally, patients who had poor mucosal visualization (Brotz < 7) had significantly lower odds of P1/P2 lesions compared to those with good mucosal visualization (Brotz ≥ 7) (OR = 0.573, SE = 0.187, p = 0.003).

Conclusion

VCE has a diagnostic yield of 65.6%, while the proximal small intestine was the most common area involved, and inflammatory lesions were the most common lesions in Sri Lankans. Ulcers were the most common inflammatory lesion, which were equally involved in both the proximal and distal small intestine. Higher PEG and water administration significantly increased the transit time, and 3× 59g PEG in 3L of water had a statistically significant effect on mucosal visualization in the distal small intestine. Poor mucosal visualization had significantly lower odds of P1/P2 lesions.

Introduction

Simple renal cyst is one of the most common diseases in the urinary system. Intervention is only considered under circumstances of large cysts (＞5cm), bleeding, recurrent infection or pain^[1]. Ethanol percutaneous sclerotherapy and laparoscopy are two main treatment modalities for simple renal cysts^[2]. However, in cases of cysts in superior renal pole, percutaneous sclerotherapy is often excluded due to the unsafety of percutaneous puncture. In recent years, endoscopic ultrasound (EUS) guided fine-needle aspiration has been proven as a safe and efficient treatment for biopsy of renal and renicapsule lesions^[3], inspired by which, we successfully performed an EUS-guided sclerotherapy on cyst in the superior renal pole^[4]. Since then, we performed nine more cases of EUS-guided sclerotherapy on cyst in the superior renal pole. This research is an retrospective analysis of the nine cases and is aimed to compare the efficacy, safety and cost-benefit analysis of endoscopic ultrasound guided sclerotherapy and laparoscopic surgery treating cyst in the superior renal pole.

Aims & Methods

To compare the efficacy, safety and cost-benefit analysis of endoscopic ultrasound guided sclerotherapy and laparoscopic surgery treating cyst in the superior renal pole.
Methods: A retrospective analysis was performed in 25 patients with cyst in the superior renal pole hospitalized in the Second Affiliated Hospital of Soochow University from January 2021 to August 2022.The efficacy, operation time, intraoperative blood loss volume, hospital stay, complications and treatment cost of EUS-guided sclerotherapy (9 cases) and laparoscopic surgery (16 cases) were compared.

Results

The EUS and laparoscopic groups had comparable efficacy (100% vs 87.5%, P=0.520). The EUS group exhibited shorter operation time (29.8±4.8 vs 70.1±11.1 min, P=0.000), less intraoperative blood loss (0 vs 26.1±5.9 ml, P=0.000), shorter length of postoperative hospital stay (3.5±0.7 vs 5.4±2.0 days, P=0.014) and lower total cost (10547.85±2388.19 vs15316.09±5352.45 yuan, P=0.019). There were no difference on total length of hospital stay(8.1±2.0 vs 9.3±3.1 days) and operation cost (3946.79±490.82 vs 3860.18.17±857.42 yuan) (both P＞0.05).

Conclusion

Compared with laparoscopic surgery, EUS-guided sclerotherapy was an effective but safer technique in treating cyst in the superior renal pole.

References

1. Richard PO, Violette PD, Jewett MA, et al. CUA guideline on the management of cystic renal lesions[J].Can Urol Assoc J. 2017, 11(3-4):E66-E73.DOI: 10.4253/wjge.v7.i3.253.
2. Eissa A, El Sherbiny A, Martorana E, et al. Non-conservative management of simple renal cysts inadults: a comprehensive review of literature[J]. Minerva Urol Nefrol. 2018, 70(2):179-192. DOI: 10.23736/S0393-2249.17.02985-X.
3. Lopes RI, Moura RN, Artifon E. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of kidney lesions: A review[J]. World J Gastrointest Endosc. 2015, 7(3):253-7. DOI: 10.4253/wjge.v7.i3.253.
4. Wu W, Zhang Y, Hu D, Song K. EUS-guided sclerotherapy as a new therapy for renal cyst (with video)[J]. Gastrointest Endosc. 2022, 95(3):587-588. DOI:10.1016/j.gie.2021.10.029.