Colonoscopic Evaluation Research Articles

Preclinical and clinical evaluation through serial colonoscopic evaluation of neratinib-induced diarrhea in HER2-positive breast cancer-A pilot study.

The irreversible pan-HER tyrosine kinase inhibitor neratinib is approved for patients with HER2-positive, early-stage and metastatic breast cancer (BC). Neratinib-associated diarrhea is the most common reason for early discontinuation. Preclinical studies identified mechanisms of neratinib-induced diarrhea and rationale for prophylactic and preventive measures. We studied effects of neratinib on rat intestines and conducted a phase 2 study of colon pathogenesis in patients with HER2-positive BC treated with neratinib (NCT04366713). Colon samples from female albino Wistar rats receiving neratinib or vehicle were examined for histopathological changes. Patients with HER2-positive BC received neratinib 240 mg once daily for up to 1 year. Colonoscopy biopsies were collected at baseline and at Day 28 to identify changes consistent with rat pathologies. Rat colons were markedly altered in appearance, with similar short circuit currents (Isc) and responses to carbachol and forskolin. Mucosal barrier loss and/or significant increase in secretory propensity in neratinib- versus control-treated animals were not seen. Two of four endpoint-evaluable patients presented with mild pathological changes, largely comparable with the rat model. Preclinical evidence supports an inflammatory component of neratinib-induced diarrhea without mucosal barrier function loss. Colonoscopy findings in patients with BC indicate mild or no pathological changes in the colon due to neratinib treatment.

Intestinal endometriosis: A rare clinical image of sigmoid presentation

A 47-year-old female patient with a history of umbilical endometriosis and iron deficiency anemia presented to the gastroenterology department with a year-long complaint of abdominal pain, rectal pain, and hematochezia during menstruation. The physical examination and the results of laboratory studies of the patient were unremarkable. A contrast MRI of the abdomen revealed pathological thickening of 1.5 cm in the middle segment of the rectum and chocolate cysts on both ovaries, and the patient was referred for colonoscopic evaluation with suspicion of infiltrative endometriosis or colon neoplasm. An upper endoscopy and colonoscopy were performed. An actively bleeding mass in sigmoid colon, partially restricting the lumen but allowing for the passage of the video colonoscope, was observed (Figure 1A,1B: Sigmoid lesion). Biopsy specimens from the sigmoidal mass showed features consistent with endometriosis. A diagnosis of endometriosis was made. The patient underwent surgical intervention by sigmoid colon resection, hysterectomy, and bilateral oophorectomy. The complaints ceased on postoperative follow-up.

Inflammatory bowel disease (IBD) in rural and urban India: results from community colonoscopic evaluation of more than 30,000 symptomatic patients

Inflammatory bowel disease (IBD) in rural and urban India: results from community colonoscopic evaluation of more than 30,000 symptomatic patients

Charity Colonoscopy Event and Fund in Singapore: A Novel Method to Raise Awareness of Colorectal Cancer Screening

Abstract Background: Despite the improvements in the incidence rate and mortality of colorectal cancer in Singapore, most cases are still diagnosed at later stages. This suggests limitations in the uptake of cancer screening, relating to suboptimal population awareness, unfamiliarity with tests, or cost concerns. Objective: We report our experience with a charity colonoscopy event to assist patients with endoscopy costs, raise public awareness of endoscopic cancer screening, and demonstrate the safety of colonoscopy. Design and Settings: The Singapore General Hospital (SGH) Preventing Rectal and Colon Cancer through Endoscopy (SPRUCE) fund was established in 2019. A charity endoscopic event was held to kickstart the official launch of the fund with corporate, individual, and industry support. Patients and Methods: The recruitment criteria were first-visit patients who required colonoscopic evaluation following specialist evaluation and those in possession of a Community Health Assist Scheme card, for which only Singapore citizens whose annual household per capita income was less than Singapore dollar (SGD) 24,000 (USD 17,500) were eligible. This enabled meaningful selection of patients who would most benefit from financial assistance. Main Outcome Measures: To determine the feasibility of a charity colonoscopy event while raising colorectal cancer public awareness. Sample Size: Forty-eight patients underwent colonoscopies by accredited endoscopists for the SPRUCE endoscopy event. Results: Of the 48 participants, 19 (39.5%) were men and 29 (60.4%) were women, with a median age of 64 years. Seven patients (14.6%) had a normal colonoscopy, while 42 (85.4%) had at least one abnormality documented. Forty-one benign polyps were detected and removed in 22 patients (45.8%), with an overall adenoma detection rate of 85.4%. One patient (2.1%) was diagnosed with colon cancer. No complications resulted from the procedures performed during the charity event. Conclusion: A charity colonoscopy event conducted in the form of a health fair for needy patients is feasible and may help raise colorectal cancer awareness. This framework may serve as a useful basis for similar future events held in Singapore or elsewhere. Limitations: Lack of longitudinal assessment of colorectal cancer awareness among the public, following the charity colonoscopy event. Conflict of Interest: The authors have no conflict of interest to declare.

Assessment of Stool DNA Markers to Detect Colorectal Neoplasia in Patients with Inflammatory Bowel Disease: A Multi-site Case-control Study.

The FDA-approved multitarget stool-DNA (mt-sDNA) test is a successful colorectal cancer (CRC) screening tool in average-risk individuals but is not indicated for patients with inflammatory bowel disease (IBD). We determined the performance of the mt-sDNA assay without the hemoglobin component (mt-sDNA Hgb-) in patients with IBD, while measuring sensitivity for colorectal cancer and advanced colorectal neoplasia (ACRN). This was a multi-center, proof-of-concept investigation in persons aged 18-84 years with a diagnosis of IBD, or primary sclerosing cholangitis (PSC) with IBD. Enrollment occurred between March 2013-May 2016. Stool was tested with the mt-sDNA molecular markers only, minus the immunochemical hemoglobin component. The analysis set contained 355 samples. The median age was 52 (range 39-62) years, 45.6% female, 93% White. Two-thirds (63%) had ulcerative colitis (UC) and 10.1% had PSC/IBD. Colonoscopy revealed cancer in 8.5% (N=30), advanced precancerous lesions (APLs) in 9.3% (N=33), non-advanced precancerous lesions in 7.6% (N=27), and three-fourths (74.7%, N=265) had negative findings. Mt-sDNA Hgb- sensitivity was 73.3% for any stage cancers, and 76.2% for ACRN. Sensitivity was highest for IBD-associated HGD at 100% and 84.6% for IBD-associated LGD ≥ 1cm. The test showed higher sensitivity and lower specificity in UC than in Crohn's disease. Increasing inflammation score was associated with a significant decrease in mt-sDNA Hgb- test score (p=0.028) amongst neoplasia-negative individuals, but not in patients with ACRN. These data highlight the potential of multitarget stool-DNA marker testing as an important addition to colorectal cancer surveillance by complementing colonoscopic evaluations in inflammatory bowel disease patients.

A case of recurrent intussusception in young adult female: Peutz Jegher syndrome

Peutz Jegher syndrome (PJS) is an autosomal dominant inherited polyposis syndrome, in which multiple characteristic polyps occur in the gastro-intestinal tract associated with mucocutaneous pigmentation especially of vermillion border of the lips. Small bowel obstruction is presenting complaint in half of the cases-intussusception due to polyp being lead point is the high risk for obstruction. A 21 year old female patient with presented to emergency department with complaining of intermittent episodes of abdominal pain and multiple episodes of billious vomiting since 7 days. Patient had history of exploratory laparotomy 10 years back for similar complaints. On examination, melanocytic pigmentation present over vermillion border and palmar aspect. Enhanced computed tomography reveals telescoping of the distal jejunum to proximal ileal loops s/o jejuno-ileal intussusception with ileo-ileal intussusception were noted. On surgical decision, patient again underwent exploratory laparotomy which revealed intussusception with non-viable small bowel segment were found, Small bowel resection was performed and jejuno-ileal anastomosis was done. Patient follow up was maintained to go with colonoscopic evaluation. In conclusion, recurrent intussusception is a rare cause of acute abdomen in adults. A high index of suspicion and appropriate investigations are helpful in prompt diagnosis. Thorough evaluation intra operative and then regular periodic follow up is required in such cases for early detection of disease before complication occurs.

Objective Disease Monitoring Strategies from a Tertiary Inflammatory Bowel Disease Center in Hungary.

Emerging data suggest that a treat-to-target approach and early therapeutic intervention using regular objective disease assessment leads to improved outcomes. Our aim was to evaluate the value of objective disease monitoring during regular follow-up in a single tertiary inflammatory bowel disease center. Consecutive inflammatory bowel disease patients (n = 161, Crohn's disease: 118/ulcerative colitis: 43; biological therapy: 70%) were included and followed up for 1 year between January and December 2018. Data on clinical disease activity, biomarkers, endoscopy, imaging, outpatient visits, treatment optimization, hospitalization, and surgery were collected. We compared the monitoring strategy according to the clinical activity (remission/flare/post-flare/continuous activity) every 3 months (assessment period). In total, n = 644 assessment periods were evaluated. Biomarkers were evaluated in 82.9%-83.9% of patients in each assess ment period regardless of clinical activity. Colonoscopy was more frequently performed in active disease (flare/continuous disease activ ity: 21.1%/18.9% vs. clinical remission: 10.1% per assessment period). Magnetic resonance imaging was performed in 7.7%-16.7%/ period in Crohn's disease patients, while the use of computed tomography was low (2.4%/period) and mainly performed in active dis ease. Treatment optimization was more frequent in patients with active disease (biological start/dose optimization: 31.1%/33.8%/ period, steroid start: 13.2%/period). Patients with continuous activity (2.62), flare (2.45), and post-flare (2.05) had higher mean patient visit counts compared to remission (1.68/period). Objective monitoring strategy was applied with routine assessment of clinical activity and biomarkers. Fast-track colo noscopic evaluations were adapted to the clinical stage of the disease while screening colonoscopies and magnetic resonance imaging were frequently used. Objective monitoring resulted in the early optimization of medical therapy and frequent specialist follow-up visits.

A step-by-step guide to approaching colon polyps.

Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps, and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation (2). Knowing this significance, the present study aims to present a brief review on classification, probability of endoscopic resection, complications of endoscopic polypectomy, as well as proper surveillance after polypectomy.

Colonoscopy following the positron emission tomography/computed tomography scan in patients with incidental colorectal uptake: what is the most effective management?

Colorectal cancer is one of the most common malignancies. Survival rates are directly related to the stage of cancer at the time of diagnosis, emphasizing the value of early diagnosis. Positron emission tomography with 18F-fluorodeoxyglucose is the gold standard imaging technique in staging, monitoring after treatment, and follow-up. We aimed to assess the importance of incidental 18F-fluorodeoxyglucose uptake by colon and rectum in positron emission tomography-computed tomography imaging to determine a significant cutoff value for further investigation using colonoscopy and histopathological assessment. We performed a retrospective analysis of patients with both 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scan and colonoscopy during 1 year and included the cases who had undergone a colonoscopy within 3 months following the positron emission tomography/computed tomography scan due to an incidental positive finding. Patients with a diagnosed colorectal malignancy or with a history of previous colorectal operations were excluded. A total of 81 patients were included in this study. Among 81 colonoscopic evaluations, histopathology revealed malignancy in 8 patients, and the prevalence of incidental colorectal cancer 18F-fluorodeoxyglucose uptake was found to be 9.87%. SUVmax was found to be significantly related to malignancy and other colonoscopic findings (p<0.001). SUVmax cutoff value to suggest colorectal cancer was found to be median [7.9 (4.1-12.7)] (p<0.001). Regarding the studies determining a significant cutoff value, incidental colonic 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography should lead the clinician to further investigation with colonoscopic biopsy, although the cutoff values for SUVmax are not certain and different in almost every published study, and negative positron emission tomography.computed tomography findings should not completely rule out malignancy, especially in high-risk patients.

Colonoscopic Evaluation of Patients Treated Conservatively for Intestinal Obstruction: An Observational Study

Background: Acute intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract, and clinical symptoms often vary based on the level of obstruction. Objectives: To evaluate the causes of obstruction of patients who were treated conservatively for acute intestinal obstruction. Materials &amp; Method: A cross-sectional observational study. The study was carried out in the Surgery In-patient Department of Comilla Medical College Hospital, Comilla, from 01.07.2013 to 31.12.2013. A total of 246 patients got admitted to the surgery in-patient department and diagnosed as a case of intestinal obstruction. 101 patients of both sex, aged 23-79 responded to initial conservative treatment and were recruited for the study. The remaining 145 patients underwent emergency surgery for intestinal obstruction and were excluded from the study. All data gathered from the data collection sheet was compiled manually. After compilation, these data were shifted to statistical analysis software for further analysis. Results: Out of 246 intestinal obstruction patients, we recorded 101 patients who responded to conservative management. 59 (58.4%) patients were male, and the remaining were female. Peak Incidence (45.5%) was in 51-66 years age group. 54(53.4%) patients presented with large bowel obstruction, the remaining with small bowel obstruction. Most of the patients 68 (67.3%), presented with sub-acute obstruction, followed by acute 28 (27.7%) and chronic 5 (4.9%) obstruction, respectively. 12(11.8%) patients were diagnosed with colorectal carcinoma, 5(4.9%) patients with intestinal TB, and 1(0.9%) patient with diverticulosis. 10(83.3%) of the patients with Colorectal carcinoma were in the elderly age group (&gt;50 years) whereas two patients were below 80 years of age. The cause of obstruction could not be detected in 83 (82.2%) patients by colonoscopy. ..............

S2166 Deceptive Presentation of Metastatic Cancer: Rectal Pain and Obstruction Leading to New Diagnosis of Urothelial Carcinoma by Colonoscopic Evaluation

S2166 Deceptive Presentation of Metastatic Cancer: Rectal Pain and Obstruction Leading to New Diagnosis of Urothelial Carcinoma by Colonoscopic Evaluation

S2716 CMV in IBD: An Innocent Bystander, or Active Pathogen?

Introduction: Ulcerative Colitis (UC) is a gastrointestinal inflammatory disease that affects over 6 million people worldwide. Clinical manifestations of UC such as bloody diarrhea and abdominal pain can often mimic an infectious colitis, such as cytomegalovirus (CMV) colitis. Often a silent infection, CMV has a worldwide seroprevalence of 83%. We present an interesting case of a UC patient with biopsy positive CMV colitis, who symptomatically improved on steroids and mesalamine alone. Case Description/Methods: A 66 year old African American female with a history of well-controlled UC was evaluated for acute onset bloody diarrhea and abdominal pain. Following negative stool studies for infection, the patient underwent colonoscopic evaluation. Preliminary imaging and results demonstrated a left-sided UC flare extending from the rectum to the splenic flexure. The patient was started on pulse dose steroids with instructions to taper as an outpatient and experienced resolution of symptoms. Biopsy revealed CMV with subsequent serologic testing showing a CMV viral load of < 390 cpy/mL, IgM level of 45.4 AU/mL and negative IgG levels. Interestingly, the patient's acute gastrointestinal symptoms resolved with glucocorticoid treatment. Discussion: CMV reactivation is common in patients with moderate to severe UC. Symptoms of diarrhea, bloody stool, abdominal pain and complications such as megacolon, fulminant colitis and perforation often overlap in both CMV and UC. Endoscopic evaluation can provide a more definitive means of differentiating CMV colitis from an acute exacerbation of UC, however, may not be able to be quickly performed before complications arise. There has been much debate on the role of CMV in UC and whether it is an active pathogen contributing to the inflammatory state or simply a surrogate marker for disease severity. Multiple studies have demonstrated an association of CMV antigenemia with endoscopically significant severe UC. In such patients, after detection of CMV in the colon with biopsy, treatment with antiviral therapy and withdrawal of immunosuppressive agents would be expected to induce clinical response. Continuation of immunosuppressive therapies was associated with adverse events such as fulminant colitis and colectomy. (Figure) Differentiating an active CMV infection versus a UC flare can be challenging given the wide overlap of symptoms. Colonoscopic evaluation is important in supplementing a diagnosis with histopathological confirmation of CMV and can help guide treatment.Figure 1.: Inflammation characterized by friability, loss of vascularity, mucous, pseudopolyps and deep ulcerations was found in a continuous and circumferential pattern in the terminal ileum (1,2), hepatic flexure (3), transverse colon (4,5,6), descending colon (7,8), sigmoid colon (9,10,11), and rectum (12,13,14). This was graded as Mayo Score 3 (severe, with spontaneous bleeding, ulcerations).

Colonoscopic Profile of Lower Gastrointestinal Bleed in Adults: A Tertiary Care Centre Based Study

Lower Gastro intestinal (LGIB) bleeding is one of the most important clinical symptoms which have significant morbidity and mortality. It has an annual admission rate of 0.15% with mortality rate of 5-10%. LGIB can be caused by a number of causes, including both neoplastic and non-neoplastic lesions. Colonoscopy is the gold standard diagnostic measure which is a simple, convenient and cost-effective procedure. The present study aimed to assess the Colonoscopic profile of LGIB presented to our tertiary care centre. This is a cross-sectional observational study conducted in a tertiary health care centre. A total number of 58 adult subjects with LGIB aged above 18 years were recruited over a period of six months after obtaining written informed consent. All included patients underwent detailed history, clinical examination, blood tests and colonoscopic evaluation. Results were analysed. In our study among the 58 subjects (n=33) were males, which were equal to 57%. The majority of our patients were between the mean age of 31-40 years. Most colonoscopic findings were suggestive of ulcerative colitis, which equalled to 31%. Other different aetiologies of LGIB were as following: carcinoma of the colon (15%), haemorrhoids (15%), colonic polyps (14%) carcinoma of anal canal (5%) and so on. The majority of our patients had moderate anaemia, which was equal to 45% and this was due to persistent LGIB. The incidence of lower GI bleeding increased with increasing age among our patients. The leading cause of lower GI bleeding was found to be ulcerative colitis. The prevalence of colon cancer increases with increase in age. It was followed by CA colon, haemorrhoids, and colonic polyps; hence colonoscopy is recommended in all patients with chronic LGIB.

Colonoscopic Evaluation of Per Rectal Bleeding in Children : Our Experience

Background: Most patients with Per Rectal Bleeding (PRB) warrant endoscopic examination of the lower GI tract. This study was done to determine the demographic profile and find out the etiology of bleeding per rectum under colonoscipic evaluation.&#x0D; Meterials and methods : In this study, we did a retrospective review of the clinical data of children between 0 and 18 years of age who presented with per rectalbleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Pediatric Gastroenterology &amp; Nutrition, Chattagram Maa-O-Shishu Hospital, Chattagram from July 2014 to July 2021.Patient demographics, clinical features and endoscopic and histopathological findings were recorded.&#x0D; Results: Overall, we included 111 patients with mean age 9.6±5.1 years. There were 69 (62.2%) male, 42(37.80%) female and with a male to female ratio of 1.64:1.0 The highest incidence was the age group of 11 to 18 years, 46 (41.40%). The most common colonoscopy finding were juvenile colorectal polyp 46 (41.44% ) which include rectal polyps 21 ( 18.9%), Sigmoid polyp 17 (15.3), recto sigmoid polyp 4 (3.6%), colonic polyp 4(3.6%), followed by internal hemorrhoids (20 cases, 18%) rectal ulcers (5 cases, 4.5%) colitis (4 cases, 3.60%) and findings suggestive of koach’s infection (2 cases, 1.8 %). All polyps were removed by colonoscopic polypectomy (47 cases 42.30%), 64 cases (57.65%) were given conservative treatment.&#x0D; Conclusion :We found that Juvenile colorectal polyps constitute the most common cause of per rectal bleeding in pediatric age group followed by hemorrhoids and colitis . Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding and it’s good for both diagnostic and therapeutic procedure.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (1); January 2022; Page 66-69

High Yield of Colonoscopic Evaluation in Selected Young Patients

High Yield of Colonoscopic Evaluation in Selected Young Patients

ADEQUACY OF SIGMOIDOSCOPY IN COMPARISION TO COLONOSCOPY TO ASSESS DISEASE ACTIVITY DURING FOLLOW UP IN PATIENTS WITH ULCERATIVE COLITIS

Abstract BACKGROUND Endoscopic remission is the current treatment target in patients with Ulcerative Colitis (UC). Literature on adequacy of sigmoidoscopy in comparison to colonoscopy to assess endoscopic and histologic activity during follow up is sparse. METHODS This is an interim analysis of a prospective study of patients diagnosed with UC with disease extent proximal to the sigmoid colon. Fifty adult patients underwent a complete colonoscopy with segmental biopsies. Endoscopic disease activity was graded using Mayo Endoscopic Subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity score (UCEIS). The histological grading was done using the Nancy score, Robarts Histopathology Index (RHI) and Simplified Geboes Score (SGS). The maximum rectosigmoid disease activity was compared with the maximum disease activity in the rest of the colon. RESULTS Endoscopic Correlation: Sigmoidoscopic evaluation using MES showed good correlation with pan colonoscopic evaluation for disease activity with a sensitivity of 92.11%, specificity of 66.67%, accuracy of 86% (95% CI – 73.26% to 94.18%), kappa value (k) of 0.58 (p value &amp;lt; 0.001) and Area under curve (AUC) of 0.82 (95% CI- 0.74 to 0.942). Similarly, sigmoidoscopic evaluation using UCEIS score showed good correlation with pan colonoscopic evaluation for disease activity with a sensitivity of 95.0%, specificity of 70%, accuracy of 90% (95% CI – 78.19% to 96.67%), k of 0.68 (p value &amp;lt; 0.001) and AUC of 0.895 (95% CI- 0.805 to 0.924). Disease activity in the colon missed by performing a sigmoidoscopy using MES and UCEIS score is only 6% and 4% respectively. Histological Correlation: Histologic findings in rectosigmoid showed good correlation with histologic findings in rest of the colon using Nancy’s score [Sensitivity of 97.96%, specificity of 100%, accuracy of 98% (95% CI – 89.35% to 99.95%), k of 0.658 (p value &amp;lt; 0.001) and AUC of 0.99 (95% CI- 0.959 to 1.0)], Simplified Geboes Score [Sensitivity of 97.92%, specificity of 100%, accuracy of 98% (95% CI – 89.35% to 99.95%), k of 0.79 (p value &amp;lt; 0.001) and AUC of 0.99 (95% CI- 0.962 to 1.0)], and Robarts Histopathology Index [Sensitivity of 95.56%, specificity of 80%, accuracy of 94% (95% CI – 83.45% to 98.75%), k of 0.694 (p value &amp;lt; 0.001) and AUC of 0.878 (95% CI- 0.667 to 1.0) ]. Histologic disease activity in the colon missed by performing a sigmoidoscopy using Nancy score, SGS and RHI is only 2%, 2% and 4% respectively. CONCLUSION In patients diagnosed with UC and having disease extent proximal to the sigmoid colon, sigmoidoscopic evaluation has good correlation with pan colonoscopic evaluation for grading endoscopic and histological disease activity. A sigmoidoscopic examination is adequate to assess the disease activity in patients with disease extent proximal to the sigmoid colon.

Endoscopic findings of the gastrointestinal tract and conjunctions with preceding tomography findings

Aim: Abdominopelvic computed tomography is commonly used for delineating the causes of abdominal pain. While its popularity has increased, the rate of non-specific findings like gastrointestinal wall thickening has also increased. We aimed to determine whether a CT finding of thickened wall predicted a pathological finding on subsequent endoscopic evaluation.Methods: This retrospective study was conducted on adult patients who underwent endoscopic or colonoscopic evaluation at our center in 2019 and had a preceding abdominopelvic CT within a month before this investigation. Patients’ gastric or colonic wall thicknesses were measured during CT scans. Endoscopy or colonoscopy results of these patients were retrieved, and their correlation with wall thicknesses was analyzed.Results: The study cohort included 647 patients. While 106 (16.38%) underwent endoscopy, 541 (83.62%) underwent colonoscopy. The endoscopic biopsies were malignant in 101 patients (95,3%) and benign in 5 (4,7%) patients. The CT sections showed thickened wall in 93 (87.7%) patients. Comparison of the patients with and without a thickened wall revealed no difference concerning malignancy rates. Increased colonic wall thickness was detected in 506 (93,5%) of the CT sections. Normal or benign colonoscopic biopsy findings were reported in 19 (3,5%) patients. Adenocarcinoma was detected in 456 (84,2%) patients. Comparison of the patient groups with or without wall thickening did not reveal any significant differences regarding malignancy rates.Conclusion: Endoscopic-colonoscopic evaluations should be performed in patients with gastrointestinal wall thickening in CT scans since the diagnostic and predictive accuracy are limited when a single test like CT is used.

Factors predicting improved compliance towards colonoscopy in individuals with positive faecal immunochemical test (FIT)

ObjectivesFollow‐up colonoscopy after a positive faecal immunochemical test (FIT) in any colorectal cancer (CRC) screening programme is integral. However, many individuals who had a positive FIT declined colonoscopy subsequently. This study aims to uncover the predictors on completion of colonoscopy using the Health Belief Model (HBM) between individuals who complete and those who did not after a positive FIT.MethodsA mixed‐method study comprising qualitative semi‐structured interviews followed by a locally validated questionnaire in Singapore was prospectively administered via telephone interview to average risk individuals with positive FIT results from a cohort of the national FIT screening database referred for follow‐up colonoscopic evaluation.ResultsA total of 394 individuals, with a median age of 66 years (range, 46–89 years), were recruited. Fifty percent completed follow‐up colonoscopic evaluation and formed the “doers” group. All participants demonstrated high knowledge of symptoms of CRC and awareness and qualitative responses were aligned to the various HBM domains. Using multi‐variable analysis, doers felt that medical recommendations (odds ratio [OR], 2.39, 95% confidence interval [CI]: 1.23–4.63, p = 0.01) and mainstream media publicity (OR, 2.16, 95% CI: 1.09–4.26, p = 0.026) were important. Non‐doers showed positive association with perceived barriers such as cost (OR, 2.15, 95% CI: 1.10–4.20, p = 0.026) and inconvenience (OR, 3.44, 95% CI: 1.50–7.89, p = 0.004).ConclusionsIdentified factors such as tackling perceived barriers, public health education and active promotion by medical physicians, family and friends could help guide subsequent interventions to improve compliance of individuals with positive FIT to undergo follow‐up colonoscopy.

A Comparative Study of Magnetic Resonance Imaging and Colonoscopy in Evaluation of Colorectal Diseases

Introduction: Colorectal disease, especially carcinoma, is an important cause of morbidity and mortality in modern era. With rising incidence of colorectal diseases and due to limitations of conventional flexible fiber-optic colonoscopy (gold standard tool), imaging plays a significant role in evaluation of these patients. Recent technical advancements coupled with noninvasive and radiation-free nature has made magnetic resonance imaging (MRI) an acceptable screening tool in colorectal diseases. Hence, we planned this study to evaluate role of MRI in colorectal diseases in our tertiary care, medical college, hospital. Materials and Methods: Forty-four patients with signs and symptoms of colorectal disease were evaluated by 1.5 Testa MRI followed by conventional, flexible, fiber-optic colonoscopy on the same day after obtaining approval from the institutional ethics committee and after obtaining written informed consent using strict criteria. Bowel preparation was done using polyethylene glycol. Data from MRI and colonoscopy were recorded in predesigned pro forma and compared with the final diagnosis. Appropriate statistical methods and tools were used to evaluate the results. Results: Majority of the patients in the study were in the age group of 21–40 years with male predominance. Altered bowel habit followed by bleeding per rectum was the most common presentations. Both MRI and colonoscopy overdiagnosed the lesions as malignant with higher errors by MRI. MRI was very effective in the detection of growth, strictures, diverticulosis, mucosal thickening/edema, and extracolonic manifestation but failed in detecting small polyps and ulcers. MRI had high sensitivity and negative predictive value (NPV) of 100% with an accuracy of more than 70%. Conclusions: Although conventional colonoscopy is considered as a gold standard tool in the diagnosis of colorectal diseases, it has several limitations including its invasive nature and low yield as a screening tool. Hence, MRI with its noninvasive and radiation-free nature along with its high sensitivity and NPV for malignant lesions should be considered over colonoscopy as well as computed tomography in evaluation of colorectal diseases.

Adenocarcinoma of the sigmoid colon in familial adenomatous polyposis syndrome: A case report

Familial adenomatous polyposis (FAP) is an autosomal dominant inherited syndrome characterized by the development of numerous adenomatous polyps in the colon and rectum. A germline mutation in the APC gene (adenomatous polyposis coli) present on chromosome 5q21 is the molecular level defect causing this syndrome. In this case series report, we report two cases of FAP from a single family of 10 members which included parents, four female siblings, and four male siblings. Apart from index cases, the rest of the family members detected to have polyps on colonoscopic evaluation. Literature review, data regarding timely surgery, surveillance, and chemoprevention are discussed. The FAP phenotype determines the type of treatment. In severe polyposis, proctocolectomy with ileoanal anastomosis is the optimal method for minimizing cancer development risk. Genetic counselling should guide genetic testing and considerations of colectomy. This case report advocates complete rectal removal, especially in cases of poor patient compliance.