Positive Fecal Occult Blood Test Research Articles

Evaluation of colonoscopic findings in patients undergoing colonoscopy due to positive fecal occult blood test: a single center experience

Aim: Fecal occult blood test is used in the early diagnosis of colorectal cancers. We aimed to evaluate the colonoscopic and pathological findings of patients who underwent colonoscopy due to positive fecal occult blood test in a tertiary center.
 Material and Method: Patients who had a positive fecal occult blood test and referred to the xxx Training and Research Hospital endoscopy unit for colonoscopy were included in this study. Age, gender, colonoscopic findings and pathology results of the patients were recorded. Statistical analyzes were performed with SPSS.
 Results: Two hundred and twenty three patients were included in the current study. Of the patients, 101 (45.3%) were male and 122 (54.7%) were female, with a mean age of 53.2 (18-90 years). Endoscopic diagnoses were as 49 (22%) polyps, 13 (5.8%) colon cancer, 4 (1.8%) inflammatory bowel disease, 15 (6.7%) diverticulum, 63 (28.3%) perianal disease, 79 (35.4%) normal colonoscopic findings. Pathological features of colon polyps were as; tubular adenoma in 51%, tubulovillous adenoma in 18.4%, serrated adenoma in 2%, and hyperplastic polyp in 28.6%. Colonoscopy findings of patients according to age groups (over and under 50 years of age); the incidence of polyps (p=0.01) and diverticulum (p=0.001) were significantly higher in patients older than 50 years, while perianal diseases (p=0.031) and normal colonoscopic findings (p=0.008) were higher in patients younger than 50 years of age.
 Conclusion: Colon pathology was detected in approximately 2/3 of the patients presenting with a positive fecal occult blood test. This test is an inexpensive, easily applicable method that helps to detect colon cancer and precursor lesions, as well as pathologies such as subclinical inflammatory bowel disease and diverticulum causing chronic blood loss.

Pedunculated early colorectal cancer with nodal metastasis: a case report

BackgroundPedunculated polyps are more likely to be amenable to complete resection than non-pedunculated early colorectal cancers and rarely require additional surgery. We encountered a patient with a pedunculated early colorectal cancer that consisted of poorly differentiated adenocarcinoma with lymphatic invasion. We performed an additional bowel resection and found nodal metastasis.Case presentationA 43-year-old woman underwent colonoscopy after a positive fecal occult blood test. The colonoscopist found a 20-mm pedunculated polyp in the descending colon and performed endoscopic resection. Histopathologic examination revealed non-solid type poorly differentiated adenocarcinoma. The lesion invaded the submucosa (3500 μm from the muscularis mucosa) and demonstrated lymphatic invasion. In spite of the early stage of this cancer, the patient was considered at high risk for nodal metastasis. She was referred to our institution, where she underwent bowel resection. Although there was no residual cancer after her endoscopic resection, a metastatic lesion was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy, and there has been no evidence of recurrence 3 months after the second surgery.ConclusionsAdditional bowel resection is indicated for patients with pedunculated polyps and multiple risk factors for nodal metastasis, such as poorly differentiated adenocarcinoma and lymphatic invasion. We encountered just such a patient who did have a nodal metastasis; herein, we report her case history with a review of the literature.

Rare cause of lower gastrointestinal bleeding: Iliac aneurysmo-colonic fistula after endovascular treatment.

A 59-year-old male visited our department for examination of positive fecal occult blood test. The patient was scheduled for colonoscopy. However, he was admitted to our hospital urgently for rupture of left internal iliac artery aneurysm (IIAA) (Fig. 1). IIAA was managed by coil embolization and stent graft. Two weeks after the discharge, the patient visited our department because of intermittent hematochezia. Colonoscopy revealed a submucosal tumor-like protrusion with a fistulous tract in the sigmoid colon (Fig. 2a). Computed tomography demonstrated an iliac aneurysm with thrombus and air bubbles, fistulizing to the sigmoid colon (Fig. 2b). The patient was treated by an iliac artery aneurysm resection, stent graft removal, right common femoral artery–left common femoral artery bypass, and colostomy. Although iliac aneurysmo-colonic fistula is a rare condition, it can cause acute and massive lower gastrointestinal bleeding. In addition to arterial intervention such as endovascular therapy, abdominal or pelvic surgery, pelvic malignancy, and infection are also known causes of fistula formation. For the secondary aneurysmo-colonic fistula that occurs after endovascular therapy, as in our case, surgical treatment is often selected instead of repeat endovascular treatment. Our case suggests that aneurysmo-colonic fistula should be considered as one of the differential diagnoses among acute lower gastrointestinal bleeding, in patients with a history of recent endovascular therapy in large vessels in proximity to the colon.

Colorectal Cancer Risk in Patients with Hemorrhoids: A 10-Year Population-Based Retrospective Cohort Study.

Colorectal cancer (CRC) is a common disease and one of the leading causes of cancer deaths worldwide. This retrospective cohort study evaluated the risk of developing CRC in people with hemorrhoids. Using Taiwan’s National Health Insurance Research Database, we established three sets of retrospective study cohorts with and without hemorrhoids. The first set of cohorts were matched by sex and age, the second set of cohorts were matched by propensity score without including colonoscopies, and the third set of cohorts were matched by propensity score with colonoscopies, colorectal adenomas, and appendectomies included. In the second set of cohorts, 36,864 persons with hemorrhoids that were diagnosed from 2000 to 2010 and a comparison cohort, with the same size and matched by propensity score, were established and followed up to the end of 2011 to assess the incidence and Cox proportional regression-measured hazard ratio (HR) of CRC. The overall incidence rate of CRC was 2.39 times greater in the hemorrhoid cohort than it was in the comparison cohort (1.29 vs. 0.54 per 1000 person-years), with a multivariable model measured adjusted HR of 2.18 (95% CI = 1.78–2.67) after controlling for sex, age, and comorbidity. Further analysis on the CRC incidence rates among colorectal sites revealed higher incidence rates at the rectum and sigmoid than at other sites, with adjusted HRs 2.20 (95% CI = 1.48–3.28) and 1.79 (95% CI = 1.06–3.02), respectively. The overall incidence rates of both cohorts were similar in the first and second sets of cohorts, whereas the rate was lower in the third set of hemorrhoid cohorts than in the respective comparison cohorts, probably because of overmatching. Our findings suggest that patients with hemorrhoids were at an elevated risk of developing CRC. Colonoscopy may be strongly suggested for identifying CRC among those with hemorrhoids, especially if they have received a positive fecal occult blood test result.

Gastrointestinal bleeding with Klippel\u2013Trenaunay syndrome: a case report

BackgroundGastrointestinal bleeding caused by gastrointestinal tract involvement in patients with Klippel–Trenaunay syndrome (KTS) is extremely rare and often overlooked.Case presentationA 9-year-old girl who presented with chronic gastrointestinal bleeding was admitted to our hospital. Laboratory examinations revealed microcytic hypochromic anemia and a positive fecal occult blood test. Computed tomography (CT) of the lower limbs combined with physical examination confirmed KTS. The pelvic CT showed concentric thickening of the sigmoid colon and rectum, with progressive enhancement after the administration of a contrast agent. Colonoscopy demonstrated vascular malformations of the sigmoid colon and rectum. The patient was finally diagnosed with KTS with gastrointestinal tract involvement. The patient improved after receiving conservative treatment.ConclusionsA suspicion of gastrointestinal tract involvement as an etiology for gastrointestinal bleeding should not be overlooked in patients with KTS. Endoscopy and imaging modalities can synergistically help diagnose this condition.

The clinical utility of a comprehensive psychosomatic assessment in the program for colorectal cancer prevention: a cross-sectional study

Few studies have investigated psychosocial characteristics and lifestyle behaviors of participants at programs for secondary prevention of colorectal cancer (CRC). This study aimed, through a comprehensive psychosomatic assessment based on clinimetric principles, to evaluate psychosocial characteristics and lifestyle behaviors in participants at CRC secondary prevention program, and to investigate the associations between these variables and endoscopic outcomes. In this cross-sectional study, the first 150 consecutive asymptomatic participants at the CRC prevention program who resulted positive to fecal occult blood test (FOBT) and were thus referred to colonoscopy, underwent a psychosomatic assessment including psychiatric diagnoses (DSM-5), psychosomatic syndromes (DCPR-R), psychological distress, psychological well-being and lifestyle behaviors. Whereas only 5.3% of the sample showed at least one DSM-5 diagnosis, 51.3% showed at least one DCPR syndrome, such as allostatic overload, alexithymia, Type A behavior, and demoralization. Patients affected by psychosomatic syndromes presented with significantly higher psychological distress, lower psychological well-being and unhealthy lifestyle behaviors, such as tobacco smoking and unhealthy diet, in comparison with patients without DCPR syndromes. Among endoscopic outcomes, the presence of adenomas was significantly associated with DCPR irritable mood. In a clinical context of secondary prevention addressing asymptomatic patients with positive FOBT, a comprehensive psychosomatic assessment may provide relevant clinical information for those patients who present certain psychosomatic syndromes associated with high psychological distress, impaired psychological well-being, unhealthy lifestyle behaviors and colorectal precancerous lesions. The results of the present study indicate a road to the practice of “preventive” medicine at CRC screening program.

Evaluation of colonoscopy results of patients in a colorectal cancer screening program: A retrospective cohort study

Background/Aim: Colorectal cancer is at the forefront of cancer-related deaths. Early detection and treatment of precursor lesions with screening programs are imperative. In this study, we aimed to determine the outcomes of colonoscopy and the effectiveness of screening. Methods: The colonoscopy results of 758 patients who were referred for positive fecal occult blood tests between October 2015 and January 2020 were examined in this retrospective cohort study. The demographic, pathological, and colonoscopic findings were recorded. Results: No pathology was detected in 53.3% of patients during colonoscopy. In patients with a pathology, polyps (28.5%), diverticular disease (15.44%), and colitis (2.37%) were most common. Patients with malignancy accounted for 3.69% of all patients and 12.96% of patients with polyps. Among adenoma types, the risk of dysplasia and/or malignancy was higher in villous polyps compared to tubulovillous and tubular polyps, and in tubulovillous polyps compared to tubular polyps (P<0.01). The presence of dysplasia and/or malignancy was evaluated mutually between the subgroups according to polyp size. There was no significant difference in the incidence of dysplasia between the patients with polyps of 6-10 mm and those with polyps of 11-20 mm (P=0.192). Among all other subgroups, an increase in polyp size caused a significant increase in dysplasia and/or malignancy (P<0.001). Conclusion: The results of this study showed that colonoscopy performed on colorectal cancer screening patients with a positive fecal occult blood test was quite successful in diagnosing precancerous lesions and colorectal cancer.

Positive impact of a faecal-based screening programme on colorectal cancer mortality risk.

The effectiveness of colorectal cancer (CRC) screening programs is directly related to participation and the number of interval CRCs. The objective was to analyse specific-mortality in a cohort of individuals invited to a CRC screening program according to type of CRC diagnosis (screen-detected cancers, interval cancers, and cancers among the non-uptake group). Retrospective cohort that included invitees aged 50-69 years of a CRC screening program (target population of 85,000 people) in Catalonia (Spain) from 2000-2015 with mortality follow-up until 2020. A screen-detected CRC was a cancer diagnosed after a positive faecal occult blood test (guaiac or immunochemical); an interval cancer was a cancer diagnosed after a negative test result and before the next invitation to the program (≤24 months); a non-uptake cancer was a cancer in subjects who declined screening. A total of 624 people were diagnosed with CRC (n = 265 screen-detected, n = 103 interval cancers, n = 256 non-uptake). In the multivariate analysis, we observed a 74% increase in mortality rate in the group with interval CRC compared to screen-detected CRC adjusted for age, sex, location and stage (HR: 1.74%, 95% CI:1.08-2.82, P = 0.02). These differences were found even when we restricted for advanced-cancers participants. In the stratified analysis for type of faecal occult blood test, a lower mortality rate was only observed among FIT screen-detected CRCs. CRC screening with the FIT was associated with a significant reduction in CRC mortality.

Process redesign and daily management to improve cancer care access at the public healthcare system in Sao Jose dos Campos, Brazil.

6530 Background: Cancer is the second leading cause of death in Sao Jose dos Campos (SJC, a mid-sized city with 720,000 hab. in Sao Paulo state, Brazil) and the most relevant budget in tertiary care. The City Healthcare Authority created in October 2018 a team to manage and provide more effective and efficient cancer care and access to the public healthcare system by using process redesign and daily management tools (Previna Project). The aim was to guarantee access to cancer specialist and care up to 60 days form diagnosis, understanding that this can impact in cancer morbidity, mortality, and cost. Methods: The Previna was grounded in 4 major actions: (1) process redesign (2) escalated daily management system, (3) improve communication channels to all providers connecting primary care to specialized care, (4) and emergency access. (1) Process Redesign involved connecting and linking access to several providers and eliminating unnecessary steps or repeated orders in the system, it also involved alerts into the system for specific conditions like elevated PSA or CEA; positive fecal occult blood test; BIRADS 4-5 mammogram; abnormal PAP smears; and new screening protocols for prostate and colorectal cancer. (2) Daily Management involved internal daily discussions about capacity and review of system alerts or demands. Weekly discussions on specialized procedures including imaging, biopsies, chemo, radiation or surgery flows; and biweekly meetings with all providers (3 hospitals and 4 specialized practices). (3) Communication channels improvements involved a hotline to access flow managers for primary and secondary care units, specialist’s consultancy by phone, and (4) emergency access provided for units with special needs or urgent care requirements. All actions were connected by flow managers using alert systems, visual boards, kanban and similar tools to manage daily progress. Results: The access to cancer care and treatment up to 60 days improved from 2017 to 2020 almost two-fold with the Previna (Table). Cancer diagnosis also increased substantially, and it is expected to be related to previous periods underdiagnosed patients. Flow redesign also reduced median time to process Her2, ER and PR for breast cancer from 38 days in 2018 to 9 days in 2019 and 4 days in 2020, positively impacting treatment decisions. The hotline access reviewed and answered 2,389 demands from care providers between 2018 and 2020. Access to Cancer Care for ICD C00 – C97 (excl. C44 and C73) in SJC. Conclusions: The combined use of daily management, lean tools and flow redesign in the Previna was able to improve access and anticipate cancer diagnosis in a public healthcare system using simple and low-cost initiatives.[Table: see text]

The present scenario of colorectal cancer in Southeastern Brazil.

e18782 Background: Cancer is the second leading cause of death in the world and in Brazil. Most of colorectal cancers (CRC) are sporadic and occur in individuals over the age of 50. Since almost all CRC originate from a polyp , the early detection and excision of an adenomatous polyp is essential to avoid the adenoma-carcinoma sequence that occurs over the years. Most colorectal polyps are asymptomatic and identified during screening colonoscopies or in patients with positive fecal occult blood test . There is evidence that detecting and removing these cancer precursor lesions can prevent many cases of cancer and reduce mortality. The CRC are public health problem in Brazil and fulfills criteria to merit the implementation of a structured screening program. and in this sense, several medical societies recommend screening through organized programs and not just opportunistic as done in Brazil. It is believed that this strategy is related to late diagnosis and has impact on high mortality. Most evidence on CRC screening interventions comes from high-income countries. The large disparities in CRC incidence and mortality rates between high-income and low-income countries are attribute to screening. The study will evaluate the stage of colorectal cancer at diagnosis at Southeastern Brazil. Methods: We collected retrospective data of patients with CRC registered in the Hospital Evangélico de Cachoeiro de Itapemirim (HECI) Health Information System - SISRHC from 2010 to 2017 to know the clinical characteristics (TNM) of the patients diagnosed during this period, age and sex. From January 1, 2010 to December 31, 2017, 6,962 newly diagnosed cases of cancer were identified. Of this total, 676 (9.7%) were new cases of colorectal cancer. When submitting to the inclusion and exclusion criteria of the present study 91 cases were excluded (1 case under the age of 18 years; 64 cases that started their first cancer treatment before the pathological result; 26 cases without information from the anatomopathological diagnosis). Data from the remaining 585 cases were analyzed. Results: Among 585 analyzed, the distribution of stage at diagnosis was : 0 (0,68%), I 45 (7,69%), II 109 (18,63%), III 225 (38,45%), IV 129 (22,05%) and 73 (12,48%) had this information missing. Mean age at diagnosis was 62 years, with 411(70,50%) between ages 51-80 years. Regarding sex we found 306 (52,49%) male and 277 (47,51%) female. Conclusions: The results found in the studied population are in agreement with the literature regarding age at diagnosis and sex. Unfortunately demonstrates that most of colorectal,cancer in southeastern region of Brazil are diagnosed in late stages. The lack of screening is an explanation to this fact. Only the implemention of national organized screening program can improve cancer detection and provide better chances of cancer survival.

Screening and Prognostic Value of Methylated Septin9 and its Association With Clinicopathological and Molecular Characteristics in Colorectal Cancer.

Screening of CRC continues to show poor compliance of endoscopy examination. The detection of mSEPT9 in peripheral blood is among the safe and simple early screening methods for CRC. The issue of how to elucidate whether detection of mSEPT9 in peripheral blood can effectively improve compliance of endoscopy and increase the early diagnosis rate of CRC and the relationship between levels of mSEPT9 in the peripheral blood and clinical stage, pathological classification, and expression of characteristic molecules in CRC remains unsolved. A total of 7759 individuals participated in the study that was performed using a questionnaire for screening of high-risk CRC. The endoscopic detection compliance of individuals with high-risk CRC who underwent the fecal occult blood test (FOBT) or mSEPT9 test was compared based on the results of the questionnaire. Additionally, correlation of mSEPT9 levels in the peripheral blood with clinicopathological features, mutation status of TP53, mismatch repair deficiency (dMMR), and KRAS/NRAS/BRAF/PIK3CA genotype was analyzed, and association of biomarkers with cancer-specific survival (CSS) and time to recurrence (TTR) was compared. We also detected levels of mSEPT9 in the peripheral blood of patients with CRC 7 days after surgery and compared the prognostic value of mSEPT9 with CEA. Results of our study showed that the mSEPT9 test could improve compliance of endoscopy and indicated a higher percentage of patients with positive mSEPT9 willing to undergo endoscopy detection than in those with positive FOBT. The specificity and sensitivity of mSEPT9 were better than that of FOBT for the detection of CRC. mSEPT9 was associated with the TNM stage, dMMR, and mutations in TP53, BRAF, and PIK3CA. A Ct value of mSEPT9 ≤ 37.5 was significantly related to poor CSS. mSEPT9 could affect association of dMMR and BRAF and PIK3CA mutations with CSS in a specific stage of CRC. The positive rate of mSEPT9 after surgery was found to correlate with poor TTR, and sensitivity was higher than CEA. The combination of mSEPT9 with CEA had a better prognostic value than that of mSEPT9 alone. The level of mSEPT9 was related to dMMR, mutations in TP53, BRAF, and PIK3CA, and was an effective biomarker for the prognosis of patients with CRC.

Enterobius vermicularis infection associated with positive faecal occult blood testing and eosinophilia

A 60-year-old asymptomatic man attended following positive faecal occult blood testing in the UK bowel cancer screening programme. He was a regular carer for young grandchildren. Recent blood tests showed an elevated eosinophil count (0·82 × 109 cells per L [range 0·04–0·4]). Colonoscopy showed patchy erythema and erosions with multiple Enterobius vermicularis (threadworm or pinworm) in the caecum (figure, A). Histopathological examination (figure, B) showed surface epithelial erosion, with attenuation, patchy regenerative changes and an E vermicularis parasite (figure, C). Crypt architecture was maintained, but there was an eosinophil-rich inflammatory cell infiltrate within the lamina propria (figure, D).

A True Positive and a False Negative? The Dilemma of Negative Colonoscopy After a Positive Fecal Occult Blood Test.

Many colonoscopies following a positive fecal immunochemical test (FIT) will not identify a probable cause for fecal blood, and missed neoplasia is a concern. The study determined whether the absence of neoplasia at a FIT positive diagnostic colonoscopy was due to a missed lesion and whether the initial FIT hemoglobin (f-Hb) concentration could predict missed lesions. This was a retrospective audit of patients who had undergone diagnostic colonoscopy after FIT screening (2 sample ≥ 20µg Hb/g feces). Probable bleeding lesions including cancer, advanced adenoma, colitis, and angiodysplasia were considered a "positive colonoscopy outcome." For those with a negative outcome, findings at the subsequent colonoscopy were assessed. There were 1087 good quality colonoscopies within 12months of a positive FIT. In total, 171 (15.7%) patients had a positive outcome at the diagnostic colonoscopy. Subsequent colonoscopies of negative outcome cases (n = 418, median of 3.1y later) were reviewed; of these, there were 57 (13.6%) cases with a positive outcome. This included CRC in 0.5% (n = 2) and advanced adenoma in 11.7% (n = 49). High f-Hb and having both FIT samples ≥ 20µg/g feces were associated with a positive outcome at the original diagnostic colonoscopy (p < 0.05). However, f-Hb was not predictive for a positive outcome at the subsequent colonoscopy by either maximum f-Hb (p = 0.768), total f-Hb (p = 0.459), or both FIT samples ≥ 20µg/g (p = 0.091). A small proportion of "false" positive FIT results had cancer or advanced adenoma found at the subsequent colonoscopy. A missed lesion could not be predicted by the initial FIT f-Hb.

Localized intestinal AL amyloidosis detected as bright green using autofluorescence endoscopy.

Amyloidosis is classifiable as systemic, with amyloid deposition in organs throughout the body, or localized, involving only one organ. Amyloidosis localized in the intestinal tract is rare. This report describes three cases of localized AL amyloidosis in the intestinal tract and presents their clinical characteristics, endoscopic findings, and prognoses. All three cases were asymptomatic, and were found accidentally during endoscopy for closer examination after a positive fecal occult blood test. Endoscopic findings included patchy redness and meandering dilated vessels of the lesion. Using autofluorescence (AFI) endoscopy, the lesion of amyloid deposition was enhanced as bright green. We used fluorescence microscopy to observe unstained specimens obtained from an amyloid deposition site with excitation light. Autofluorescence was detected with the broad excitation wavelength at amyloid deposition lesion sites of the specimen. Results revealed that AL amyloid has autofluorescence that engenders its detection by AFI endoscopy as bright green. In none of the three cases was systemic amyloidosis or organ failure observed. The long-term course of all the cases was favorable.

Impact of cumulative experience on the quality of screening colonoscopy: A 13-year observational study.

To investigate trends in quality of screening colonoscopy (using the Global Rating Score) in the 13 years since introduction of the Bowel Cancer Screening Programme in England. An English Bowel Cancer Screening Programme colonoscopy service from 2007 to 2019. A retrospective observational study was undertaken using a prospectively collected database in order to analyse trends in screening endoscopies (including patients following positive faecal occult blood test or with high-risk findings on flexible sigmoidoscopy). The Global Rating Score quality indicators for Bowel Cancer Screening Programme colonoscopy were used as outcome measures, and trends over time were analysed. These included caecal intubation rate, adenoma detection rate, colorectal cancer detection rate, proportion of patients with minimal or mild discomfort scores, proportion of patients who required intravenous sedation, and adverse events. There were 5352 colonoscopies included, performed by 3 endoscopists; 73.8% were index procedures (i.e. first Bowel Cancer Screening Programme colonoscopy) and the remainder were follow-up or surveillance colonoscopies. The mean age of patients was 66 (standard deviation 5) years, and 59.8% were male. Mean age increased over time (R2=0.033; p < 0.001). There were significant trends over time towards higher caecal intubation rate (p = 0.015), higher adenoma detection rate (p < 0.001), lower proportion requiring intravenous sedation (p < 0.001). There were no significant trends in comfort scores (p = 0.606), adverse events (p = 0.503) or colorectal cancer detection (p = 0.089). There was a consistent improvement in the Global Rating Score for Bowel Cancer Screening Programme colonoscopies since the start of the programme, even when quality was already high at the start. Patients can expect high-quality colonoscopy when participating in the Bowel Cancer Screening Programme.

Perforation and post-polypectomy bleeding complicating colonoscopy in a population-based screening program.

Background and study aims We aimed to estimate the rate of hospital admissions for perforation and for post-polypectomy bleeding, after outpatient colonoscopy following a first positive fecal occult blood test screen through the population-based ColonCancerCheck program in Ontario, Canada. Patients and methods We identified all individuals aged 50 to 74 years with a first positive CCC gFOBT screening result from 2008 to 2017 who underwent outpatient colonoscopy ≤ 6 months later and who did not receive a diagnosis of CRC ≤ 24 months later. We identified inpatient hospital admissions for colonic perforation ≤ 7 days after and for post-polypectomy bleeding ≤ 14 days following colonoscopy. Results Among 121,626 individuals who underwent colonoscopy, the rate of perforation was 0.6 per 1000 from 2008 to 2012 and 0.4 per 1000 from 2013 to 2017. The rate was elevated among those aged 70 to 74 years; those with comorbidities; when colonoscopy was performed by endoscopists other than gastroenterologists or endoscopists with low prior year volume; and when polypectomy was performed during colonoscopy. The rate of bleeding was 4.3 per 1000 and was elevated among those aged 70 to 74 years, those with comorbidity, and with complex polypectomy. Both outcomes were more common among those aged 70 to 74 years, those with a 5-year cumulative Charlson score ≥ 1, those with prior hospitalization for ischemic heart disease, and those with endoscopists whose prior year colonoscopy volume was in the three lower quartiles. Conclusions Colonic perforation and post-polypectomy bleeding, among participants of population-based colorectal screening programs who test positive in the absence of colorectal cancer, are infrequent but serious complications, which increase with participant age and comorbidity, and with endoscopist characteristics.

Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer

BackgroundThe risk of colorectal cancer (CRC) among subjects with a positive faecal immunochemical test (FIT) who do not undergo a colonoscopy is unknown. We estimated whether non-compliance with colonoscopy after...

Overexpression of CD44v8-10 in Colon Polyps-A Possible Key to Early Diagnosis.

Background and aims: The majority of colorectal cancers arise from detectable adenomatous or serrated lesions. Here we demonstrate how deregulated alternative splicing of CD44 gene in diseased colon mucosa results in downregulation of standard isoform of CD44 gene (CD44s) and upregulation of variant isoform CD44v8-10. Our aim is to show that upregulation of CD44v8-10 isoform is a possible marker of precancerous lesion in human colon. Methods: We analysed pairs of fresh biopsy specimen of large intestine in a cohort of 50 patients. We studied and compared alternative splicing profile of CD44 gene in colon polyps and adjoined healthy colon mucosa. We performed end-point and qRT PCR, western blotting, IHC staining and flow cytometry analyses. Results: We detected more than five-fold overexpression of CD44v8-10 isoform and almost twenty-fold downregulation of standard isoform CD44s in colon polyps compared to adjoined healthy tissue with p = 0.018 and p < 0.001 in a cohort of 50 patients. Our results also show that aberrant splicing of CD44 occurs in both biologically distinct subtypes of colorectal adenoma possibly in ESRP-1 specific manner. Conclusion: 92% of the colon polyp positive patients overexpressed CD44v8-10 isoform in their colon polyps while only 36% of them had positive fecal occult blood test which is currently a standard non-invasive screening technique. Impact: We believe that our results are important for further steps leading to application of CD44v8-10 isoform as a biomarker of colorectal precancerosis in non-invasive detection. Early detection of colon precancerosis means successful prevention of colorectal carcinoma.

A case of early rectal carcinoma with submucosal tumor-like morphology

Submucosal tumor (SMT)-like colorectal cancer is relatively rare. The patient was a 59-year-old man who underwent colonoscopy after a positive fecal occult blood test. Colonoscopy showed a protruded lesion of 10mm in the lower rectum. On initial observation, conventional endoscopy showed that the lesion was covered with normal mucosa and its surface was reddish with small dimples. A neuroendocrine tumor was suspected, and a biopsy was performed, but the pathological diagnosis was adenocarcinoma. Re-examination 3weeks later showed a depression at the surface of the lesion owing to the biopsy. Magnifying NBI showed a vessel pattern of uneven and irregular distribution, and an irregular surface pattern in the depressed area. Magnifying observations with crystal violet staining showed irregular pit patterns. The preoperative diagnosis was submucosal invasive cancer, and operation was performed. The final pathological diagnosis was well-differentiated tubular adenocarcinoma with deep submucosal invasion. The tumor was primarily localized in the submucosal layer and was covered by non-neoplastic mucosa except for the depressed area. The tumor was not exposed on the surface and was proliferating under the mucosa, which resulted in an SMT-like morphology. Our present case indicates that colorectal cancers should be differentially considered when SMT lesions are detected.

Clinical Characteristics of Patients with Clostridium Difficile Infection and Its Relationship with Fecal Occult Blood Test

Clostridium difficile infection (CDI) is an important health problem with severe morbidity and mortality. In our study, 266 adult patients admitted to the hospital between the years 2005 and 2020, and were diagnosed with CDI were included. The relationship between CDI and fecal occult blood test (FOBT) was examined, and it was aimed to determine the clinical characteristics of CDI patients and risk factors for mortality and recurrence in these patients. FOBT was found to be positive in 42.8% of our CDE patients who had occult blood in stool. Pseudomembranous enterocolitis (PME) developed in 2.2% of our patients and toxic megacolon developed in 0.8%; while 10.2% of the patients had a mortal course within 30 days and 5.2% of them had a recurrence. In our study, a significant relationship was found between mortality and advanced age, negativity of FOBT, presence of hospitalization history, and also between FOBT positivity and the presence of PME and recurrence. We believe that the data documented in this study are important because it both reveal the clinical characteristics of CDI patients and its relationship with FOBT.