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Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Gross structural abnormalities and colonic strictures can be excluded using a double contrast barium enema. Colonoscopy should be reserved for those in whom colorectal cancer or inflammatory bowel disease need exclusion (alarm symptoms are sudden onset after 50 years of age or a significant family history of colorectal neoplasia or inflammatory bowel disease).
Oral examinations
Published in Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop, A Complete Guide to the Final FRCR 2B, 2011
Deepak Subedi, Marialena Gregoriades, En Hsun Choi, John T Murchison, Graham McKillop
Double-contrast barium enema study: Multiple small round ulcers clustered along the transverse colonLucent halo of oedematous mucosa surrounding the ulcers.
Management of colorectal cancer
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Colonoscopy This is the ‘gold standard’ investigation for colorectal cancer and is recommended by NICE (National Institute for Health and Care Excellence) as a first line investigation. It can be performed as outpatient (<2-week wait) and allows direct visualisation and tissue biopsy.Alternatives to colonoscopy include: Flexible sigmoidoscopy: Can be offered to patients with major co-morbidities and who are unable to tolerate bowel prep. Advantages include being a simpler and less invasive procedure, however, it only visualises the left side of the bowel and will miss more proximal lesions.CT colonography: Offered to patients with major co-morbidities or who are unable to tolerate a colonoscopy. It still requires the patient to take bowel prep (although a reduced faecal tagging protocol can be used in high-risk individuals). Advantages include being a less invasive technique and no sedation is required, however, it doesn't allow direct visualisation or tissue biopsy.Double contrast barium enema: Useful to assess location of an obstruction in patients who can't undergo CT. However, it is dependent on local radiology expertise and therefore rarely performed in the UK in the advent of CT.
Estimating the preferences and willingness-to-pay for colorectal cancer screening: an opportunity to incorporate the perspective of population at risk into policy development in Thailand
Published in Journal of Medical Economics, 2021
Pochamana Phisalprapa, Surachat Ngorsuraches, Tanatape Wanishayakorn, Chayanis Kositamongkol, Siripen Supakankunti, Nathorn Chaiyakunapruk
Table 3 shows the characteristics of participants. The average age of participants was 62.4 ± 6.4 years. Two hundred and forty-six (61.5%) were female. The common comorbidities were hypertension, dyslipidemia, diabetes mellitus, and cardiovascular disease (51.0%, 31.0%, 24.0%, and 6.0%, respectively). More than half of the participants were retirees. The average monthly income was US$495 (US$217–929) (16,000 THB [7,000–30,000 THB]). More than half (53.5%) of the participants were aware of CRC. Approximately, one-fourth (23.5%) of the participants were aware of CRC screening. One hundred and sixty-two (40.5%) participants were not apprehensive about CRC. When the participants were directly asked, 47.0%, 11.0%, and 42.0% of them mentioned that they preferred colonoscopy, double-contrast barium enema (DCBE), and FIT, respectively, if these screening programs were free of charge. On the other hand, 25.5%, 12.5%, and 62.0% of the participants would prefer colonoscopy, DCBE, and FIT, respectively, if they had to pay out of their own pockets. The acceptable copayment amounts from their own pockets were US$93, US$46, and US$3 (3,000, 1,500, and 100 THB) from the full costs of US$186, US$93, and US$3 (6,000, 3,000, and 100 THB) for colonoscopy, DCBE, and FIT, respectively (Supplementary Table 7E). However, 71 participants (17.8%) refused to undergo any CRC screening with various reasons, such as no symptom, busy, and afraid to know the results.
Colorectal carcinoma screening: Established methods and emerging technology
Published in Critical Reviews in Clinical Laboratory Sciences, 2020
Erika Hissong, Meredith E. Pittman
CT colonography has recently emerged as a noninvasive screening modality for patients who opt out of colonoscopy, and it has largely replaced double contrast barium enema as the imaging study of choice for most indications. Estimated sensitivity rates for CT colonography are between 88% and 98% for high risk adenomas (greater than 10 mm) and around 87% for adenomas between 6–9 mm in size [85–90]. A meta-analysis of 49 studies estimate the pooled sensitivity for detection of colorectal carcinoma to be 96.1% for CT colonography, which is at least as good as invasive colonoscopy [73]. Screening with CT colonography every 5 years is now a recommended screening strategy by both the United States Preventive Services Task Force and the American Cancer Society [91,92].
Feasibility of salvage colonoscopy by water exchange for failed air-insufflated patients: a prospective, randomized, controlled trial
Published in Scandinavian Journal of Gastroenterology, 2022
Mo Wang, Hai-Tao Shi, Xin-Xing Tantai, Lei Dong, Shi-Yang Ma
Other options aiming to reduce the pain caused by colonoscopy have also been reported. Some researchers chose CO2 to replace air for its advantage in reduction of postprocedural pain. It is known that CO2 could be relatively rapidly absorbed through the intestinal mucosa into the blood and then being eliminated through respiration [22–24]. However, it contributes little to pain reduction during the procedure. As its principle remains the same as the conventional AI, CO2 colonoscopy is inappropriate for complicated intestines or conditions, thus is not considered as an effective salvage measure. Anesthesia or sedation colonoscopy is another alternative method to reduce pain. However, colonoscopy with sedation is associated with an increased risk of complications, such as respiratory depression, hypotension and cardiac arrhythmia [9]. Other drawbacks of sedation colonoscopy include longer postprocedural recovery time, postprocedural monitoring and additional cost and space [25]. In addition, failed cases are always associated with complex intestine, which requires the change of position and abdominal compression. Sedation will bring difficulties to these operations. New technologies have also occasionally been used as a rescue measure, such as balloon-assisted colonoscopy, CT or MR colonoscopy, double-contrast barium enema, colon capsule and check-cap [3]. However, none of these methods have the conditions for large-scale clinical application. Although acquiring new skills of WEC is required, it is relatively easy to master. Unlike other methods, WEC does not require additional human power, equipment or costs, and thus seems to be the best colonoscopy salvage technique.