• Humans
• Gastroenterology
• Endoscopy, Gastrointestinal/methods
• Endoscopes, Gastrointestinal
• Societies, Medical

• colorectal cancer
• economic evaluation
• electronic colonoscopy
• fecal immunochemical testing
• screening

• Colonoscopy
• Colorectal Neoplasms
• Cost-Benefit Analysis
• Early Detection of Cancer
• Humans
• Occult Blood

• National Natural Science Foundation of China
• National Outstanding Youth Science Fund Project of National Natural Science Foundation of China

• colonoscopy
• polypectomy
• small bowel perforation
• thermal injury

• Aged
• Colectomy/adverse effects
• Colon/surgery
• Colonoscopy/adverse effects
• Humans
• Intestinal Perforation/diagnosis
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Laparotomy/adverse effects
• Male

•

The current Shanghai CRC screening program is cost-effective.

The current community-based colorectal cancer (CRC) screening program in Shanghai, launched in 2013, invited individuals aged 50–74 years to triennial screening with a qualitative faecal immunochemical test (FIT) and questionnaire-based risk assessment (RA). We aimed to evaluate the effectiveness and cost-effectiveness of the existing Shanghai screening program and compare it to using a validated two-sample quantitative FIT.

We simulated four strategies (no screening, Shanghai FIT, Shanghai FIT + RA and validated FIT) for the Shanghai screening program and evaluated CRC incidence, CRC mortality, the number of life years gained (LYG), the number of FITs, and colonoscopies required for each. An incremental cost-effectiveness analysis was performed to assess the cost- effectiveness of each strategy.

All screening modalities reduced CRC incidence and CRC mortality, gained extra number of LYG compared to no screening. Screening using the Shanghai FIT and validated FIT reduced CRC incidence from 45 cases to 43 per 1,000 simulated individuals (4.4%). Incidence was reduced to 42 cases (6.7%) using the Shanghai FIT + RA. All screening strategies reduced CRC mortality by 10.0% (from 10 to 9 deaths) and resulted in 6 to 7 LYG. The validated FIT was the most cost-effective among the evaluated strategies (ICER ¥26,461 per LYG).

Our findings show that the current Shanghai screening program is (cost-) effective compared to no screening, but changing to a validated FIT would make the program more efficient.

Background: Many studies have been done regarding perforation after colonoscopy, but few studies analyzed the risk factors of endoscopic treatment failure after colonoscopy perforation. This study aimed to analyze the clinical characteristics and treatment plan of those patients with perforation after colonoscopy diagnosis and the treatment and risk factors of failure to endoscopic treatment.

Method: This was a retrospective observational study of patients who underwent colonoscopy examination and treatment at the Affiliated Hospital of Yangzhou University, from 04/2009 to 03/2020. The patients were grouped as perforation, treatment success, or failure (required laparoscopy or laparotomy).

Results: From April 2009 to March 2020, 43,470 patients were examined and treated with colonoscopy. There were 35 cases of intestinal perforation, for an incidence of 0.081%. Four patients had immediate surgical intervention (two patients with laparoscopic surgery and two with laparotomy surgery). Thirty-one (88.57%) patients underwent endoscopic treatment. Endoscopic treatment was successful in 20 patients and failed in 11. Compared with the failure group, the perforation size in the success group was smaller (7.60±4.85 vs. 14.4±7.03 mm, P=0.004), hospital stay was shorter (26.6±13.1 vs. 14.2±3.0, P=0.011), and hospitalization costs were lower (30,208±9506 vs. 23,053±6227 RMB, P=0.002). Multivariable logistic stepwise analysis showed that the absence of abdominal pain after therapeutic colonoscopy was independently associated with the success of endoscopic treatment.

Conclusions: Endoscopic treatment is logically the preferred modality for perforation management, leading to good recovery, shorter hospital stay, and lower costs of treatment. Postoperative abdominal pain is significantly related to the failure of endoscopic treatment.

• gastrointestinal tumours
• health economics
• health policy
• public health
• screening

• China/epidemiology
• Colonoscopy
• Colorectal Neoplasms/epidemiology
• Cost-Benefit Analysis
• Early Detection of Cancer
• Humans
• Mass Screening
• Occult Blood

• U01 CA199335 NCI NIH HHS
• U01 CA253913 NCI NIH HHS

Colonoscopy is essential for the diagnosis of intestinal Behcet’s disease (BD), which is characterized by a typical oval-shaped ulcer in the ileocecal region. However, potential risks of colonoscopy have rarely been reported.

Herein, we describe a patient with intestinal BD who presented with decreased oxygen saturation and shortness of breath during a diagnostic colonoscopy. Bilateral pneumothorax, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and subcutaneous emphysema of the neck, chest, abdomen, back and scrotum were confirmed by computed tomography scan. The sudden change in condition was considered to be associated with iatrogenic bowel perforation. After receiving closed thoracic drainage and conservative therapy, the patient was discharged in stable condition.

Endoscopists should be aware of the risks of colonoscopy in patients with intestinal BD and the possibility of pneumothorax associated with intestinal perforation and make adequate preparations before colonoscopy.

• Intestinal Behcet’s disease
• colonoscopy
• Intestinal perforation
• Pneumothorax
• Case report

• Colonoscopy complications
• Gastrointestinal hemorrhage
• Graduate medical education
• Intestinal perforation

The global trend of an expanding aged population has increased concerns about complications correlated with gastrointestinal (GI) endoscopy in elderly patients; however, there have been few reports published on this issue.

In this retrospective, observational cohort study performed between 2012 and 2017, serious complications of esophagogastroduodenoscopy (EGD), colonoscopy, and colonoscopic polypectomy were compared between patients according to age (≥65 years vs 18–64 years). We used the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. Serious complications within 30 days of the procedure included both GI complications (bleeding and perforation) and non-GI complications (cerebrovascular accident [CVA], acute myocardial infarction [AMI], congestive heart failure [CHF], and death).

A total of 387,647 patients who underwent EGD, 241,094 who underwent colonoscopy, and 89,059 who underwent colonoscopic polypectomy were assessed as part of this investigation. During the study period, endoscopic procedures in the older group steadily increased in number in all endoscopy groups (all p<0.001). Further, pooled complication rates of bleeding, CVA, AMI, CHF, and death were approximately three times higher among older patients who underwent EGD or colonoscopy. Moreover, pooled complication rates of CVA, AMI, CHF, and death were approximately 2.2 to 5.0 times higher among older patients who underwent colonoscopic polypectomy.

Elderly patients experienced approximately three times more GI and non-GI complications after EGD or colonoscopy than young patients. Physicians should pay attention to the potential risks of GI endoscopy in elderly patients.

• Colonoscopy
• Common Data Model
• Complications
• Esophagogastroduodenoscopy
• Population

• bleeding
• end-stage renal disease
• perforation
• polypectomy

• Adenoma detection rate
• Cecal intubation rate
• Colonoscopy
• Perforation
• Quality indicator
• Sedation

• Adenoma/diagnostic imaging
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Cecum/diagnostic imaging
• Colonic Polyps/diagnostic imaging
• Colonoscopy/adverse effects
• Colonoscopy/methods
• Colonoscopy/standards
• Colorectal Neoplasms/diagnostic imaging
• Conscious Sedation/adverse effects
• Conscious Sedation/statistics & numerical data
• Deep Sedation/adverse effects
• Deep Sedation/statistics & numerical data
• Early Detection of Cancer
• Female
• Humans
• Intestinal Perforation/etiology
• Male
• Middle Aged
• Retrospective Studies
• Young Adult

• 81270461 Major Research Plan
• 81570483 Major Research Plan
• 81770541 Major Research Plan
• 2018MSXM207 Chongqing Health Commission

Propofol provides a prominent sedation effect in colonoscopy. However, anesthesia and sedation induced with propofol in the elderly might result in cardiopulmonary complications, especially when it is combined with opoids in the regimen. This study aimed to test the hypothesis that the addition of intravenous lidocaine to propofol-based sedation could decrease the overall propofol requirement in elderly patients during colonoscopy while the procedural sedation satisfaction and the hemodynamic stability were not compromised.

Ninety-two patients undergoing colonoscopy were randomly enrolled into lidocaine+propofol (L + P) group or normal saline+propofol (NS + P) groups. Subjects received intravenous bolus of 1.5 mg/kg lidocaine followed by 4 mg kg^− 1 h^− 1 lidocaine continuous infusion in L + P group or equivalent volumes of normal saline for boluses and infusion in NS + P group. Anesthesia was induced with 2.5 μg sufentanil followed by injection of 1.2 mg kg^− 1 propofol in all patients. A single supplemental bolus of 0.6 mg kg^− 1 propofol was administered whenever MOAA/S score > 1 or had body movement during the colonoscopy. The recorded primary endpoints included: the total amount of propofol administered during entire procedure, the supplemental amount of propofol after induction, and the frequencies of boluses of supplemental propofol.

A total of 79 patients were included in the final analysis. Compared with NS + P group, the total amounts of propofol (induction plus supplemental) were no significant differences in L + P group; however, the required supplemental propofol was less (69.9 ± 39.2 mg vs. 51.5 ± 38.6 mg) (P = 0.039); the average frequencies of boluses of supplemental propofol given after induction were lower (2.1 ± 1.1 vs. 1.4 ± 0.9) (P = 0.003); the calculated “unit propofol” infusion rate was lower (0.18 ± 0.05 vs. 0.14 ± 0.04 mg kg^− 1 min^− 1) (P = 0.002).

The addition of intravenous lidocaine to propofol-based sedation resulted in a remarked reduction of supplemental propofol in the elderly during colonoscopy.

The present clinical trial was registered at http://www.chictr.org.cn on 11th March 2019 (registration No. ChiCTR1900021818).

• Anesthetic
• Colonoscopy
• Endoscopy
• Lidocaine
• Propofol

• colonoscopic perforation
• colonoscopy
• postoperative complications
• risk factors

• colon perforation
• colonoscopy
• perforation

Colonoscopy is a widely used method for diagnosing and treating colonic disease. The number of colonoscopies is increasing worldwide, and concerns about associated adverse events are growing. Large-scale studies using big data for post-colonoscopy complications have been reported. A colon perforation is a severe complication with a relatively high mortality rate. The perforation rate, as reported in large studies (≥ 50,000 colonoscopies) published since 2000, ranges from 0.005-0.085%. The trend in the overall perforation rate in the past 15 years has not changed significantly. Bleeding is a more common adverse event than perforation. Recent large studies (≥ 50,000 colonoscopies) have reported post-colonoscopy bleeding occurring in 0.001-0.687% of cases. Most studies about adverse events related to colonoscopy were performed in the West, and relatively few studies have been conducted in the East. The incidence of post-colonoscopy complications increases in elderly patients or patients with inflammatory bowel diseases. It is important to use a unified definition and refined data to overcome the limitations of previous studies. In addition, a structured training program for endoscopists and a systematic national management program are needed to reduce post-colonoscopy complications. In this review, we discuss the current trends in colonoscopy related to adverse events, as well as the challenges to be addressed through future research.

• Colonoscopy
• Adverse events
• Perforation
• Bleeding
• Post-colonoscopy

• Colonic Diseases/diagnostic imaging
• Colonic Diseases/epidemiology
• Colonoscopy/adverse effects
• Colonoscopy/education
• Education, Medical, Continuing/trends
• Gastrointestinal Hemorrhage/epidemiology
• Gastrointestinal Hemorrhage/etiology
• Global Health/statistics & numerical data
• Global Health/trends
• Humans
• Incidence
• Intestinal Perforation/epidemiology
• Intestinal Perforation/etiology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Risk Factors
• Survival Rate
• Treatment Outcome

• Antibiotic therapy
• Colonoscopy
• Emergency surgery
• Gastrointestinal endoscopy
• Iatrogenic colonoscopy perforation
• Intra-abdominal infection
• Laparoscopy
• Open abdomen

• Aged
• Aged, 80 and over
• Colon/injuries
• Colon/surgery
• Colonoscopy/adverse effects
• Colonoscopy/economics
• Colonoscopy/methods
• Disease Management
• Female
• Guidelines as Topic
• Humans
• Iatrogenic Disease
• Intestinal Perforation/economics
• Intestinal Perforation/surgery
• Male
• Middle Aged

• China
• Colonoscopy
• Insufflation
• Pain
• Polyps
• Propofol
• Prospective Studies
• Water

• R01 DK106130 NIDDK NIH HHS

• Colonoscopic perforation
• Emergency surgery
• Laparoscopy
• Meta-analysis
• Open surgery

• Colonoscopy/adverse effects
• Colonoscopy/methods
• Digestive System Surgical Procedures/methods
• Digestive System Surgical Procedures/standards
• Humans
• Iatrogenic Disease
• Intestinal Perforation/surgery
• Laparoscopy/methods
• Laparoscopy/standards
• Postoperative Complications/surgery
• Treatment Outcome

To evaluate the value of the fecal calprotectin in the diagnosis of inflammatory bowel disease (IBD) patients systematically.

PubMed, EMBASE, CNKI, and Wanfang digital journals database were searched for the studies which evaluated the value of the fecal calprotectin in the diagnosis of IBD patients. Meta-Disc 1.40 was used to calculate the pooled sensitivity, specificity and 95% confidence intervals (95%CI). The summary receiver operating characteristic curve (SROC), the area under the curve (AUC), and Q* were also calculated.

A total of 13 studies involving 721 IBD patients and 664 controls were finally included in this meta-analysis. The pooled sensitivity and specificity were 0.86 (95%CI: 0.84-0.88) and 0.76 (95%CI: 0.74-0.79), respectively. The AUC was 0.9169, and the Q* was 0.8498.

Fecal calprotectin is a good noninvasive marker with high sensitivity and specificity in the diagnosis of IBD patients.

• Inflammatory bowel disease
• Fecal calprotectin
• Meta-analysis

•

With our case we have adopted an innovative approach of using endolooping for an early perforation that was within a short distance of the appendicular base, applied proximal to the site of the perforation.

An iatrogenic caecal perforation is rare, but a serious complication associated with significant morbidity and mortality. We present a 4 min and 50 s video on a new improvisation undertaken during laparoscopic management of post-polypectomy caecal perforation.

Our patient presented with an acute abdomen following endoscopic polypectomy. At surgery, the site of caecal perforation was close to the appendicular base with devitalization tissue, secondary to diathermy usage. The hallmark of safety within this novel technique included fresh healthy tissue margins within the endoloop (detachable snare ligation) and ensuring no ischemic tissue was gathered. Complete freeing of the appendix and meso-appendicular base was required and securing three endoloops proximal to the site of perforation. The post-operative course was uneventful.

The World Society of Emergency Surgery (WSES) 2013 guidelines suggested an early laparoscopic approach is a safe and effective treatment for colonoscopy-related colonic perforation. There are no national guidelines and the management is dictated by the clinical condition of the patient, co-morbidity, size and site of perforation as well as the scale of bowel preparation, and surgical experience.

The endoloop technique described, undertaken during a laparoscopy is a novel approach. It is a simple and effective method, reminding clinicians to adapt techniques when necessary. Nevertheless, it is only limited to perforations around the appendicular base.

• Caecal
• Colonoscopy
• General surgery
• Laparoscopic surgery
• Perforation
• Polypectomy