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Performance and Compliance of Immunochemical vs. Guaiac Faecal Occult Blood Test in Screening for Colorectal Cancer in a Chinese Population
*W1682 Endoscopic Implantation of Self-expanding Metal Stents (SEMS) in Acute Malignant Colonic Obstruction Max Bittinger, Werner Schmidbaur, Reinhard Scheubel, Thomas Eberl, Reinhard Fleischmann, Juergen Barnert, Helmut Messmann Up to now emergency surgical decompression is considered to be the standard therapy for acute colonic obstruction caused by colorectal malignoma. However, endoscopic implantation of self-expanding metal stents (SEMS) not only allow rapid colonic decompression with the possibility of one-stage elective surgical resection several days later due to a better preoperative condition of the patient but also can serve as definitive nonsurgical palliative treatment in some patients. We analyzed our experience with SEMS in this indication since 2002. Methods: In 23 patients (15f, 3m, 36-94y) with acute malignant colonic obstruction (Rektum: 4, Sigma: 15, Descendens: 3, Transversum: 1) 30 SEMS (27 uncovered Wallstents and 3 UltraflexTM-Precision-Stents; length 60 mm (18) or 90 mm (12), diameter 18 mm(1), 20 mm (2), 22 mm (24) or 25 mm (3)) were implanted endoscopically. The tumorous stenosis could not be passed with the endoscope in 21/23 patients. All patients showed clinical signs of obstruction (abdominal pain, meteorism, vomiting) and the radiological signs of colonic ileus. Results: Endoscopic SEMS implantation was technically successful in all patients. In 19/23 patients (83%) SEMS implantation resulted in a sufficient improvement of colonic obstruction. In 10 of these 19 patients elective surgical resection was performed after a mean time of 3 days. In the remaining 9 patients (advanced tumor stage) surgery could be avoided, but one of them had to be resected due to stent overgrowth after 5 months. In 4/23 patients a sufficient colonic decompression was not achieved until the next day by SEMS implantation. In these patients surgical decompression was performed, but 2/4 patients died in the following days. In 2 patients stent migration occurred in the further course, both of them could be successfully treated by restenting. No major complication such as perforation or bleeding occurred. Conclusion: Endoscopic SEMS implantation is an effective, safe and minimal invasive treatment of acute malignant colonic obstruction. It allows either elective surgical resection after preoperative improvement of patient condition or can serve as definitive palliative non-surgical treatment in patients with advanced tumor stage.
*W1683 Performance and Compliance of Immunochemical vs. Guaiac Faecal Occult Blood Test in Screening for Colorectal Cancer in a Chinese Population L. L. Lim, Khek-Yu Ho, T. Z. Ong, K. G. Yeoh Aims: We aim to compare performance characteristics and subject compliance of the guaiac based faecal occult blood test (FOBT) vs the immunochemical FOBT (IFOBT). Method: Individuals 50 years or older presenting for colonoscopy at our institution were recruited, advised on dietary and medication restrictions required for FOBT and were tested with guaiac FOBT (Hemoccult-II (HII), Beckman Coulter, USA) for 3 consecutive days and IFOBT (OC light, Nagase, Japan) for 2 days concurrent with HII. The FOBT results were read by a single trained nurse blinded to the colonoscopic findings. The latter was used as the reference standard to calculate the PPV and NPV for significant neoplasia, defined as cancer and large adenomas (size 1cm). Patients answered a questionnaire on compliance, convenience of kits, dietary and medication restrictions. Results: 126 patients were recruited, but 20 (16%) failed to attend (n=106). Colonoscopy diagnosed 2 cancers, 2 large adenomas and 15 other patients with h1cm adenomatous polyps. IFOBT was positive in 4/4 (100%) of the significant neoplasia, while HII detected 3/4 (75%). The PPV for IFOBT vs HII was 80% vs 4.5% (p=0.00017) and the NPV was 100% vs 97.5% (p=0.28) respectively. HII had a very high false positive rate of 61.8%. The compliance rates for FOBT testing, dietary and medication restrictions were 95.3%, 91.7% and 89.5% respectively. 16.7% of patients felt inconvenienced by dietary restrictions. 71.3% of patients preferred the IFOBT kit compared to the HII and 72% agreed to use the IFOBT again if advised for screening. Conclusions: Compared with HII, IFOBT was more predictive of significant colorectal neoplasia when used as a screening test. Majority of patients found the IFOBT kit more convenient to use and would agree to use it subsequently.
VOLUME 59, NO. 5, 2004
*W1684 Correlation Between Mucosal Crypt Patterns Using Magnifying Colonoscopy and Mucosal Dye Spraying and Histological Findings of Colorectal Lesions. Giovanni D. De Palma, Maria Rega, Paola Ciamarra, Francesco Patrone, Luigi Mastantuono, Giovanni Persico Background and Study Aims: Assessing the nature of lesions at the time of colonoscopy is important, and magnifying colonoscopy allows examination of mucosal crypt patterns. In this study, we assessed mucosal crypt patterns to see whether we could predict the histological findings. Patients and Methods: This prospective study of total colonoscopy using magnifying colonoscopy involved 75 patients between January and December 2003. The mucosal crypt patterns of 102 lesions were observed under magnifying colonoscopy with 0.2% indigo carmine solution, and classified according to a modified Kudo classification (type I to V). After endoscopic or surgical resection (71 cases and 4 cases, respectively), histopathological examination was performed. Results: The diagnostic accuracy of magnifying endoscopy for non-neoplastic lesions was 73% (8/11), for adenomatous polyps it was 92% (65/60), and for invasive carcinomas it was 75% (3/4). Conclusions: The combination of magnifying colonoscopy and dye spraying is helpful in determining the nature of colonic lesions as non-neoplastic, adenomas, or invasive carcinomas. Therefore it may be possible to determine, at the time of colonoscopy, which lesions require no treatment, which can be removed endoscopically, and which should be removed by surgery.
*W1685 Patient Acceptance of MR-Colonography and Conventional Colonoscopy: - Preliminary Data of a Propsective Comparative Study in Patients with Suspected Colorectal Disease Dieter Schilling, Dirk Hartmann, Barbara Tiziani, Boris Bassler, Guenter Layer, Juergen Riemann Introduction: MR-Colonography could became a complement non invasive technique to current methods in clinical practice to screen for colorectal carcinoma eems to be one possible non invasive method to screen for colorectal carcinoma. The aim of our study was to compare the acceptance of MR-Colonography (MRC) and total colonoscopy. Patients and Methods: Up to now 53 patients (24 females, 29 men, mean age 63 [25 - 95 ] years) underwent after conventional bowel preparation with PEG electrolyte solution MRC followed immediately by conventional colonoscopy. Each patient completed a questionaire that assessed preparation inconvenience and discomfort, examination discomfort, willingness to repeat examination, examination preference, and diagnostic accuracy of MRC and colonoscopy. Results: The mayority of patients considered the preparation to be uncomfortable (39 /53 [74% ]). Reported discomfort was similar at MRC and colonoscopy (11%, 15 respectively). Patients willingness to undergo frequent rescreening was greater for MRC than for colonoscopy (38%, 19% respectively). Overall patients preferred MRC to colonoscopy despite colonoscopy was in 45% of all patients interpretated as the method with the best diagnostic accuracy. Conclusion: Patients undergoing colorectal examination due to suspected colorectal disease prefer MRC to colonoscopy. The majority of patients experience discomfort and inconvenience with bowel preparation.
GASTROINTESTINAL ENDOSCOPY
P287
*W1683 Performance and Compliance of Immunochemical vs. Guaiac Faecal Occult Blood Test in Screening for Colorectal Cancer in a Chinese Population L. L. Lim, Khek-Yu Ho, T. Z. Ong, K. G. Yeoh Aims: We aim to compare performance characteristics and subject compliance of the guaiac based faecal occult blood test (FOBT) vs the immunochemical FOBT (IFOBT). Method: Individuals 50 years or older presenting for colonoscopy at our institution were recruited, advised on dietary and medication restrictions required for FOBT and were tested with guaiac FOBT (Hemoccult-II (HII), Beckman Coulter, USA) for 3 consecutive days and IFOBT (OC light, Nagase, Japan) for 2 days concurrent with HII. The FOBT results were read by a single trained nurse blinded to the colonoscopic findings. The latter was used as the reference standard to calculate the PPV and NPV for significant neoplasia, defined as cancer and large adenomas (size 1cm). Patients answered a questionnaire on compliance, convenience of kits, dietary and medication restrictions. Results: 126 patients were recruited, but 20 (16%) failed to attend (n=106). Colonoscopy diagnosed 2 cancers, 2 large adenomas and 15 other patients with h1cm adenomatous polyps. IFOBT was positive in 4/4 (100%) of the significant neoplasia, while HII detected 3/4 (75%). The PPV for IFOBT vs HII was 80% vs 4.5% (p=0.00017) and the NPV was 100% vs 97.5% (p=0.28) respectively. HII had a very high false positive rate of 61.8%. The compliance rates for FOBT testing, dietary and medication restrictions were 95.3%, 91.7% and 89.5% respectively. 16.7% of patients felt inconvenienced by dietary restrictions. 71.3% of patients preferred the IFOBT kit compared to the HII and 72% agreed to use the IFOBT again if advised for screening. Conclusions: Compared with HII, IFOBT was more predictive of significant colorectal neoplasia when used as a screening test. Majority of patients found the IFOBT kit more convenient to use and would agree to use it subsequently.
VOLUME 59, NO. 5, 2004
*W1684 Correlation Between Mucosal Crypt Patterns Using Magnifying Colonoscopy and Mucosal Dye Spraying and Histological Findings of Colorectal Lesions. Giovanni D. De Palma, Maria Rega, Paola Ciamarra, Francesco Patrone, Luigi Mastantuono, Giovanni Persico Background and Study Aims: Assessing the nature of lesions at the time of colonoscopy is important, and magnifying colonoscopy allows examination of mucosal crypt patterns. In this study, we assessed mucosal crypt patterns to see whether we could predict the histological findings. Patients and Methods: This prospective study of total colonoscopy using magnifying colonoscopy involved 75 patients between January and December 2003. The mucosal crypt patterns of 102 lesions were observed under magnifying colonoscopy with 0.2% indigo carmine solution, and classified according to a modified Kudo classification (type I to V). After endoscopic or surgical resection (71 cases and 4 cases, respectively), histopathological examination was performed. Results: The diagnostic accuracy of magnifying endoscopy for non-neoplastic lesions was 73% (8/11), for adenomatous polyps it was 92% (65/60), and for invasive carcinomas it was 75% (3/4). Conclusions: The combination of magnifying colonoscopy and dye spraying is helpful in determining the nature of colonic lesions as non-neoplastic, adenomas, or invasive carcinomas. Therefore it may be possible to determine, at the time of colonoscopy, which lesions require no treatment, which can be removed endoscopically, and which should be removed by surgery.
*W1685 Patient Acceptance of MR-Colonography and Conventional Colonoscopy: - Preliminary Data of a Propsective Comparative Study in Patients with Suspected Colorectal Disease Dieter Schilling, Dirk Hartmann, Barbara Tiziani, Boris Bassler, Guenter Layer, Juergen Riemann Introduction: MR-Colonography could became a complement non invasive technique to current methods in clinical practice to screen for colorectal carcinoma eems to be one possible non invasive method to screen for colorectal carcinoma. The aim of our study was to compare the acceptance of MR-Colonography (MRC) and total colonoscopy. Patients and Methods: Up to now 53 patients (24 females, 29 men, mean age 63 [25 - 95 ] years) underwent after conventional bowel preparation with PEG electrolyte solution MRC followed immediately by conventional colonoscopy. Each patient completed a questionaire that assessed preparation inconvenience and discomfort, examination discomfort, willingness to repeat examination, examination preference, and diagnostic accuracy of MRC and colonoscopy. Results: The mayority of patients considered the preparation to be uncomfortable (39 /53 [74% ]). Reported discomfort was similar at MRC and colonoscopy (11%, 15 respectively). Patients willingness to undergo frequent rescreening was greater for MRC than for colonoscopy (38%, 19% respectively). Overall patients preferred MRC to colonoscopy despite colonoscopy was in 45% of all patients interpretated as the method with the best diagnostic accuracy. Conclusion: Patients undergoing colorectal examination due to suspected colorectal disease prefer MRC to colonoscopy. The majority of patients experience discomfort and inconvenience with bowel preparation.
GASTROINTESTINAL ENDOSCOPY
P287