Noellene M. Foster

Community-Based Screening by Colonoscopy or Computed Tomographic Colonography in Asymptomatic Average-Risk Subjects

OBJECTIVES:Visualizing the entire colorectum in screening is an advantage of colonoscopy, and also computed tomographic (CT) colonography, another potentially suitable screening test. Our objective was to compare screening CT colonography and colonoscopy in an asymptomatic average-risk population, and to determine whether providing a choice of tests increased participation.METHODS:One thousand and four hundred subjects from the general community, randomly selected from the parliamentary electoral roll, were allocated one of three screening groups: colonoscopy, CT colonography, or a choice of these tests, and were sent an institutional letter of invitation. Those with symptoms, colorectal cancer in first-degree relatives, or colonoscopy within 5 yr were ineligible. Outcome measures were participation, acceptability of screening, and yield for advanced colorectal neoplasia in participants.RESULTS:Of the subjects, 24.9% were ineligible; the overall participation rate was 18.2% (184/1,009). Participation in each screening group was not different. Both tests were accompanied by the same high levels of acceptability; most participants found colonoscopy (87%) and CT colonography (67%, p < 0.001) less unpleasant than expected. About 29% (26/89) CT colonography subjects had a positive screening test. The yield of advanced colorectal neoplasia was 8.7% (95% CI 5–14%), with no difference in yield between tests.CONCLUSION:Colorectal neoplasia screening by colonoscopy or CT colonography was associated with modest participation, high levels of acceptability, and similar yield for advanced colorectal neoplasia. Providing a choice of test did not increase participation.

Influences on participation in a community‐based colorectal neoplasia screening program by virtual colonoscopy in Australia

Objective: To determine the effect of certain personal and health behaviour characteristics on participation in a community‐based colorectal neoplasia (CRN) screening program using virtual colonoscopy.

Detection of Helicobacter Pylori Antigen in Faeces by Enzyme Immunoassay

Summary The detection of Helicobacter pylori antigen directly in faecal specimens may offer an alternative non‐invasive method for determining the presence of H. pylori infection. This study compared the performance of the Premier Platinum HpSA enzyme immunoassay (HpSA) with histology and CLOtest, a rapid urease test. Of 134 patients undergoing upper gastrointestinal intestinal endoscopy, 37 (28%) were H. pylori ‐positive by histology and CLOtest. Using the HpSA test, H. pylori was detected in 35 H. pylori ‐positive patients (95% sensitivity) and one H. pylori ‐negative patient (99% specificity). The positive and negative predictive values for HpSA were 97 and 98%, respectively. HpSA is a rapid, easily performed, non‐invasive method for detecting H. pylori.

Randomized single blind trial of two low-volume bowel preparations for screening computed tomographic colonography

BackgroundBowel preparation is an important part of computed tomographic colonography (CTC); we evaluated two small-volume preparations for screening CTC with regard to quality of preparation and patient acceptability.MethodsAsymptomatic subjects at average risk for colorectal cancer from a community-based CTC screening program were randomized to bowel preparation comprising magnesium/bisacodyl/picolax or polyethylene glycol (PEG)/picolax. CTC images were evaluated by a blinded investigator for residual feces and fluid; subjects completed a questionnaire regarding acceptability of the preparation.ResultsIn 176 subjects randomized to magnesium/bisacodyl/picolax (n = 82) or PEG/picolax (n = 94), the former preparation was discontinued because of syncope or presyncope in four (5%) subjects. Another 137 subjects received PEG/picolax without a significant adverse event. There were no other major differences in acceptability of the preparations as reported by subjects. The quality of bowel preparations for reporting CTC was similar.ConciusionFor subjects having screening CTC, both small-volume bowel preparations are generally well tolerated and result in minimal fluid and fecal residue; however, the magnesium/bisacodyl/picolax preparation was accompanied by an unacceptable incidence of syncope and is no longer used by us.

ACCEPTABILITY OF VIRTUAL COLONOSCOPY AS A COMMUNITY BASED CRC SCREENING TEST IN ASYMPTOMATIC AVERAGE RISK SUBJECTS

Objectives  The acceptability of virtual colonoscopy (VC) in an average risk colorectal cancer (CRC) screening population is unknown. Our aims were to (1) assess acceptability of VC and (2) compare this with colonoscopy (CY), in a community based screening programme.