Paul Strock

Colorectal cancer incidence is low in patients following a colonoscopy

BACKGROUND/AIMS Colonoscopy has been proven a valuable tool in preventing colorectal cancer in controlled studies; we conducted a longitudinal confirmation study in everyday clinical practice. METHODS In a retrospective study, we monitored the outcome of patients with a total colonoscopy at our hospital between 1994 and 2007. We analysed the data of in-house follow-up colonoscopies, a national person registry and the morphological tumour registry centralizing all histopathological data at a national level. Patients with a particular colorectal cancer risk were excluded. RESULTS 8950 patients were included in our study. 2032 (22.7%) patients had at least one colorectal adenoma at index colonoscopy. Adenoma prevalence was significantly higher in men than in women (27.9% vs. 17.4%, p<0.001) and was increasing with age in both sexes. Patients were followed for a mean of 5.2 years and 19 had invasive colorectal cancer detected over 47,725 person years of follow-up. The incidence rate was 0.40 cases/1000 person years of follow-up (95% confidence interval, 0.25-0.62), and the standardized incidence ratio was 0.37 (95% confidence interval, 0.24-0.58). CONCLUSION Incidence rates of colorectal cancer are low in the follow-up of patients having undergone a total colonoscopy in everyday practice. After standard therapy of colorectal adenomas at colonoscopy, there is little evidence for excess colorectal cancer incidence in this subgroup.

Effects of Octreotide on Lower Esophageal Sphincter in Patients with Cirrhosis and Portal Hypertension

We investigated the effects of octreotide infusion on the contractile activity of the esophageal body and lower esophageal sphincter in cirrhotic patients with esophageal varices. Esophageal manometry was performed in 36 alcoholic cirrhotic patients. They were randomly allocated to three groups and received the following treatments blindly for 90 min: an initial 100-μg intravenous bolus followed by a continuous 25 μg/hr octreotide infusion (group I, N = 13), a continuous 25 μg/hr octreotide infusion without an initial bolus (group II, N = 13), and a continuous placebo infusion (group III, N = 10). Before drug infusion, mean lower esophageal sphincter pressure and mean esophageal body contraction pressure and duration were similar in the three groups. Compared to the placebo group, lower esophageal sphincter pressure increased significantly in groups I and II, 30 min (30%, 22%, 3% respectively; P = 0.006), 60 min (44%, 35%, 0.6%; P = 0.0002), and 90 min (67%, 41%, 2.5%; P = 0.0001) after octreotide infusion, as did esophageal body contraction pressure and duration. We conclude that octreotide has a potent effect on LES tone in cirrhotic patients.

L'endoscopie après chirurgie bariatrique

RésuméAujourd’hui, la chirurgie bariatrique est bien établie dans le traitement de l’obésité morbide. Dans la majorité des cas, cette chirurgie se réalise sous cœlioscopie. Trois types d’interventions couvrent plus de 90% des gestes chirurgicaux.Au vu de l’augmentation du nombre d’interventions réalisées, il est essentiel pour l’endoscopiste de connaître cette nouvelle anatomie endoscopique. Ainsi, l’aspect endoscopique normal de la gastroplastie verticale calibrée, du cerclage gastrique et du court-circuit gastrique est présenté. Le rôle de l’endoscopie dans le diagnostic et le traitement des complications des différentes techniques opératoires, sont revus en détail, sur la base de la littérature et de nos propres expériences.SummaryBariatric surgery is currently well established in the treatment of morbid obesity. In the majority of cases, this surgical procedure is carried out under laparoscopy. Three types of procedures cover more than 90% of this surgery.Considering the increase of surgical procedures performed, it is essential for the endoscopist to know this new endoscopic anatomy. Thus, the normal endoscopic aspect of vertical banded gastroplasty, of gastric banding and of gastric bypass is presented. The role of endoscopy in the diagnosis and treatment of the different surgical complications is reviewed in detail, based on literature and on our own experience.

Aspect échoendoscopique d'un condylome acuminé géant rectal malin (tumeur de Buschke-Loewenstein)

Giant condyloma acuminatum is a large, exophytic, cauliflower-like lesion that usually affects the anogenital region. Localisation in the rectum is uncommon and has a high rate of malignant transformation but does not lead to develop distant metastases. For the time, we report the endosonographic appearance of a malignant intrarectal giant condyloma acuminatum.

Impact du rôle des médecins hospitaliers dans le dépistage du cancer colorectal

RésuméObjectifsTrop de patients avec un cancer colorectal (CCR) sont encore diagnostiqués à un stade symptomatique. Dans notre hôpital, beaucoup de ces patients étaient passés par un ou plusieurs services dans les années précédant le diagnostic de CCR, sans jamais bénéficier d’un examen de dépistage. Nous avons étudié si une campagne d’information, destinée aux médecins hospitaliers, pouvait améliorer le dépistage du CCR.MéthodesNous avons envoyé un questionnaire avant et après la campagne. Par ailleurs, nous avons évalué le nombre de coloscopies réalisées dans notre service.RésultatsLa participation aux enquêtes était de 55 et 51 %. Les connaissances en matière de dépistage du CCR étaient correctes, et 90 % des médecins déclaraient suivre personnellement les recommandations. Cependant, seulement 40 % sensibilisaient suffisamment leurs patients au dépistage. Ce taux augmentait à 50 % après la campagne (NS). Le nombre de coloscopies dans notre service augmentait de 11 % dans les six mois après la campagneConclusionLa grande majorité des médecins hospitaliers adhèrent personnellement aux recommandations de dépistage du CCR. Cependant, ils ne recommandent le dépistage qu’insuffisamment à leurs patients. Une campagne d’information unique aide à faire progresser les attitudes des médecins, mais n’a qu’un impact limité sur le dépistage du CCR.AbstractObjectiveToo many patients with colorectal cancer (CRC) are still diagnosed when they are already symptomatic. In our hospital, many patients have been attending various departments in the years before the diagnosis of CRC, but never had CRC screening. We studied whether specially targeting information to hospital specialists might enhance CRC screening awareness.MethodsWe studied the knowledge and implication of hospital physicians before and after a specially targeted information campaign about CRC screening in our hospital. We conducted two paper questionnaire surveys at 12-month interval. The results were compared to the colonoscopy activity of our endoscopy unit.ResultsParticipation was 55% in the first survey and 51% in the second survey. Knowledge about screening principles was fairly good. A large majority of physicians (90%) declared adhering personally to CRC screening. However, only 40% of physicians recommended screening frequently or regularly to patients (after the campaign: 50%, NS). Colonoscopies raised 11% in the 6 months after the campaign.ConclusionThe large majority of hospital physicians report adhering personally to CRC screening guidelines. However, this translates only infrequently into screening recommendations for their patients. One-off information campaigns may help change specialist physicians’ attitudes but have only a small impact on CCR screening attendance.