Aims The British Society of Gastroenterology (BSG) guidelines provide a framework for the management of large (> 2 cm) non-pedunculated colorectal polyps (LNPCPs). This includes a recommendation to have access to a polyp multidisciplinary meeting (MDM). We aimed to evaluate patients diagnosed with large colorectal polyps at an elective (´cold´) endoscopy unit.
Achieving key quality indicators of colonoscopy are recognised to be associated with quality of bowel cleansing.1 However, the impact of bowel preparation quality on colorectal cancer (CRC) detection and associated mortality rates is unclear. Limited published studies report conflicting results correlating detection of pre-malignant lesions with quality of bowel preparation and do not report on colorectal mortality.2 Current guidelines suggest that if bowel preparation is poor, colonoscopy should be repeated within 1 year.3 Aim: To determine the prevalence of poor bowel preparation in patients achieving complete colonoscopy, and its association with polyp detection, CRC, and mortality rates within a large district general hospital.
Methods
All patients with poor bowel preparation (Boston Bowel Preparation Scale <5) undergoing colonoscopy by a single endoscopist were identified using the UNISOFT database over 5 years (2006–2010). Electronic records were analysed to identify indication for colonoscopy, completion rates, adenoma detection rate (ADR), diagnosis, 1 and 5 year mortality rates, and number of repeat colonoscopies/completion CT colonography.
Results
990 colonoscopies were performed (ADR 26%). 208/990 (21%) had poor bowel preparation (M:F 103:105, mean age 62 years). Of these, 197/208 (95%) had complete colonoscopy to the terminal ileum, caecum or anastomosis and 51/208 (25%) underwent repeat colonoscopy/CT colonography. 86/208 (41%) had indications of anaemia, previous polyps, previous CRC and abnormal imaging. Of these, 9% (n = 8/86) were found to have CRC. There was a 3/86 (3.5%) 1 year mortality rate, and 24/86 (28%) 5 year mortality rate, none from CRC. In a comparison group with the same indications for colonoscopy and good bowel preparation (n = 69), 1 and 5 year mortality rates were 2.9% (2/69) and 7.3% (n = 5/69), respectively, 1 of which resulted from CRC.
Conclusion
The quality of bowel preparation does not significantly impact on CRC detection or mortality rates if complete colonoscopy examination is achieved. Early repeat colonoscopy/CT colonography within 1 year may not be necessary and subsequent examination could be at the standard recommended surveillance interval.
References
1 Hassan, et al. Bowel preparation for colonoscopy: ESGE Guideline. Endoscopy 2013;45:142–150. 2 Wong, et al. Determinants of Bowel Preparation Quality and Its Association With Adenoma Detection. Medicine (Baltimore) 2016;95(2). 3 Lieberman, et al. 2012. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the us multi-society task force on colorectal cancer. Gastroenterology143(3):844–57.
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Dynamic testing of muscle tissue oxygenation (StO2) with near-infrared spectroscopy and vascular occlusion (VOT) has been used to study pathophysiological states, but there is a paucity of data for standardised techniques in normal subjects. Three-minute VOT is frequently described. We have collected StO2 data for this technique and compared them with a shorter 2-minute test.
Annually, homicide contributes to a greater number of the total head injury cases. This retrospective study was conducted from 1(st) January 2009 to 31(st)December 2011 at Dhaka Medical College Mortuary. During this study period of three years a total of 15300 autopsies were done of which 5649 cases (36.84%) were of head injuries. Of them 747(13.22%) were of homicidal, 4080(72.22%) road-traffic accidents, 502(8.88%) accidental and 320(5.66%) cases of fall from heights. Three hundred ninety eight (398) urban cases (53.27%) out numbered 307 rural cases (41.09%) followed by 42 unknown cases (5.62%). Most cases belong to the younger age group i.e. 21-40 years (43.34%) with male preponderance 470(63.10%). Defense wounds were present in 281 cases (37.82%) out of the total 747 homicidal head injuries. There were 206(27.57%) upper limb, 176(23.56%) spinal, 139(18.60%) abdominal, 135(18.07%) thoracic, 58(7.76%) lower limb and 33(4.41%) pelvic injuries found as associated injury. There were 258(34.53%) fractures of occipital followed by 209(28.29%) parietal, 113(15.01%) frontal, 104(13.75%) temporal, 24(3.21%) ant. Cranial fossa, 23(3.07%) post. Cranial fossa and 16(2.08%) of middle cranial fossa fractures. Extradural haemorrhage was more i.e. 434 cases (58.43%) followed by subdural, combination of all, subarachnoid and intra-cerebral haemorrhages. Cases of concussion were more common i.e. 445(59.75%) than lacerated and combination of them. Blunt weapon tops the list of causative weapons i.e. 669(89.22%) than firearms 59(8.07%) and sharp pointed weapons 19(2.68%).
Upper gastrointestinal haemorrhage (UGIH) in cardiac patients receiving antiplatelets presents a difficult management problem. The aim of this study was to describe a series of cardiac inpatients receiving antiplatelets who underwent endoscopy for an acute UGIH. Cardiac inpatients receiving antiplatelets and requiring endoscopy for UGIH over an 18-month period were followed up. Forty-one patients were studied. Most patients (25 [61%]) presented with melaena. Antiplatelets were withheld in 34 (83%) patients; predominantly in those with higher pre-endoscopy Rockall scores (median, 4; interquartile range [IQR], 3-5 versus median, 3; IQR, 2-4; P < 0.05). Positive findings were identified at endoscopy in 80%. Duodenal ulcers were the most common lesion and adrenaline the most common method of haemostasis. Median time to first endoscopy was 0 (IQR, 0-1) days. Seven (17%) patients re-bled, median Rockall score was six (IQR, 4-8). Three (7%) patients experienced procedural complications, two patients became hypoxic and one patient died. Following endoscopy, antiplatelets were restarted after a median of three (IQR, 3-5) days. On discharge, 27/28 (96%) patients continued with antiplatelet and proton-pump inhibitor therapy. Thirty-day inpatient mortality was 7% (3 patients). One patient re-bled within six months of discharge. Endoscopy helped assess the risk of re-bleeding and timing of antiplatelet re-introduction in cardiac inpatients experiencing UGIH.
Aims Faecal calprotectin (FC) is a biomarker that is elevated in active inflammatory bowel disease (IBD). Ileo-colonoscopy is usually performed to confirm a diagnosis of IBD, but isolated non-specific terminal ileitis is often inconclusive despite biopsy. We explored the the presence of macroscopic terminal ileum (TI) ulceration in predicting Crohn’s disease, over and above endoscopic terminal ileitis alone.
As we less frequently encounter cases of death due to electrocution, less attention is given to them. These all have significant impact on morbidity and mortality of the common people of different ages. This autopsy based retrospective study (from January 2014 to December 2016) was carried out by the history of the case, inquest report and by doing thorough autopsy of each of the cases at Chattogram Medical College Mortuary, Bangladesh. Fifty (50) cases of electrocution accounted for 1.23% of the total 4020 autopsies. Male victims i.e. 43(86%) outnumbered the females 7(14%). The majorly affected age group was 21-30 (24 cases) followed by 31-40 years (13 cases) and 41-50 years (5 cases). The commonest place of occurrence was on the street side in 33 cases (66%) followed by home 17 (34%). High tension wire i.e. in 28 cases (56%) were the main causative agents followed by home appliances 16 (32%) and water pump 6 (12%). In relation to distribution of entry and exit wounds, we observed evidence of both entry and exit wounds in 32 cases (64%) followed by no entry or exit wounds in 11 (22%) and entry wounds only in 7 (14%). As per this study, entry wounds were present in the upper limbs in 34 cases (68%) followed by head-neck (7 cases) and lower limbs (3 cases). We also observed maximum exit wounds were in the lower limbs i.e. in 36 cases (72%) followed by upper limbs (5 cases) and chest-abdomen (2 cases). Considering manner of death, we observed all the cases of electrocution i.e. 50 cases (100%) were of accidental. Electrocution accounts for a smaller proportion of all unnatural deaths which could be prevented by adequate awareness and adopting safety measures.
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