Acceptability and side-effects of colonoscopy and sigmoidoscopy in a screening setting

Senore, Carlo; Ederle, A.; Fantin, Alberto; Andreoni, B.; Bisanti, Luigi; Grazzini, Grazia; Zappa, Marco; Ferrero, Franco; Marutti, Anna; Giuliani, Orietta; Armaroli, Paola; Segnan, Nereo

doi:10.1258/jms.2011.010135

Cited by 75 publications

(59 citation statements)

References 41 publications

(52 reference statements)

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“…19 Strategies to address pain, particularly in women, could help improve FS screening programmes. It was reassuring that no detrimental differences were found by deprivation or ethnicity, and based on these results, participant experience is unlikely to drive inequalities in uptake.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK

Robb

Power

et al. 2012

Journal of Medical Screening

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Objectives Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme. Methods Eligible adults aged 58-59 (n ¼ 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a 'morning-after' questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up. Results In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome. Conclusions PROMs indicate high acceptability of FS screening in 58-59 year olds, with no adverse effects on colorectal symptoms, health status or psychological wellbeing.

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Section: Discussionmentioning

confidence: 99%

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK

Robb

Power

et al. 2012

Journal of Medical Screening

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“…This approach is based on the observation that some miRNAs can also downregulate mRNA levels in addition to down regulating protein levels of their target genes [136]. An experimental validation of miRNA target sites has been to express a miRNA in vivo while simultaneously expressing and monitoring the target mRNA linked to a reporter gene, i.e., Luciferase [134,[137][138][139][140][141][142][143][144].…”

Section: Discussionmentioning

confidence: 99%

“…Although there are fewer miRNA than mRNA genes, we and others [140,141] are in the opinion that diagnostic studies employing large numbers of subjects (in the hundreds of individuals) are needed to evaluate potential application of miRNA in early detection and diagnosis of colon cancer [142], whereas for analysis of transcriptomic mRNA expressions, the number of subjects needed will be at least in the thousand because there are much more transcripts than miRNAs. When working with body fluids such as plasma, a challenge is to establish standardized protocols for extracting and quantifying circulating miRNAs.…”

Section: Recommendationsmentioning

confidence: 99%

Role of MicroRNA Molecules in Colon Cancer Etiology

Ahmed¹

2014

Biol Med

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The biogenesis of micro (mi) RNA suggests that nearly 3% of human genes are encoded for micro (mi) RNAs, and computer predictions indicate that more than 30% of protein coding genes in humans are coded by miRNAs through an imperfect binding to the 3' untranslated region (UTR) of target messenger (m) RNA affecting gene silencing and leading to either transcription repression, or induction of messenger (m) RNA degradation. The expression of several miRNAs in noninvasive body fluids/excrements has been linked to development of colorectal cancer (CRC) and its progression. The majority of miRNA genes are oriented antisense to neighboring genes, and miRNA genes are transcribed by polymerases II and III. The rate of evolution of miRNAs has been very slow, which has permitted morphological innovation by making gene expression specific, a process that permitted the genesis of complex organisms. Bacteria lack true miRNAs. Bioinformatics approaches to predict putative miRNA target genes has been facilitated by finding that miRNA target recognition is partly based on simple sequence complementarity, and exact base pairing between miRNAs and their targets is required only in the first six to eight bases from the 5′ end of the miRNA.

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“…8,9 Older patients or patients with comorbidities are at increased risk of complications and are also less likely to tolerate the purgative full bowel preparation that is required to cleanse the colon prior to colonoscopy. 10,11 The bowel preparation required for colonoscopy is often the part of this procedure that patients find most difficult, 12 and failure to complete it results in loss of procedural accuracy. 10,13,14 There is also a small miss rate of colonoscopy for colorectal neoplasia, as demonstrated by tandem colonoscopy studies.…”

mentioning

confidence: 99%

Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study

Atkin

Wooldrage

Shah

et al. 2017

Health Technol Assess

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BackgroundFor patients referred to hospital with suspected colorectal cancer (CRC), it is current standard clinical practice to conduct an examination of the whole colon and rectum. However, studies have shown that an examination of the distal colorectum using flexible sigmoidoscopy (FS) can be a safe and clinically effective investigation for some patients. These findings require validation in a multicentre study.ObjectivesTo investigate the links between patient symptoms at presentation and CRC risk by subsite, and to provide evidence of whether or not FS is an effective alternative to whole-colon investigation (WCI) in patients whose symptoms do not suggest proximal or obstructive disease.DesignA multicentre retrospective study using data collected prospectively from two randomised controlled trials. Additional data were collected from trial diagnostic procedure reports and hospital records. CRC diagnoses within 3 years of referral were sourced from hospital records and national cancer registries via the Health and Social Care Information Centre.SettingParticipants were recruited to the two randomised controlled trials from 21 NHS hospitals in England between 2004 and 2007.ParticipantsMen and women aged ≥ 55 years referred to secondary care for the investigation of symptoms suggestive of CRC.Main outcome measureDiagnostic yield of CRC at distal (to the splenic flexure) and proximal subsites by symptoms/clinical signs at presentation.ResultsThe data set for analysis comprised 7380 patients, of whom 59% were women (median age 69 years, interquartile range 62–76 years). Change in bowel habit (CIBH) was the most frequently presenting symptom (73%), followed by rectal bleeding (38%) and abdominal pain (29%); 26% of patients had anaemia. CRC was diagnosed in 551 patients (7.5%): 424 (77%) patients with distal CRC, 122 (22%) patients with cancer proximal to the descending colon and five patients with both proximal and distal CRC. Proximal cancer was diagnosed in 96 out of 2021 (4.8%) patients with anaemia and/or an abdominal mass. The yield of proximal cancer in patients without anaemia or an abdominal mass who presented with rectal bleeding with or without a CIBH or with a CIBH to looser and/or more frequent stools as a single symptom was low (0.5%). These low-risk groups for proximal cancer accounted for 41% (3032/7380) of the cohort; only three proximal cancers were diagnosed in 814 low-risk patients examined by FS (diagnostic yield 0.4%).LimitationsA limitation to this study is that changes to practice since the trial ended, such as new referral guidelines and improvements in endoscopy quality, potentially weaken the generalisability of our findings.ConclusionsSymptom profiles can be used to determine whether or not WCI is necessary. Most proximal cancers were diagnosed in patients who presented with anaemia and/or an abdominal mass. In patients without anaemia or an abdominal mass, proximal cancer diagnoses were rare in those with rectal bleeding with or without a CIBH or with a CIBH to looser and/or more frequent stools as a single symptom. FS alone should be a safe and clinically effective investigation in these patients. A cost-effectiveness analysis of symptom-based tailoring of diagnostic investigations for CRC is recommended.Trial registrationCurrent Controlled Trials ISRCTN95152621.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 66. See the NIHR Journals Library website for further project information.

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Acceptability and side-effects of colonoscopy and sigmoidoscopy in a screening setting

Cited by 75 publications

References 41 publications

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK

Role of MicroRNA Molecules in Colon Cancer Etiology

Is whole-colon investigation by colonoscopy, computerised tomography colonography or barium enema necessary for all patients with colorectal cancer symptoms, and for which patients would flexible sigmoidoscopy suffice? A retrospective cohort study

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