Would You Recommend Screening Colonoscopy for the Very Elderly?

Life expectancy in Korea has increased, and the number of screening colonoscopies in the elderly has also dramatically increased. The net benefit of colonoscopy in the very elderly (≥80 years of age as defined by the World Health Organization) may be reduced because of the competing risk of mortality due to other diseases. Therefore, the decision to perform screening colonoscopy may be more complex in this age group. As the potential increase in life expectancy due to screening colonoscopy is significantly reduced in the very elderly, this procedure should be limited to those among the very elderly who have substantial life expectancies. Furthermore, considering the common major complications associated with colonoscopy, poor bowel preparation, and the possibility of incomplete colonoscopies in the very elderly, the performance of screening colonoscopy in the very elderly may not be an ideal recommendation. In terms of providing the greatest benefit to the most number of people, patients with the highest potential gain in terms of life expectancy, relative to the diagnostic yield, should be targeted for colonoscopy screening. This review addresses the unique considerations regarding screening colonoscopy in the very elderly and the individualized approach, which involves the weighing of the risks and benefits for each individual with consideration of their overall health status

Quality indicators in colonoscopy: the chasm between ideal and reality

Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice

Gastrointestinal endoscopy’s carbon footprint

Climate change is a global emergency. Consequently, current global targets to combat the climate crisis include reaching net-zero carbon emissions by 2050 and keeping global temperature increases below 1.5 ˚C. In 2014, the healthcare carbon footprint was 5.5% of the total national footprint. Gastrointestinal endoscopy (GIE) has a large carbon footprint compared to other procedures performed in healthcare facilities. GIE was identified as the third largest generator of medical waste in healthcare facilities for the following reasons: (1) GIE is associated with high case volumes, (2) GIE patients and relatives travel frequently, (3) GIE involves the use of many nonrenewable wastes, (4) single-use devices are used during GIE, and (5) GIE is frequently reprocessed. Immediate actions to reduce the environmental impact of GIE include: (1) adhering to guidelines, (2) implementing audit strategies to determine the appropriateness of GIE, (3) avoiding unnecessary procedures, (4) using medication rationally, (4) digitalization, (5) telemedicine, (6) critical pathways, (7) outpatient procedures, (8) adequate waste management, and (9) minimizing single-use devices. In addition, sustainable infrastructure for endoscopy units, using renewable energy, and 3R (reduce, reuse, and recycle) programs are necessary to reduce the impact of GIE on the climate crisis. Consequently, healthcare providers need to work together to achieve a more sustainable future. Therefore, strategies must be implemented to achieve net-zero carbon emissions in the healthcare field, especially from GIE, by 2050

Impact of Sigmoidoscopy and Colonoscopy on Colorectal Cancer Incidence and Mortality: An Evidence-Based Review of Published Prospective and Retrospective Studies

Screening for colorectal cancer (CRC) using sigmoidoscopy or colonoscopy is now common in many developed countries. This concise, evidence-based review looks at the impact of sigmoidoscopy or colonoscopy screening on CRC incidence, CRC mortality and overall mortality. Data from controlled retrospective and prospective (observational or randomized) studies have generally shown that sigmoidoscopy and colonoscopy, whether for diagnostic, screening or surveillance purposes, are associated with a significant reduction in CRC incidence and CRC mortality. The data on their impact on overall mortality is much more limited, with most studies unable to report a reduction in overall mortality. The results of three meta-analyses have confirmed these conclusions. As expected, sigmoidoscopy has a predominant effect on left-sided CRC, although some studies have shown modest effects on right-sided colon cancer as well. Most studies on colonoscopy have demonstrated that the protective effect applies to both right and left-sided cancer, although the protection seemed better on the left side. Despite the introduction of other screening and diagnostic modalities for the colon, such as computed tomography colonography and colonic capsule endoscopy, lower endoscopy will continue to be an important mode of screening for CRC and evaluating the colon

Pengaruh Ekstrak Jahe Merah (Zingiber Officinale Roscoe Var. Rubrum) Terhadap Kadar Mda Serum Tikus Setelah Terpapar Asap Rokok

Latar Belakang: Asap rokok merupakan salah satu sumber radikal bebas. Kadar radikal bebas yang tinggi dapat menyebabkan terjadinya kondisi stres oksidatif dan memicu terjadinya peroksidasi lipid pada membran sel yang akan menghasilkan Malondialdehyde (MDA). Sebenarnya, tubuh mempunyai sejumlah enzim dan zat yang dapat menetralkan radikal bebas yang disebut antioksidan. Kadar radikal bebas yang tinggi dapat menyebabkan antioksidan endogen tidak mampu untuk menetralisir. Kemampuan jahe sebagai antioksidan alami juga tidak terlepas dari kadar komponen fenolik total yang terkandung di dalamnya sehingga memiliki efek protektif yang tinggi dalam menangkal stres oksidatif. Tujuan: Penelitian ini bertujuan untuk mengetahui pengaruh pemberian ekstrak jahe merah terhadap kadar MDA serum tikus setelah terpapar asap rokok. Metode: Penelitian ini merupakan penelitian true experimental dengan desain pre-post test only control group design pada tikus. Perlakuan yang diberikan yaitu dengan pemberian ekstrak jahe merah (Zingiber officinale var. Rubrum) dan pemberian paparan asap rokok pada tikus, sedangkan keluarannya (outcome) adalah kadar MDA serum tikus. Hasil: Pemberian paparan asap rokok pada kelompok 2 meningkatkan kadar MDA serum dibandingkan dengan kelompok 1. Kelompok 3 yang diberikan ekstrak jahe merah 200 mg/kgBB/hari tidak efektif menurunkan kadar MDA serum. Pemberian ekstrak jahe merah menurunkan kadar MDA serum setelah diberikan paparan asap rokok (K4) jika dibandingkan dengan kelompok yang diberikan jahe merah tanpa diberikan paparan asap rokok (K3), penurunan tersebut tidak bermakna secara statistik. Kelompok 4 meningkatkan kadar MDA serum tikus dibandingkan dengan kelompok 2. Kesimpulan: Tidak terdapat pengaruh yang bermakna dari pemberian jahe merah (Zingiber officinale var. Rubrum) terhadap kadar MDA darah tikus setelah terpapar asap rokok

The current capacity and quality of colonoscopy in Korea

Background/Aims Little is known for the capacity and quality of colonoscopy, and adherence to colonoscopy surveillance guidelines in Korea. This study aimed to investigate the present and potential colonoscopic capacity, colonoscopic quality, and adherence to colonoscopy surveillance guidelines in Korea. Methods We surveyed representative endoscopists of 72 endoscopy units from June to August 2015, using a 36-item questionnaire regarding colonoscopic capacity, quality, and adherence to colonoscopy surveillance guidelines of each hospitals. Results Among the 62 respondents who answered the questionnaire, 51 respondents were analyzed after exclusion of 11 incomplete answers. Only 1 of 3 of endoscopy units can afford to perform additional colonoscopies in addition to current practice, and the potential maximum number of colonoscopies per week was only 42. The quality of colonoscopy was variable as reporting of quality indicators of colonoscopy were considerably variable (29.4%–94.1%) between endoscopy units. Furthermore, there are substantial gaps in the adherence to colonoscopy surveillance guidelines, as concordance rate for guideline recommendation was less than 50% in most scenarios. Conclusions The potential capacity and quality of colonoscopy in Korea was suboptimal. Considering suboptimal reporting of colonoscopic quality indicators and low adherence rate for colonoscopy surveillance guidelines, quality improvement of colonoscopy should be underlined in Korea

Successful management of heterotopic cornual pregnancy with laparoscopic cornual resection

AbstractObjectiveTo examine the feasibility of laparoscopic cornual resection for the treatment of heterotopic cornual pregnancy.Study designWomen who underwent laparoscopic cornual resection for heterotopic cornual pregnancy at our hospital between January 2003 and March 2015 were retrospectively analyzed. We evaluated significant parameters such as operative complications and postoperative pregnancy outcomes of concomitant pregnancy.ResultsThirteen patients with heterotopic cornual pregnancy were included in the study. All were pregnant through assisted reproductive technology, and the diagnosis was made at a median of 6+6 weeks (range 5+4–10+0). They were successfully treated with laparoscopic cornual resection and admitted for a median of 4 days (range, 2–7) postoperatively. The median operative time was 65min (range, 35–145min) and estimated blood loss was 200mL (range, 10–3000mL). There was a spontaneous abortion at 7+6 gestational weeks in a patient who received bilateral cornual resection. Seven patients delivered babies at term and 3 at preterm. All 10 women delivered without any maternal or neonatal complications. Two were lost to follow-up.ConclusionsLaparoscopic cornual resection is a feasible primary approach for the management of heterotopic cornual pregnancy