High lifetime risk of cancer in primary sclerosing cholangitis

Background/Aims: Primary sclerosing cholangitis (PSC) patients are at risk for developing cholangiocarcinoma (CCA) and colorectal carcinoma (CRC). Our aim was to assess the risk of malignancies and their influence on survival. Methods: Data from PSC patients diagnosed between 1980 and 2006 in two university hospitals were retrieved. The Kaplan-Meier method and a time-dependent Cox regression model were used to calculate risks of malignancies and their influence on survival. Results: Two hundred and eleven patients were included, 143 (68%) were male and 126 (60%) had inflammatory bowel disease (IBD). Median transplantation-free survival was 14 years. The risk of CCA after 10 and 20 years was 9% and 9%, respectively. In patients with concomitant IBD the 10-year and 20-year risks for CRC were 14% and 31%, which was significantly higher than for patients without 1131) (2% and 2% (P = 0.008)). CCA, cholangitis, and age at entry were independent risk factors for the combined endpoint death or liver transplantation. Risk factors for the endpoint death were CCA, CRC, age, and symptomatic presentation. Conclusions: Patients with PSC and IBD have a high long-term risk of developing CRC and this risk is about threefold higher than the risk for CCA. Both malignancies are associated with decreased survival. (C) 2008 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved

Adenoma detection with cap-assisted colonoscopy versus regular colonoscopy: a randomised controlled trial

Objective Conventional colonoscopy (CC) is considered the reference standard for detection of colorectal neoplasia, but it can still miss a substantial number of adenomas. The use of a transparent plastic cap may improve colonic visualisation. Cap-assisted colonoscopy (CAC) was compared with CC for adenoma detection. Secondary outcomes were caecal intubation time, caecal intubation rate and the degree of discomfort of colonoscopy. Design This is a parallel, randomised, controlled trial at two centres. Asymptomatic participants (aged 50-75 years) in a primary colonoscopy screening programme were consecutively invited. Consenting subjects were 1: 1 randomised to either CAC or CC. All colonoscopies were performed by experienced endoscopists (>= 1000 colonoscopies) who were trained in CAC. Colonoscopy quality indicators were prospectively recorded. Results A total of 1380 participants were randomly allocated to CC (N = 694) or CAC (N = 686). Caecal intubation rate was comparable in the two groups (98% vs 99%; p = 0.29). Caecal intubation time was significantly lower in the CAC group: 7.7 +/- 5.0 min with CAC vs 8.9 +/- 6.2 min with CC (p= 20%. The proportion of subjects with at least one adenoma was similar in the two groups (28% vs 28%; RR 0.98; 95% CI 0.82 to Conclusion CAC does not improve adenoma detection, but does reduce caecal intubation time by more than 1 min and does lessen the degree of discomfort during colonoscopy