Background and study aims: Several studies have evaluated the utility of double-balloon enteroscopy (DBE) and capsule endoscopy (CE) for patients with small-bowel disease showing inconsistent results. The aim of this study was to determine the sensitivity and specificity of overtube-assisted enteroscopy (OAE) as well as the diagnostic concordance between OAE and CE for small-bowel polyps and tumors. Patients and methods: We conducted a systematic review and meta-analysis of studies in which the results of OAE were compared with the results of CE for the evaluation of small-bowel polyps and tumors. When data for surgically resected lesions were available, the histopathological results of OAE and surgical specimens were compared. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the diagnosis of small-bowel polyps and tumors were analyzed. Secondarily, the rates of diagnostic concordance and discordance between OAE and CE were calculated. Results: There were 15 full-length studies with a total of 821 patients that met the inclusion criteria. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were as follows: 0.89 (95 % confidence interval [CI] 0.84 – 0.93), with heterogeneity χ2 = 41.23 (P = 0.0002) and inconsistency (I 2) = 66.0 %; 0.97 (95 %CI 0.95 – 0.98), with heterogeneity χ2 = 45.27 (P = 0.07) and inconsistency (I 2) = 69.1 %; 16.61 (95 %CI 3.74 – 73.82), with heterogeneity Cochrane’s Q = 225.19 (P < 0.01) and inconsistency (I 2) = 93.8 %; and 0.14 (95 %CI 0.05 – 0.35), with heterogeneity Cochrane’s Q = 81.01 (P < .01) and inconsistency (I 2) = 82.7 %, respectively. A summary receiver operating characteristic curve (SROC) curve was constructed, and the area under the curve (AUC) was 0.97. Conclusion: OAE is an accurate test for the detection of small-bowel polyps and tumors. OAE and CE have a high diagnostic concordance rate for small-bowel polyps and tumors.This study was registered in the PROSPERO international database () with the study number CRD42015016000.

The tumor regression grade is the most important factor for the decrease in the number of lymph nodes.

Background:Since 1990 it was proposed that distal and proximal location of colon cancer might follow different biological, epidemiology, pathology and prognosis, probably due to embryologic different development of the two segments of the colon, which may represent two separate disease entities. These differences might have consequences for the treatment of patients with colorectal cancer. Aim:To compare the characteristics between patients with right and left colon cancer, with severity and tumor characteristic that influence in the survival of these patients. Method:Were evaluated the outcomes of surgical treatment of patients with colon cancer with data collected retrospectively from prospectively collected database. Results:The tumor’s side did not influence survival time of patients with colon cancer (p=0.112) in the regression model. Only the diseases stage leads to influence on survival time; patients with right colon cancer have more advanced staging (III or IV) and present a risk of death greater in 3.23 times. Conclusion:This analysis provides evidence that the prognosis of localized left-sided colon cancer is better compared to right-sided colon cancer. Also, the patients with right colon cancer have more advanced stage, mucinous tumor and are older.

BackgroundColorectal cancer is one of the most common malignancies in the world. There are many controversies in the literature about the prognostic value of primary tumor location. Many studies have shown higher survival rates for tumors in the right colon, and worse prognosis for lesions located more distally in the colon.AimTo analyze the results of surgical treatment of right-sided colon cancers patients operated in one decade period and identify the prognostic factors that were associated with lower overall survival in stages I-IV patients.MethodsA retrospective review from the prospectively collected database identified 178 patients with right-sided colon cancer surgically treated with curative intent. Demographic factors (gender and age), tumor factors (site, T stage, N stage, M stage, histological type and tumor differentiation), and lymph node yield were extracted to identify those associated with lower overall survival.ResultsMean age was 65 (±12) years old, and 105 (56.1%) patients were female. Most common affected site was ascending colon (48.1%), followed by cecum (41.7%) and hepatic flexure (10.2%). Mean length of hospital stay was 14 (±2.8) days. T stage distribution was T1 (4.8%), T2 (7.5%), T3 (74.9%), and T4 (12.8%). Nodal involvement was present in 46.0%, and metastatic disease in 3.7%. Twelve or more lymph nodes were obtained in 87.2% of surgical specimens and 84.5% were non-mucinous tumors. Mean survival time was 38.3 (±30.8) months. Overall survival was affected by T stage, N stage, M stage, and final stage. Lymph node involvement (OR=2.06) and stage III/IV (OR=2.81) were independent negative prognostic factors. ConclusionRight-sided colon cancer presented commonly at advanced stage. Advanced stage and lymph node involvement were factors associated with poor long term survival.

Background: To evaluate the prevalence of upper gastrointestinal (GI) polyps in familial adenomatous polyposis (FAP), and to discuss current therapeutic recommendations. Methods: Clinical, endoscopic, histological and treatment data were retrieved from charts of 102 patients . Duodenal adenomatosis was classified according to Spigelman stages.Results: this series comprised 59 women (57.8%) and 43 men (42.1%) with a median age of 32.3 years.Patients underwent 184 endoscopic procedures, the first at a median age of 35.9 years (range, 13-75 years).Fundic gastric polyps (n=31; 30.4%) prevailed in the stomach. While only 5 adenomas were found in the stomach, 33 patients (32.4%) presented duodenal ones. Advanced lesions (n=13; 12.7%) were detected in the stomach (n=2) and duodenum (n=11). During follow-up, Spigelman stages improved in 6 (12.2%) patients, remained unchanged in 25 (51.0%) and worsened in 18 (36.7%). Carcinomas were diagnosed in the stomach and duodenum (4 lesions each, 3.9%), at median ages of 50.2 and 55.0 years, respectively. Advanced lesions and carcinomas were managed through local or surgical resections. Severe complications occurred in only 2 patients (one death). Enteroscopy in 21 patients revealed jejunal adenomas in 12, 11 of whom also presented duodenal adenomas. Conclusions: There is a high prevalence of upper GI adenomas and cancer in FAP. There were diagnosed fundic gastric polyps (30.4%), duodenal (32.4%) and jejunal adenomas (11.8%), respectively. One third of duodenal polyps progressed slowly throughout the study. The rates of advanced gastroduodenal lesions (12.7%) and cancer (7.8%) raise the need for continuous surveillance during follow-up.

Aim To determine the diagnostic accuracy of colon capsule endoscopy for colorectal cancer screening. Methods Studies that compared the diagnostic performance of colonoscopy and second-generation colon capsule endoscopy (CCE-2) for screening of asymptomatic patients aged 50–75 years were included. The primary outcomes were sensitivity, specificity, and positive and negative likelihood ratios for polyps and adenomas measuring at least 6 mm or 10 mm. Results Eight full-text studies that evaluated 1602 patients were included for systematic review. Of these, 840 (52.43%) patients participated in an opportunistic screening program. The pooled outcomes of CCE-2 for polyps at least 6 mm / 10 mm were (CI = confidence interval): sensitivity: 88% (95% CI: 0.84–0.91) / 88% (95% CI: 0.82–0.93), specificity: 94% (95% CI: 0.92–0.95) / 95.5% (95% CI: 0.94–0.97); positive likelihood ratio: 11.86 (95% CI: 5.53–25.46) / 23.07 (95% CI: 6.163–86.36); negative likelihood ratio: 0.14 (95% CI: 0.1–0.21) / 0.14 (95% CI: 0.09–0.21). The area under the summary receiver operating characteristic curve for polyps at least 6 and 10 mm was 96.3% and 96.7%, respectively. The only cancer missed by complete CCE-2 was shown at multiple frames in the unblinded review. In total, 125 (7.8%) patients presented mild adverse events mostly related to bowel preparation. Conclusion CCE-2 is demonstrated to be an effective and safe alternative method for colorectal cancer screening. Diagnostic performance of CCE-2 for polyps of at least 6 and 10 mm was similar. Completion rates still need to be improved.

The prevalence of fecal incontinence among obese patients was high regardless of age, gender, and body mass index. Anal squeeze pressure was significantly lower in obese patients compared to non-obese controls.

Background: In addition to the presence of neoplasia in the colon and rectum, patients with familial adenomatous polyposis (FAP) may develop numerous polyps and carcinoma within the upper gastrointestinal tract. Methods:The aim of the present paper was to review the incidence advanced duodenal polyposis or cancer and their surgical outcomes. A retrospective review of patients' records from our department was performed. respectively. Duodenal carcinomas occurred later (55.8 years) when compared to advanced adenomatosis (45.3 years). Three patients were diagnosed due to symptoms, while the others were detected under endoscopic surveillance. Age interval between FAP treatment and duodenal neoplasia diagnosis was 15.3 years . All but one patient underwent duodenopancreatectomy (DP). Two from the 7 patients undergoing DP died, one from pulmonary embolism 30 days after surgery and the other from recurrent T4N0 duodenal tumor. Thus, major operative morbidity and mortality were 12.5%. Conclusions:In this single-center Brazilian series of FAP patients: (I) advanced duodenal neoplasia or cancer requiring surgery occurred in 5.5% of patients; (II) when reaching the fifth decade of life, patients should be carefully evaluated to diagnose and treat early lesions; (III) in spite of the technical complexity of DP, operative morbidity is acceptable in experienced hands; and (IV) continuous surveillance is necessary during follow-up.