Detecting Colorectal Ca From Feces
Fecal DNA testing detects advanced colorectal neoplasia in asymptomatic patients at average risk for colorectal cancer with a significantly greater sensitivity than fecal occult-blood testing, reported Thomas F. Imperiale, M.D., of Indiana University, Indianapolis, and his associates.
In 418 patients with advanced neoplasia (tubular adenoma 1 cm or larger, villous polyp, polyp with high-grade dysplasia, or cancer), fecal DNA testing had a significantly greater sensitivity than fecal occult-blood testing (18% vs. 11%). The sensitivity of fecal DNA testing was 52% in detecting invasive cancer alone and 41% for carcinoma in situ and invasive cancer together. Fecal occult-blood testing remained nearly the same at 13% and 14%, respectively (N. Engl. J. Med. 2004;351:2704–14).
Other studies of fecal DNA testing have reported sensitivities of 64% and 90% for cancer, but they tested patients known to have colorectal cancer and not asymptomatic patients. Colonoscopy was the reference standard in this study, which included 2,507 patients with an average age of 70 years. Dr. Imperiale and most of his colleagues in the study reported that they have received consulting fees or grants from, own shares in, or have been employed by Exact Sciences, which funded the trial and analyzed stool samples…
Diabetes in Chronic Hepatitis C
Type 2 diabetes is independently associated with histologically advanced chronic hepatitis C infection, according to the results of a prospective cross-sectional study.
The prevalence of type 2 diabetes mellitus (DM) in patients with chronic hepatitis C virus (HCV) infection ranged from 5% among 80 patients with early histological disease (fibrosis stage 0–2) to 21% among 56 patients with advanced histological disease (fibrosis stage 3–4), reported Claudia O. Zein, M.D., of the Mayo Clinic and Foundation, Rochester, Minn., and colleagues. Patients with advanced histological disease had a significantly higher prevalence of DM than the general population (8%) and a control cohort of 179 patients from the same institution with either primary biliary cirrhosis or primary sclerosing cholangitis (7%), regardless of the presence of advanced histological disease in the control patients (Am. J. Gastroenterol. 2005;100:48–55).
Advanced histological hepatitis C and family history of DM remained independently associated with DM after controlling for other diabetes risk factors and other variables. None of the patients with chronic hepatitis C infection had taken interferon or corticosteroids.
Hemorrhoidectomy Methods Compared
Hemorrhoidectomy performed with a Ligasure hemostatic device causes less postoperative pain and takes less time to do than hemorrhoidectomy with the Harmonic Scalpel, reported Shek Yuen Kwok, M.D., and colleagues at the Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Seven days after patients with a total of three grade 3 or 4 hemorrhoids underwent a hemorrhoidectomy in a single-blind, randomized trial, the median postoperative pain score (assessed pain with a visual analog score) for the 24 patients in the Ligasure group was significantly lower than that for 23 patients in the Harmonic Scalpel group (2.6 vs. 4.8) (Dis. Colon Rectum [online] Dec. 21, 2004).
The Ligasure operation took significantly less time to perform than did the procedure using the Harmonic Scalpel (11 min. vs. 18 min.). No differences in complications or other parameters were found.
Endoscopic Enteryx Therapy for GERD
Augmentation of the lateral esophageal sphincter with the Enteryx procedure can significantly reduce heartburn symptoms and the use of proton pump inhibitors (PPIs) in gastroesophageal reflux disease patients, reported Jacques Devière, M.D., of the Free University of Brussels and his colleagues.
Of 32 patients who underwent the procedure—endoscopic implantation of Enteryx, a nonresorbable copolymer—in a randomized, patient-blinded trial, 78% reduced their use of PPIs by 50% or more after 3 months, compared with 53% of 32 patients who underwent a sham procedure consisting of an upper GI endoscopy. The GERD health-related quality-of-life heartburn score improved 3 months after the procedure by a significantly greater amount on average in Enteryx patients than in sham patients (63% vs. 25%) (Gastroenterology [online] accepted Dec. 4, 2004;
Around the time of the 3-month follow-up, 20 of 23 patients in the sham group who were eligible for Enteryx treatment underwent the procedure, whereas 6 of 9 eligible patients in the Enteryx group were retreated. Six months after the initial procedure, PPI usage and heartburn symptoms remained stable in the Enteryx group and improved in the sham group because many of the patients in that group.