This home-based screening, done every two years, is effective in reducing colorectal cancer mortality.

This is the 36th issue of information for you! Once every two years, fecal occult blood screening can effectively reduce the mortality of colorectal cancer! Gastroenterology is a good way to prevent pancreatitis after ERCP.01 fecal occult blood screening once every two years can effectively reduce the mortality of colorectal cancer. Colorectal cancer has a strong insidious, early symptoms are not obvious, often patients found and began treatment has developed to the middle and late stage, greatly reducing the cure rate and five-year survival rate of colorectal cancer, early detection is of great significance.and fecal occult blood test is an effective method to early warning intestinal risk, which has important reference value for early detection of colorectal cancer.studies have shown that biennial fecal occult blood test (FOBT) screening can reduce the mortality rate of colorectal cancer (CRC), but the effect of gender and age difference is unknown.Dr. aasma Shaukat and his team further explored the effects of FOBT on CRC mortality in men, women and different age groups. The results were published online in the journal Clinical Gastroenterology and Hepatology recently.Figure 1. The title of the article and the author's information. The researchers conducted a systematic literature search on randomized trials of annual or biennial FOBT screening to reduce CRC mortality. Two trials in Minnesota and Denmark in the United States were finally selected, and a cooperative agreement was reached with the corresponding researchers to obtain the detailed data of patients and continue to follow up.through follow-up, the researchers updated CRC mortality and all-cause mortality in the Danish trial and combined participants' data with 30-year follow-up data from the US trial.Kaplan Meier survival analysis was used to evaluate the mortality and all-cause mortality of CRC, and the influence of age and gender on mortality.the results showed that after 30 years of follow-up, there were 33478 (71.9%) and 33479 (72.2%) total deaths and 1023 (2.2%) and 1146 (2.5%) CRC deaths in the biennial FOBT screening group (n = 46553) and the control group (n = 46358), respectively.Table 1. Analysis of baseline information found that a two-year FOBT screening significantly reduced CRC mortality by 16% (RR 0.84; 95% CI 0.74-0.96) and all-cause mortality by 2% (RR 0.98; 95% CI 0.97-0.99).Figure 2. The reduction of CRC mortality in males (RR 0.75; 95% CI 0.62-0.90) was greater than that in females (RR 0.91; 95% CI 0.75-1.09).CRC mortality decreased most in men aged 60-69 and women aged 70 and above.Figure 3. The influence of gender on CRC mortality reduction. Based on the above results, it can be seen that the two-year FOBT screening can continuously reduce CRC mortality; compared with women, the decrease in CRC mortality rate is greater in men, and men benefit about 10 years earlier than women.FOBT has a warning effect on many intestinal diseases, including colorectal cancer. Regular screening is necessary for early detection of diseases.early detection and treatment can obtain better prognosis.02 five steps to prevent pancreatitis after ERCP. Endoscopic retrograde cholangiopancreatography (ERCP) is a technique in which the endoscope is inserted into the descending part of the duodenum through the mouth, the contrast tube is inserted through the duodenal papilla, and the contrast agent is injected. X-ray photography is used to display the pancreaticobiliary duct. Since its development in 1968, it has played an important role in the diagnosis and treatment of many biliary pancreatic diseases.but ERCP may also cause some adverse reactions, among which post ERCP pancreatitis is the most common. how to avoid and prevent pancreatitis after ERCP? A recent article published in the Journal of Gastroenterology introduces this issue in detail. Figure 4. Article title and author's information. The article introduces that the prevention of post ERCP pancreatitis can be divided into the following five steps: ■ step 1: firstly, all risk factors related to patients and ERCP operation should be identified and carefully evaluated before operation. the article pointed out that female, young age, suspected Oddi sphincter dysfunction, obesity, previous history of pancreatitis, chronic pancreatitis, etc. were risk factors related to ERCP operation; duration of intubation, sphincterotomy and balloon dilatation were risk factors related to ERCP. for example, a young obese female patient with common bile duct stones and previous acute biliary pancreatitis has a much higher risk of post ERCP pancreatitis than other patients. Table 2. Risk factors of pancreatitis after ERCP ■ some preventive drugs and measures can be used in the second step. the effectiveness of more than 35 different drugs in preventing post ERCP pancreatitis has been evaluated. the article points out that non steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac are definitely effective in preventing pancreatitis after ERCP; somatostatin, octreotide, gabexate and epinephrine sprayed on the duodenal papilla may be effective; pancreatic stents are also effective preventive measures. Table 3. Preventive measures for pancreatitis after ERCP ■ the third step is to carefully evaluate the condition of duodenal papilla. during ERCP, after clearly seeing the duodenal papilla, we should fully understand its size, diameter, opening orientation and other characteristics, and then choose the best intubation method. ■ from the fourth step to the insertion of contrast catheter, the guide wire intubation or contrast agent injection can be selected according to the clinical situation. the article points out that although some studies have shown that the guide wire intubation is safer than contrast agent injection, the volume, concentration and type of contrast agent are difficult to control, and the quality of these studies is not high. ■ step 5: if necessary, pancreatic stenting can be performed. Figure 5. Steps and key points to avoid and prevent post ERCP pancreatitis. In conclusion, it is very important to have trained endoscopists and nurses, which are the basis of ERCP. It is the key to avoid adverse reactions to comply with the applicable indications of ERCP. NSAIDs can be used to prevent post ERCP pancreatitis 20 minutes before operation. before intubation, the duodenal papilla should be fully evaluated and the appropriate type and method of intubation should be selected. pancreatic stents can be placed in high-risk patients and situations. after ERCP, we still need to carefully evaluate the relevant situation of patients. If adverse reactions occur, we should strive to find out and treat them as soon as possible. [2] Shaukat a, kaaly L, baatrup g, et al. Effects of screening compliance on long-term reduction in all-cause and coloritic cancer mortality [published] published on February 2015, 2015, 158 (8): 2037-2040. [2] Shaukat a, kaaly L, baatrup g, et al. Effects of screening compliance on long-term reduction in all-cause and coloritic cancer cancer tumor [published] published on on on on public health [published on February 2015, 2015, 158 (8): 2037-2040. [2] Shaukat a, kaaly L, baatrup g, et al. Effects of screening compliance on long-term reductions in all-cause and coloritic cancer mortar [published on published on online cancer mortar [published on published on February 2015, published on cancer hospital [published, published on cancer hospital [published, published on line ahead of print, 2020 Jul 4]. Clin Gastroenterol Hepatol. 2020;S1542-3565(20)30825-9.