Canadian Association of Radiologists Gastrointestinal Imaging Referral Guideline.

The Canadian Association of Radiologists (CAR) Gastrointestinal Expert Panel consists of radiologists, a gastroenterologist, a general surgeon, a family physician, a patient advisor, and an epidemiologist/guideline methodologist. After developing a list of 20 clinical/diagnostic scenarios, a systematic rapid scoping review was undertaken to identify systematically produced referral guidelines that provide recommendations for one or more of these clinical/diagnostic scenarios. Recommendations from 58 guidelines and contextualization criteria in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) for guidelines framework were used to develop 85 recommendation statements specific to the adult population across the 20 scenarios. This guideline presents the methods of development and the referral recommendations for dysphagia/dyspepsia, acute nonlocalized abdominal pain, chronic abdominal pain, inflammatory bowel disease, acute gastrointestinal bleeding, chronic gastrointestinal bleeding/anemia, abnormal liver biopsy, pancreatitis, anorectal diseases, diarrhea, fecal incontinence, and foreign body ingestion.

Modeling and in vitro experimental validation for kinetics of the colonoscope in colonoscopy.

Colonoscopy is the most sensitive and specific means for detection of colon cancers and polyps. To make colonoscopy more effective several problems must be overcome including: pain associated with the procedure, the risk of perforation, and incomplete intubation colonoscopy. Technically, these problems are the result of loop formation during colonoscopy. Although, several solutions such as modifying the stiffness of the colonoscope, using an overtube and developing image-guided instruments have been introduced to resolve the looping problem, the results of these systems are not completely satisfactory. A new paradigm to overcome loop formation is proposed that is doctor-assistive colonoscopy. In this approach, the endoscopists performance is enhanced by providing using a kinetic model that provides information such as the shape of the scope, direction of the colon and forces exerted within certain sections. It is expected that with the help of this model, the endoscopist would be able to adjust the manipulation to avoid loop formation. In the present studies, the kinetic model is developed and validated using an ex vivo colonoscopy test-bed with a comprehensive kinematic and kinetic data collection. The model utilizes an established colon model based on animal tissue with position tracking sensors, contact force sensors for the intraluminal portion of the scope and a Colonoscopy Force Monitor for the external insertion tube.

Analysis of and mathematical model insight into loop formation in colonoscopy.

The colonoscope is an important tool in the diagnosis and management of diseases of the colon; yet its design has not changed appreciably since it was first introduced to clinical practice 40 years ago. One of the ongoing challenges with this device is that the natural shape of the colon predisposes to loop formation by the scope during the examination. The result of this looping is that further insertion of the scope results in a larger loop size without any advancement of the tip of the scope. Looping thus causes pain in the patient, risks perforation of the colon, and results in incomplete examinations. In this article, loop formation is analyzed in terms of frictional force state and Kirchhoff's slender rod model in order to better understand the generic principle of loop formation. Next, a mathematical model of deformation of the colon with respect to external manipulation involving a number of variables involved in loop formation is constructed. Finally, a model of the motion of the scope relative to the colon when looping occurs is presented. The model has clinical significance for prediction of advancement of the tip of the scope when looping occurs. The mathematical model was then validated and verified using data available from the literature. Our models are an important starting point in the development of a novel device to overcome loop formation and result in increased patient comfort and an improved completion rate for colonoscopy procedures.

Overview of upcoming advances in colonoscopy.

Although colonoscopy is a very commonly carried out procedure, it is not without its problems, including a risk of perforation and significant patient discomfort, especially associated with looping formation. Furthermore, looping formation may prevent a complete colonoscopy from being carried out in certain patients. The conventional colonoscope has not changed very much since its original introduction. We review promising technologies that are being promoted as a way to address the problems with current colonoscopy. There are some methods to prevent looping formation, including overtube, variable stiffness, computer-guided scopes, Aer-O-Scope, magnetic endoscopic imaging and the capsule endoscope. In recent years, with the progress of microelectromechanical and microelectronic technologies, many biomedical and robotic researchers are developing autonomous endoscopes with miniaturization of size and integration functionality that represent state of the art of the micro-robotic endoscope. The initial results by using aforementioned methods seem promising; however, there are some conflicting reports of clinical trials with the overtube colonoscope, the computer-guided scope and the variable stiffness colonoscope. There are also some limitations in the use of the Aer-o-scope and the capsule endoscope. The autonomous endoscope is based on a self-propelling property that is able to avoid looping completely. This novel technology could potentially become the next generation endoscope; however, there are still critical techniques to be approached in order to develop the effective and efficient novel endoscope.

Predicting local recurrence following breast-conserving therapy for early stage breast cancer: the significance of a narrow (≤ 2 mm) surgical resection margin.

BACKGROUND AND OBJECTIVES: Controversy continues over the extent of surgical resection margin required to minimize the risk of local recurrence (LR) in breast-conserving therapy (BCT) for early stage breast cancer. This study explores whether or not a narrow (≤ 2 mm) but negative resection margin affects LR. METHODS: All patients registered at the Saskatoon Cancer Center between January 1, 1991 and December 31, 2000 with a diagnosis of early stage invasive duct carcinoma treated with BCT were examined. All charts and pathology reports were reviewed with a review of the pathology for all cases where the resection margin was unclear in the original report. Other factors known or thought to effect LR (age, radiation boost, grade, extensive DCIS, ER/PR receptor status) were considered in the statistical analysis. RESULTS: Amongst the 200 narrow margin cases 19 LR were detected (19/201 = 9.5%) while 52 LR were detected in the 491 wide margin cases (52/491 =10.6%). This difference was not statistically significant. CONCLUSIONS: A narrow (≤ 2 mm) surgical resection margin does not result in an increase in LR compared to a surgical resection margin 2 mm in BCT for early stage duct carcinoma and does not warrant re-excision.