The cover image is based on the article The Lipidomic Profile Discriminates Between MASLD and MetALD by Kai Markus Schneider et al., https://doi.org/10.1111/apt.70012
The cover image is based on the article The Lipidomic Profile Discriminates Between MASLD and MetALD by Kai Markus Schneider et al., https://doi.org/10.1111/apt.70012
The authors of the large English colon capsule endoscopy (CCE) diagnostic accuracy study are grateful to Dr. Lei et al. for their informed and thoughtful observations [1, 2]. We think that there are two important and related observations of our own to make in response.
First, on an ‘intention to investigate’ basis, rather than in complete and adequately prepared CCE, more polyps were detected by CCE than colonoscopy. This meant that an informed management plan could be made for many patients even when CCE was incomplete or inadequately prepared. Second, as you infer, CCE was introduced to mitigate the impact of the Covid-19 pandemic on colorectal cancer diagnosis. That is, its purpose was primarily to inform risk rather than prevent onward investigation, as one might plan for in the future.
We very much agree that multiple, mitigatable factors, not yet fully defined, may contribute to the onward investigation rate and so inform how best CCE should complement a future colorectal diagnostics pathway. Beyond patient selection, touched on above, all of the factors outlined are absolutely pertinent. Our own view about polyp overdiagnosis is uncertain. Double counting seems unlikely since polyp detection was recorded on both a per patient and per polyp basis. The high false positivity of polyps ≥ 10 mm in those who had matched investigations, both of which were complete and adequately prepared, suggests that the reference standard may need to be revisited.
We believe other factors are also important, such as shared decision making, patient choice, and the purpose of CCE in a clinical setting. We very much agree that such should help generate a ‘balanced approach’ for future recommendations. Our study importantly allows us to move beyond the safety and accuracy across a broad clinical setting and into that exciting new space where we can optimise.
James Turvill: conceptualization, writing – original draft. Monica Haritakis: project administration. Scott Pygall: funding acquisition. Emily Bryant: funding acquisition. Harriet Cox: project administration. Greg Forshaw: project administration. Crispin Musicha: formal analysis. Victoria Allgar: formal analysis. Robert Logan: conceptualization, funding acquisition, writing – original draft. Mark McAlindon: conceptualization, writing – original draft.
This article is linked to Turvill et al. paper. To view this article, visit, https://doi/10.1111/apt.70046 and https://doi.org/10.1111/apt.70104.
Older patients with constipation are at an increased risk of inadequate bowel preparation.
To assess the effectiveness of an abdominal vibration combined with walking exercise (AVCWE) programme compared to walking exercise (WE) and standard preparation regimens for bowel preparation in older patients with constipation.
This three-arm randomised controlled trial involved 271 older patients with constipation scheduled for colonoscopy. Patients assigned to the AVCWE group were asked to walk independently for at least 5500 steps and received two cycles of moderate-intensity abdominal vibrations. Patients in the WE group were required to walk independently for at least 5500 steps, whereas patients in the control group received only the standard regimen. The primary outcome was the rate of adequate bowel preparation, defined as a total score of ≥ 6 on the Boston Bowel Preparation Scale.
The rate of adequate bowel preparation in the AVCWE group (92.2%) was significantly higher than in the WE group (78.9%) and the control group (60.4%) (p < 0.001). Additionally, the AVCWE group had statistically significant increases in adenoma detection rate (p = 0.003) and patient satisfaction (p < 0.001), and a reduced incidence of bloating (p = 0.016). Logistic regression analysis identified first colonoscopy (OR = 2.329), laxative use ≥ 3 times per week (OR = 2.675) and poor dietary compliance (OR = 2.249) as risk factors for inadequate preparation.
This provides empirical evidence suggesting that AVCWE may help improve bowel preparation quality among older patients with constipation.
Chinese Clinical Trial Registry, Number: ChiCTR2300067667
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