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Anal cancer screening: Techniques and guidelines
Anal squamous cell cancer has a precancerous stage of high grade squamous intraepithelial lesion (HSIL). Some centers still use the terminology of anal intraepithelial neoplasia (AIN) where HSIL covers AIN2 and AIN3. Techniques that may be used for screening to prevent anal cancer aim to detect HSIL with high sensitivity and specificity and relatively low cost. Cytology and human papillomavirus detection are currently available however both have insufficient sensitivity and specificity to be reliable screening techniques, especially in the highest risk groups for anal cancer. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Tamzin Cuming, Mayura Nathan Source Type: research

High Resolution Anoscopy: Procedure and findings
High Resolution Anoscopy (HRA) using a colposcope or operating microscope with 5% acetic acid and Lugol ′s solutions was developed to identify abnormal epithelial changes such as high-grade squamous intraepithelial lesions (HSIL) and other lesions associated with human papillomavirus (HPV). It is hypothesized that targeted treatment of HSIL will prevent progression to cancer. HRA has become more acc epted in clinical practice especially for populations considered at-risk for anal cancer including those who are immunocompromised and men who have sex (MSM). (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Naomi Jay Source Type: research

Ablative Therapies for the Treatment of Anal High Grade Squamous Intraepithelial Lesions
Anal HSIL is the precursor lesion of anal squamous cell carcinoma. The exact rate of cancer progression from HSIL is not clear, but likely approaches 10% in immunocompromised individuals. Just as excision and destruction of cervical dysplasia has been shown to significantly decrease the risk of cervical cancer, several studies have shown a reduced incidence of anal cancer after targeted ablation of HSIL. Given the morbidity of anal mapping and wide local excision, we cannot justify this treatment method, especially since recurrence is common. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Joseph P. Terlizzi, Stephen E. Goldstone Source Type: research

Topical therapies for the treatment of anal high-grade squamous intraepithelial lesions
Anal cancer may be prevented by treating anal high-grade squamous intraepithelial lesions (HSIL). Ablative therapies are the most commonly used treatments, but they may not be appropriate for all patients including those with extensive HSIL or bleeding diastheses. Researchers have studied topical therapies for human papillomavirus related lesions including anal HSIL. These therapies include patient-applied 5-fluorouracil, imiquimod and cidofovir, and provider-applied trichloroacetic acid. This review will discuss literature supporting efficacy of these products, which is based mainly on case series with few controlled tria...
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Christina Megill, Timothy Wilkin Source Type: research

Progression of Anal High-grade Squamous Intraepithelial Lesions to Anal Squamous Cell Carcinoma and Clinical Management of Anal Superficially Invasive Squamous Cell Carcinoma
Anal high-grade squamous intraepithelial lesions (HSIL) are the precursors to anal squamous cell carcinoma. High-resolution anoscopy (HRA) uses a colposcope after application of acetic acid to visualize anal HSIL that are otherwise invisible. Magnification allows the identification of friability and abnormal vascular changes including punctation, mosaic pattern, and atypical vessels that are the hallmarks of HSIL. These areas are targeted for biopsy and in addition to identifying HSIL, sometimes yield a newly defined pathologic entity, superficially invasive squamous cell carcinoma (SISSCA). (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: J. Michael Berry-Lawhorn, Joel M. Palefsky Source Type: research

Anal Cancer and Anal Cancer precursors in Women with a History of HPV-Related Dysplasia and Cancer
The epidemiology of anal cancer in the U.S. has changed over the past 3 decades. During this period the incidence of anal cancer has increased among both men and women. Of note, women with a history of anogenital HPV infection are at higher risk than the general population for anal cancer. The increased risk ranged from increased incidence rate ratios ranging from 1.82 to 6.3 in women with a history of cervical cancer, to 4.2 –16.4 in women with a history of prior cervical intraepithelial neoplasia 3 (CIN 3). (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Elizabeth A. Stier, Elizabeth Y. Chiao Source Type: research

High Resolution Anoscopy: Is it Necessary in the Management of Anal Epithelial Neoplasia
The prevalence of anal cancer has more than doubled in the United States over the past 30 years. Consequently, there is a need to develop effective screening, treatment and surveillance programs for patients at increased risk for anal cancer. Many of these approaches have been borrowed from cervical cancer due to the shared pathology involving the human papillomavirus and successful screening and surveillance methods developed with the use of high resolution magnification. However, there is limited evidence to support the use of high resolution anoscopy for populations at increased risk for anal cancer. (Source: Seminars i...
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Justin T. Brady, Bona Ko, Sharon L. Stein Source Type: research

The role of HPV vaccination in the prevention of anal dysplasia
Preventing infection with HPV is likely the best strategy to decrease the incidence of anal cancer. The qvHPV and 9vHPV vaccines are highly immunogenic with the same serious adverse event rates as placebo. The qvHPV vaccine has been FDA approved since 2006 for the prevention of cervical, vaginal and vulvar cancer and anogenital warts in women from 9 –26 years of age related to HPV types 6, 11, 16 and 18. In 2009 it was FDA approved for prevention of anogenital warts in men and anogenital dysplasia in men and women 9–26 years of age related to the same HPV types. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Joseph P. Terlizzi, Stephen E. Goldstone Source Type: research

Incorporating anal dysplasia screening and management into a surgical practice
Screening practices for anal dysplasia with the use of anal cytology and high-resolution anoscopy (HRA) has become a topic of increased interest to colon and rectal surgeons. However, screening continues to be practiced by a minority of clinicians. One major hurdle is how to incorporate anal cytology screening programs into busy colorectal surgical practices. In this article I highlight my early experience treating anal dysplasia and review my current approach and practice pattern for treating anal dysplasia. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Mark Lane Welton, Amy L. Lightner Source Type: research

Introduction
In the mid 1990 ′s I began seeing more and more men with anal condyloma. Having been trained as a surgeon to always send a specimen for biopsy, I was quite alarmed when I noticed pathology reports returning as not simply condyloma but condyloma with high-grade dysplasia. I probably shrugged off the first few but when they kept coming with increasing frequency I called the pathologist. I guessed I was probably dealing with a phenomenon similar to an adenoma with areas of high-grade dysplasia, but that was not the case at all. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - April 26, 2017 Category: Gastroenterology Authors: Stephen E. Goldstone Source Type: research

Colonic stenting: when and how
Since the first report in 1990 by Dohomoto et al,1 endoluminal stenting of the colorectum has become a viable alternative to surgery. For patients with unresectable disease, stent implantation can be considered, avoiding the need for colostomy and has been associated with a better quality of life. The long –term outcomes of palliative stenting has shown favorable results.2 Emergency surgery in patients with colonic obstruction is associated with significant morbidity and mortality rates. Stenting as bridge to surgery is now an alternative to emergency surgery despite the uncertainity of its longterm oncologic safety. (So...
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Zoltan Lackberg, Maher A. Abbas Source Type: research

Utility and techniques of intraoperative endoscopy and interventions
Intraoperative endoscopy is an indispensable tool for gastrointestinal surgery. Advent of CO2 endoscopy has allowed for incremental expansion of its applications. With experienced endoscopist surgeon and operating room staffs, intraoperative endoscopy can be done without added morbidity in time-efficient manner, while providing value in diagnosis and treatment. Intraoperative endoscopy has long been used to localize small tumor when palpation and preoperative endoscopic tattoo do not clarify the precise location of the tumor. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Elizabeth Arcila, Joongho Shin Source Type: research

How to avoid and treat endoscopic complications
Colonoscopy is a common procedure performed for screening, diagnostic, or therapeutic indications; nevertheless, it is an invasive procedure that has associated risks. Complications of colonoscopy can be divided into four main categories: (1) bleeding, (2) postpolypectomy syndrome, (3) perforation, and (4) rarely, solid organ injury. In this review, we discuss strategies to avoid and treat complications of colonoscopy. Diligent biopsy and use of electrocautery and avoiding looping and blind advancement of the colonoscope minimize the risk of these complications. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Lea Lowenfeld, Nicole M. Saur, Joshua I.S. Bleier Source Type: research

Patient comfort during colonoscopy
Patient comfort plays a role in acceptance of the procedure both initially and in surveillance. Unsedated colonoscopy should be offered to appropriate motivated patients and the use of some of the techniques discussed above (CO2 insufflation, water-aided colonoscopy, smaller diameter scopes) may improve patient comfort during these exams. Likewise these techniques could allow for a decrease in the amount of sedation required for the exam and thus allow for fewer cardiopulmonary complications. Additional benefits beyond patient comfort may also impact the adaptation of these adjuncts. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Shaun Brown, Charles B. Whitlow Source Type: research

How to achieve cecal intubation in patients with angulated and redundant colons?
Colonoscopy has many purposes, both diagnostic and therapeutic. Accepted standards indicate that the cecum should be reached in 95% of screening examinations and 90% of all procedures. Some patients may have difficult or elongated colons which may make successful intubation more difficult. This manuscript reviews some common strategies for achieving cecal intubation in these colons. It includes a series of rules developed and used for trainees and expert endoscopists alike to safely complete a colonoscopy with a high degree of reliability. (Source: Seminars in Colon and Rectal Surgery)
Source: Seminars in Colon and Rectal Surgery - November 24, 2016 Category: Gastroenterology Authors: Kyle G. Cologne, Amir Bastawrous Source Type: research