The edition · Top Clinical Updates
After high-risk adenomas, first surveillance colonoscopy can wait five years
EPoS II found a 5-year first surveillance was non-inferior to 3 years for colorectal cancer in 10,799 patients. Also: catheter-directed thrombolysis in intermediate-high-risk PE, antidepressants and the QT interval, and two negative trials — FMT for IBS and maternal egg and peanut diets.
The edition in brief
EPoS II randomised 10,799 patients with high-risk adenomas to a first surveillance colonoscopy at 5 or 3 years; at an interim analysis the 5-year cumulative colorectal cancer incidence was 0.77% vs 0.82%, meeting non-inferiority. PRAGUE-26 randomised 558 haemodynamically stable patients with intermediate-high-risk pulmonary embolism to catheter-directed alteplase plus anticoagulation or anticoagulation alone; death, recurrence or decompensation within 7 days fell from 6.8% to 0.7% (RR 0.10), without a significant rise in bleeding, though two intracranial haemorrhages occurred with thrombolysis. An individual participant data analysis of 35 trials found escitalopram (8.7 ms) and amitriptyline (5.3 ms) lengthened QTc against placebo, but 139 trials with 52,398 participants showed no rise in early major cardiovascular events. REFIT2 found a single donor faecal transplant did not improve IBS symptoms over autologous transplant (40% vs 38% responders). A trial of 2,137 pregnant women found a diet rich in eggs and peanuts during pregnancy and breastfeeding did not reduce infant egg or peanut allergy (7.8% vs 8.4%).
Catheter-directed thrombolysis prevents early collapse in intermediate-high-risk PE
Refer haemodynamically stable PE with right ventricular strain and raised biomarkers for catheter-directed thrombolysis where available, because it cut early decompensation.
Escitalopram and amitriptyline lengthen QTc, but antidepressants did not raise early cardiac events
Choose an antidepressant with a smaller QT effect, such as venlafaxine or vortioxetine, when a patient already has QT risk factors.
A single donor faecal transplant does not improve IBS symptoms
Do not offer faecal microbiota transplantation for IBS; a large blinded trial found no benefit over placebo.
Eating more eggs and peanuts in pregnancy does not prevent infant allergy
Tell pregnant and breastfeeding women their egg and peanut intake does not change allergy risk; introduce these foods to the infant early.
Write the surveillance interval, and the reason, in the discharge letter after polypectomy
After polypectomy, put the surveillance interval and its reason in the record and a recall system.
First surveillance colonoscopy at five years is non-inferior to three after high-risk adenomas
After complete removal of high-risk adenomas, do not shorten surveillance; five years to first colonoscopy was non-inferior to three.
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