Browsing by Author "Goldberg, Paul"

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    Bowel preparation for colonoscopy: is diet restriction necessary?
    (2021) Chang, Hung-Jou; Goldberg, Paul; Chu, Kathryn
    Background: Bowel preparation is essential for quality colonoscopy. Although most bowel preparation regimens recommend dietary restriction for 24 to 48 hours before the procedure, the evidence for this is poor. Objectives: To establish whether dietary restriction during bowel preparation improves the quality of bowel preparation. Methods: A prospective single blind, randomised controlled pilot study. The dietary restriction (DR) group was instructed not to ingest high fibre foods for 48 hours prior to the use of a polyethylene glycol (PEG) bowel preparation. The non-dietary restriction (NDR) group was not given any dietary modification, but received instructions for the use of the PEG-based preparation solution. On the day of colonoscopy, the quality of the bowel effluent was assessed, and additional preparation given as necessary. The primary endpoint was quality of bowel cleansing using the Harefield Cleansing Scale during colonoscopy. The secondary endpoint was the need for additional bowel preparation and quantity of additional bowel preparation given prior to endoscopy. Data were analysed on an intention to treat basis. Results: Twenty-three participants were randomised to the intervention group and thirty-four to the control group. Patient demographics were similar in both groups. Dietary restriction did not influence the success rate of bowel preparation: 97% successful bowel preparation in the DR group, vs 91% successful bowel preparation in the NDR group (p=0.559). Additional bowel preparation requirement were similar in both groups: 35% in DR group vs 39% in NDR group (p=0.768). Mean amount of additional bowel preparation required was similar: 560 ml in the DR group vs 460 ml in the NDR group (p=0.633). Conclusion: The quality of bowel preparation was comparable in patients with and without dietary restrictions prior to colonoscopy. Non-restrictive diets prior to bowel preparation should be considered to increase compliance. The sample size of this pilot study prohibited definite statistical conclusions but demonstrated this to be a reasonable methodology for a larger study.
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    Cancer free survival in mutation positive HNPCC individuals with colorectal adenomatous polyps identified on surveillance colonoscopy
    (2013) Swart, Oostewalt; Goldberg, Paul
    The prevalence of colorectal cancer (CRC) places it in the top five cancers worldwide and is the second most common cause of cancer related death. Developed populations have a 5-6% lifetime risk of CRC(l). The South African Cancer Registry (last updated 2004) shows a 1/98 and 1/150 life time risk for developing CRC in males and females respectively (2).
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    Influence of Genetic Polymorphisms on the Age at Cancer Diagnosis in a Homogenous Lynch Syndrome Cohort of Individuals Carrying the MLH1:c.1528C>T South African Founder Variant
    (2024-09-27) Ndou, Lutricia; Chambuso, Ramadhani; Algar, Ursula; Goldberg, Paul; Boutall, Adam; Ramesar, Raj
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    The knowledge and attitude of family members who have receIved predictive genetic test results for hereditary nonpolyposis colorectal cancer in South Africa
    (2005) Algar, Ursula; Hill, Renee; Goldberg, Paul
    Predictive genetic testing for hereditary nonpolyposis colorectal cancer (HNPC) has been offered to families with known mutations in South Africa since 1997. The aim of this study is to evaluate the benefits and limitations, as perceived by family members, of the current management of inherited colorectal cancer.
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    Quantitative Profiling of Colorectal Cancer-Associated Bacteria Reveals Associations between Fusobacterium spp., Enterotoxigenic Bacteroides fragilis (ETBF) and Clinicopathological Features of Colorectal Cancer
    (Public Library of Science, 2015) Viljoen, Katie S; Dakshinamurthy, Amirtha; Goldberg, Paul; Blackburn, Jonathan M
    Various studies have presented clinical or in vitro evidence linking bacteria to colorectal cancer, but these bacteria have not previously been concurrently quantified by qPCR in a single cohort. We quantify these bacteria ( Fusobacterium spp ., Streptococcus gallolyticus , Enterococcus faecalis , Enterotoxigenic Bacteroides fragilis (ETBF), Enteropathogenic Escherichia coli (EPEC), and afaC- or pks-positive E . coli ) in paired tumour and normal tissue samples from 55 colorectal cancer patients. We further investigate the relationship between a) the presence and b) the level of colonisation of each bacterial species with site and stage of disease, age, gender, ethnicity and MSI-status. With the exception of S . gallolyticus , we detected all bacteria profiled here in both tumour and normal samples at varying frequencies. ETBF (FDR = 0.001 and 0.002 for normal and tumour samples) and afaC -positive E . coli (FDR = 0.03, normal samples) were significantly enriched in the colon compared to the rectum. ETBF (FDR = 0.04 and 0.002 for normal and tumour samples, respectively) and Fusobacterium spp. (FDR = 0.03 tumour samples) levels were significantly higher in late stage (III/IV) colorectal cancers. Fusobacterium was by far the most common bacteria detected, occurring in 82% and 81% of paired tumour and normal samples. Fusobacterium was also the only bacterium that was significantly higher in tumour compared to normal samples (p = 6e-5). We also identified significant associations between high-level colonisation by Fusobacterium and MSI-H (FDR = 0.05), age (FDR = 0.03) or pks -positive E . coli (FDR = 0.01). Furthermore, we exclusively identified atypical EPEC in our cohort, which has not been previously reported in association with colorectal cancer. By quantifying colorectal cancer-associated bacteria across a single cohort, we uncovered inter- and intra-individual patterns of colonization not previously recognized, as well as important associations with clinicopathological features, especially in the case of Fusobacterium and ETBF.
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    Randomised study of EndoRings™-assisted vs. standard colonoscopy for detection of polyps in at risk individuals with Lynch Syndrome
    (2020) Dhar, Rohin; Goldberg, Paul
    Introduction: Lynch syndrome (LS) is an autosomal dominant condition and is the most common cause of inherited colorectal cancer (CRC), contributing to approximately 3%-5% of newly diagnosed cases of colorectal malignancy. LS affected individuals bear 18% – 53% lifetime risk for development of CRC. The only therapeutic approach to prevent development of CRC among individuals with LS is periodic colonoscopic screening for detection and removal of adenomas and polyps, which are the precursors for cancer. Despite being the current gold standard, and accounting for all other variables (such as experience of the physician), conventional colonoscopy has been known to sometimes miss detecting adenomas/polyps, specifically those present in the folds of the colonic mucosa and on the inner luminal wall of the colonic flexures. EndoRings™ assisted colonoscopy has therefore been developed to improve colonoscopy outcomes in terms of enhancing adenoma detection rates (ADR)/polyp detection rates (PDR) and involves flexible silicone rings mechanically stretching the colonic folds and thus enhancing total colon visualisation. Objectives: The present study aims to primarily investigate the efficacy of EndoRings™ assisted colonoscopy compared to traditional colonoscopy in terms of ADR/PDR in a known cohort of individuals with LS in a South African setting. Methods: The study was conducted as a cross-sectional randomised controlled trial. Individuals from the Northern Cape province of South Africa with LS were enrolled into the study during our Annual Northern Cape Colonoscopy Outreach trip for the year 2015. A total of 54 individuals (per-protocol) were included in the study and randomised blindly using computer randomisation into a control arm undergoing standard colonoscopy (n=27) and a study arm undergoing EndoRings™-assisted colonoscopy (n=27). Number of polyps detected (the primary outcome) along with a set of secondary outcomes was recorded in real time on data sheets for each individual and statically analysed using IPython. Results: The female to male ratio in the EndoRings™ group was 19:8 versus 15:12 in the standard colonoscopy group (P = 0.40) whereas the mean age of patients was 43.98±15.27 years and 44.26±14.67 years (P = 0.05) respectively. The average number of polyps detected in the EndoRings™ group was 1.4 versus 0.9 in the non-EndoRings™ group (P = 0.60). Conclusion: The present study outcomes observed comparable ADR/PDR in EndoRings™ assisted versus standard colonoscopy with no statistically significant difference. This result may be due to the study's limitations (small sample size) and design. Though no statistically significant conclusions could be reached, EndoRings™ assisted colonoscopy was perceived as being helpful in terms of increasing total colonic visualisation and allowing better scope stabilisation during interventions. Comparable intubation times, withdrawal times, total procedure times and similar complication rates were observed in both study arms. Although this study demonstrated non-inferiority of EndoRings™ compared to standard colonoscopy, further studies with a larger sample size in an easily accessible population over a longer study period are recommended.
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    Surveillance colonoscopy for Lynch syndrome in the Northern Cape: Does direct contact improve compliance?
    (2018) Coccia, Anna Claudia; Goldberg, Paul
    Introduction The Annual Northern Cape Colonoscopy Outreach program provides surveillance colonoscopy to high–risk individuals known with Lynch Syndrome along the west coast and in the Northern Cape Province of South Africa. There are currently over 100 known mutation positive individuals. Surveillance colonoscopies are performed annually in August/September, and are preceded a by a preparation visit approximately 6-8 weeks prior. The aim of the preparation trip has been to directly impart information, regarding preparation and importance of attendance, to individuals required to attend annual surveillance. During the preparation trip an attempt is made to reach all individuals scheduled for surveillance but due to the vastness of the Northern Cape inevitably every year some areas are not visited. It has been noted that over the past few years fewer than 25 % of the total participants obtained 100 % adherence to surveillance. Objectives The primary objective of this study is to determine whether there is a need for a yearly colonoscopy preparation visit to high–risk individuals in the Northern Cape. The study determines if direct interaction with patients prior to surveillance colonoscopy will significantly impact attendance and adequacy of bowel preparation. Methods Seventy-eight individuals known with a genetic mutation for Lynch syndrome were enrolled in this randomised crossover trial spanning two years of surveillance. The control group (Group A) of individuals had bowel preparation and instructions forwarded to their local clinics and distributed to them via clinic or hospital staff. The test group (Group B) of individuals were personally visited and provided with instructions and bowel preparation by the research team. A measurement of attendance at surveillance colonoscopy as well as cleanliness of the colon was recorded. The study spanned two years of colonoscopy surveillance, July 2014 to September 2015, with a crossover of the control and test groups. Results The study cohort consisted of 28 (36%) male and 50 (64%) female participants with a median age of 39.5 years. Groups A and B consisted of 38 and 40 participants respectively. In September 2014 thirty-six (46.2%) participants presented for annual surveillance colonoscopy, 19 (50%) from the control group (Group A) and 17 (42.5%) from the intervention group (Group B). In 2015 there were 41 (53%) compliant individuals; this included 21 (55%) individuals receiving a preparatory direct contact visit (Group A), and 20 (50%) individuals from the 2015 control group B. Following exclusion of carry-over and period effect, the study intervention was found not to significantly impact attendance (p-value = 0.853). Superior attendance was noted in individuals with prior compliance to surveillance (p-value = 0.001). Conclusions Direct interaction with known Lynch syndrome individuals prior to annual surveillance colonoscopy has not shown to positively impact attendance. Interaction and counselling should focus on individuals identified to be defaulting surveillance.
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    Tuberculous anal fistulas-prevalence and clinical features in an endemic area
    (Health and Medical Publishing Group, 2009) Stupart, Douglas; Goldberg, Paul; Levy, Anthony; Govender, Dhiren
    Introduction: The aim of this study was to determine the prevalence of tuberculosis (TB) in anal fistulas at a referral hospital in Cape Town, and to document the clinical features and course of patients with tuberculous anal fistulas. Patients and methods: This was a prospective study of all patients who underwent surgery for anal fistulas at the Colorectal Surgery Unit at Groote Schuur Hospital, Cape Town, from 2004 to 2006. Tissue was submitted for histopathological examination, Ziehl-Neelsen (ZN) staining and TB culture. The patients with proven TB were followed up until January 2008. Results: During the 3-year study period, 117 operations were performed on 96 patients. TB was diagnosed in 7 of the 96 patients (7.3%). In 5 of these 7 cases, the diagnosis of TB could be proven on histological examination and ZN staining, while in 2 cases the diagnosis could only be made on TB culture. None of the 7 patients had systemic features suggestive of TB, and only 1 had evidence of TB on a chest radiograph. Five patients were HIV-negative, and 2 declined testing. After a median follow-up of 2 years, 5 of 7 patients had evidence of recurrent or persistent fistulas, despite having completed 6 months of TB treatment. Conclusion: At a referral hospital in an endemic area, TB was present in 7.3% of anal fistulas. Histopathological examination including ZN staining was inadequate to make the diagnosis in a third of these patients. Tissue from anal fistulas should therefore routinely be sent for TB culture as well as histopathological examination and ZN staining in areas where TB is prevalent.