Physical Stress from Colonoscopy and Polypectomy in Elderly Individuals: Evaluation Using Damage Biomarkers in Blood
American Journal of Clinical and Experimental Medicine
Volume 6, Issue 2, March 2018, Pages: 33-39
Received: Feb. 3, 2018;
Accepted: Feb. 25, 2018;
Published: Mar. 21, 2018
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Hiroaki Igarashi, Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan
Hiroko Yamashita, Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan
Kiyoshi Tsuchiya, Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan
Yuki Hanaoka, Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan
Dai Sugimoto, Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan
Itsuro Ogata, Department of Gastroenterology, Kawakita General Hospital, Tokyo, Japan
Colonoscopy is routinely performed worldwide, but it is still a physically stressful screening method for colorectal cancer, particularly in elderly individuals. No previous study has evaluated physical stress from colonoscopy itself and polypectomy using blood-derived biomarkers. This study aimed to evaluate physical stress from colonoscopy and polypectomy in elderly individuals using white blood cell counts (WBCs) and C-reactive protein (CRP) levels, which are widely used blood-based biomarkers that respond quickly to tissue damage. In this single-center, retrospective observational study, 109 consecutive patients, aged ≥ 80 years, were enrolled. In all patients, WBCs and CRP levels were measured before and half-a-day after colonoscopy. The changes were subsequently compared. Patients were divided into two groups: those with polypectomy (P+) and those without polypectomy (P-). The changes in WBCs and CRP levels were determined and compared between the two groups. In the P + group, correlations between the number of resected polyps and changes in WBCs and CRP levels were also evaluated. Of the 109 patients, there were 48 men and 61 women with a mean age of 83.9 ± 3.1 years (range, 80-91 years); 58 patients received polypectomy. In all patients, the mean WBC after colonoscopy showed no significant change from that before colonoscopy (before: 5400/μL, after: 5200/μL, P = 0.092), and the mean CRP level showed a slight elevation after colonoscopy (before: 0.05 mg/dL, after: 0.08 mg/dL, P < 0.001). Compared to before colonoscopy, the mean WBC after colonoscopy decreased slightly in the P- group (before 5400/μL, after 4900/μL, P = 0.002), but showed no significant difference in the P+ group (5400/μL, 5400/μL, P = 0.48). Conversely, the mean CRP level increased very slightly in both the P- and P+ groups (from 0.06 mg/dL to 0.07 mg/dL, P = 0.003; from 0.04 mg/dL to 0.08 mg/dL, P < 0.001, respectively), but it was not significantly different between the groups. The elevation of both WBCs and CRP levels showed only minor correlations with the number of resected polyps. In conclusion, colonoscopy can be well tolerated even by elderly individuals because physical stress from colonoscopy, with respect to WBCs and CRP levels, was minimal even if polypectomy was performed.
Physical Stress from Colonoscopy and Polypectomy in Elderly Individuals: Evaluation Using Damage Biomarkers in Blood, American Journal of Clinical and Experimental Medicine.
Vol. 6, No. 2,
2018, pp. 33-39.
Vital Statistics Japan (Ministry of Health, Labour and Welfare) 2016.
Mandel JS, Bond JH, Church TR et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. New Engl J Med 1993; 328: 1365-1371.
Hardcastle JD, Chamberlain JO, Robinson MHE et al. Randomised controlled trial of fecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477.
Kronborg O, Fenger C, Olsen J, Jorgensen OD, and Sondergaard O. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471.
European Colorectal Cancer Screening Guidelines Working Group. European guidelinesfor quality assurance in colorectal cancer screening and diagnosis: Overview and introduction to the full supplement publication. Endoscopy 2013; 45: 51-59.
Shaukat A, Mongin SJ, Geisser MS et al. Long-term mortality after screening for colorectal cancer. New Engl J Med 2013; 369: 1106-1114.
Canadian Task Force on Preventive Health Care. Recommendations on screening for colorectal cancer in primary care. CMAJ 2016; 188: 340-348.
US Preventive Services Task Force. Screening for colorectal cancer. JAMA 2016; 315: 2564-2575.
Nishihara R, Wu K, Lochhead P et al. Long-term colorectal-cancer incidence and mortality after lower endoscopy. New Engl J Med 2013; 369: 1095-1105.
Whitlock EP, Lin J, Liles E et al. Screening for colorectal cancer: An updated systematic review [Internet]. Agency for Healthcare Research and Quality (US); 2008 Oct. Report No.: 08-05-05124-EF-1.
Iida T, Okamura S, Kakizaki S et al. Carbon dioxide insufflation reduces the discomfort due to colonoscopy as objectively analyzed by salivary stress markers. Acta Gastroenterol Belg 2013; 76: 219-224.
Kiriyama S, Naitoh H, Fukuchi M et al. Evaluation of abdominal circumference and salivary amylase activities after unsedated colonoscopy using carbon dioxide and air insufflations. J Dig Dis 2015; 16: 747-751.
Kushner I. The phenomenon of the acute phase response. NYAS 1982; 82: 39-48.
Thompson D, Ward AM, and Whicher JT. The value of acute phase protein measurements in clinical practice. Ann Clin Biochem 1992; 29: 123-131.
Clos TWD. Function of C-reactive protein. Ann Med 2000; 32: 274-278.
Gilman SC, Fischer GJ, Biersner RJ, Thornton RD, and Miller DA. Human parotid gland alpha-amylase secretion as a function of chronic hyperbaric exposure. Undersea Biomed Res 1979; 6: 303-307.
Chatterton RT Jr, Vogelsong KM, Lu Y, Ellman AB, and Hudgens GA. Salivay α-amylase as a measure of endogenous adrenergic activity. Clin Physiol 1996; 16: 433-448.
Takai N, Yamaguchi M, Aragaki T, Eto K, Uchihashi K et al. Effect of psychological stress on the salivary cortisol and amylase levels in healthy young adults. Arch Oral Biol 2004; 49: 963-968.
Rohleder N, Nater UM, Wolf JM, Ehlert U, and Kirschbaum C. Psychosocial stress-induced activation of salivary alpha-amylase. An indicator of sympathetic activity? Ann NY Acad sci 2004; 1032: 258-263.
Yamaguchi M, Deguchi M, Wakasugi J et al. Hand-held monitor of sympathetic nervous system using salivary amylase activity and its validation by driver fatigue assessment. Biosens Bioelectron 2006; 21: 1007-1014.
Stegeren AV, Rohleder N, Everaerd W, and Wolf OT. Salivary alpha amylase as marker for adrenergic activity during stress: Effect of betablckade. Psychoneuroendocrinology 2006; 31: 137-141.
Noto Y, Sato T, Kudo M, Kurata K, and Hirota K. The relationship between salivary biomarkers and state-trait anxiety inventory score under mental arithmetic stress: A pilot study. Anesth Analg 2005; 101: 1873-1876.
Nater UM, Marca RL, Florin L et al. Stress-induced changes in human salivary alpha-amylase activity–associations with adrenergic activity. Psychoneuroendocrinology 2006; 31: 49-58.
Robles TF, Shetty V, Zigler CM et al. The feasibility of ambulatory biosensor measurement of salivary alpha amylase: Relationships with self-reported and naturalistic psychological stress. Biol Psychol 2011; 86: 50-56.
Engert V, Vogel S, Efanov SI et al. Investigation into the cross- correlation of salivary cortisol and alpha-amylase responses to psychological stress. Psychoneuroendocrinology 2011; 36: 1294-1302.
Kirschbaum C, and Hellhammer DH. Salivary cortisol in psychobiological research: An overview. Neuropsychobiology 1989; 22: 150-169.
Eck MV, Berkhof H, Nicolson N, and Sulon J. The effects of perceived stress, traits, mood states, and stressful dialy events on salivary cortisol. Psychosom Med 1996; 58: 447-458.
Fujimoto S, Nomura M, Niki M et al. Evaluation of stress reactions during upper gastrointestinal endoscopy in elderly patients: assessment of mental stress using chromogranin A. J Med Invest 2007; 54: 140-4.
Robles TF, Sharma R, Park KS, Harrell L, and Yamaguchi M. Utility of salivary biosensor for objective assessment of surgery-related stress. J Oral Maxillofac Surg 2012; 70: 2256-2263.
Tonnesen H, Puggaard L, Braagaard J, Ovesen H, and Rasmussen V. Stress Response to endoscopy. Scand J Gastroenterol 1999; 6: 629-631.
Luo K, Li JS, Li LT, Wang KH, and Shun JM. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol 2003; 9: 847-850.
Tsimogiannis KE, Tellis CC, Tselepis AD, Pappas-Gogos GK, and Tsimoyiannis EC. Toll-like receptors in the inflammatory response during open and laparoscopic colectomy for colorectal cancer. Surg Endosc 2012; 26: 330-336.
Tsimogiannis KE, Telis K, Tselepis A, Pappas-Gogos GK, and Tsimoyiannis EC. α-Defensin Expression of Inflammatory Response in Open and Laparoscopic Colectomy for Colorectal Cancer. World J surg 2011; 35: 1911-1917.
Andersson B, Ansari D, Norden M, Nilsson J, and Andersson R. Surgical stress response after colorectal resection. Int surg 2013; 98: 292-299.
Tomizawa M, Shinozaki F, Hasegawa R et al. Elevated C-reactive protein level predicts lower gastrointestinal tract bleeding. Biomed Rep 2016; 4: 711-714.