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Lu YB, Lu SC, Li FD, Le PH, Zhang KH, Sun ZZ, Huang YN, Weng YC, Chen WT, Fu YW, Qian JB, Hu B, Xu H, Chiu CT, Xu QW, Gong W. Artificial intelligence-aided diagnostic imaging: A state-of-the-art technique in precancerous screening. J Gastroenterol Hepatol 2024; 39:544-551. [PMID: 38059883 DOI: 10.1111/jgh.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Chromoendoscopy with the use of indigo carmine (IC) dye is a crucial endoscopic technique to identify gastrointestinal neoplasms. However, its performance is limited by the endoscopist's skill, and no standards are available for lesion identification. Thus, we developed an artificial intelligence (AI) model to replace chromoendoscopy. METHODS This pilot study assessed the feasibility of our novel AI model in the conversion of white-light images (WLI) into virtual IC-dyed images based on a generative adversarial network. The predictions of our AI model were evaluated against the assessments of five endoscopic experts who were blinded to the purpose of this study with a staining quality rating from 1 (unacceptable) to 4 (excellent). RESULTS The AI model successfully transformed the WLI of polyps with different morphologies and different types of lesions in the gastrointestinal tract into virtual IC-dyed images. The quality ratings of the real IC-dyed and AI images did not significantly differ concerning surface structure (AI vs IC: 3.08 vs 3.00), lesion border (3.04 vs 2.98), and overall contrast (3.14 vs 3.02) from 10 sets of images (10 AI images and 10 real IC-dyed images). Although the score depended significantly on the evaluator, the staining methods (AI or real IC) and evaluators had no significant interaction (P > 0.05) with each other. CONCLUSION Our results demonstrated the feasibility of employing AI model's virtual IC staining, increasing the possibility of being employed in daily practice. This novel technology may facilitate gastrointestinal lesion identification in the future.
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Affiliation(s)
- Yang-Bor Lu
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Si-Cun Lu
- Departmemt of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Fu-Dong Li
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Puo-Hsien Le
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Kai-Hua Zhang
- School of Computer, Nanjing University of Information Science and Technology, Nanjing, China
| | - Zi-Zheng Sun
- School of Computer, Nanjing University of Information Science and Technology, Nanjing, China
| | - Yung-Ning Huang
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Yu-Chieh Weng
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yi-Wei Fu
- Department of Gastroenterology, Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun-Bo Qian
- Department of Gastroenterology, The Second Hospital affiliated to Nantong University, Nantong, China
| | - Bin Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Qin-Wei Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Gong
- Departmemt of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Shenzhen, China
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Wang Y, Li L, Niu X, Gao F, Chai N, Linghu E. Melanosis coli: a contrast effect or an oncogenic effect? A large-scale retrospective cohort study. Int J Colorectal Dis 2023; 38:63. [PMID: 36884096 DOI: 10.1007/s00384-023-04357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Melanosis coli is characterized by brown mucosa with pigmentation. Studies have showed an increased adenoma detection rate in melanosis patients, whether it is caused by a contrast effect or an oncogenic effect is still controversial. The detection of serrated polys in melanosis patients remains unknown. AIMS The study aimed to clarify the correlation of adenoma detection rate with melanosis coli and discuss outcomes in less-experienced endoscopists. Serrated polyp detection rate was also been investigated. METHODS A total of 2150 patients and 39,630 controls were enrolled. A propensity score matching method was used to balance covariates between the two groups. The detection of polyps, adenomas, serrated polyps, and their features was analyzed. RESULTS The polyp detection rate (44.65% vs 41.01%, P = 0.005) and adenoma detection rate (30.34% vs 23.92%, P < 0.001) were significantly higher, and the serrated polyp detection rate (0.93% vs 1.58%, P = 0.033) was significantly lower in melanosis coli. The percentage of low-risk adenomas (44.60% vs 39.16%, P < 0.001) and polyps with 6 to 10 mm in size (20.16% vs 16.21%, P < 0.001) were higher in melanosis coli. The detection of large serrated polyps was lower (0.11% vs 0.41%, P = 0.026) in melanosis coli. CONCLUSION Melanosis coli correlates with an increased adenoma detection rate. The detection of large serrated polyps was lower in melanosis patients. Melanosis coli may not be considered a precancerous lesion.
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Affiliation(s)
- Yan Wang
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Longsong Li
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Xiaotong Niu
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Fei Gao
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China.
| | - Enqiang Linghu
- Nankai University School of Medicine, Nankai University, Tianjin, 300071, China.
- Department of Gastroenterology, the First Medical Center of PLA General Hospital, Beijing, 100853, China.
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Young EJ, Rajandran A, Philpott HL, Sathananthan D, Hoile SF, Singh R. Mucosal imaging in colon polyps: New advances and what the future may hold. World J Gastroenterol 2022; 28:6632-6661. [PMID: 36620337 PMCID: PMC9813932 DOI: 10.3748/wjg.v28.i47.6632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/23/2022] [Accepted: 11/23/2022] [Indexed: 12/19/2022] Open
Abstract
An expanding range of advanced mucosal imaging technologies have been developed with the goal of improving the detection and characterization of lesions in the gastrointestinal tract. Many technologies have targeted colorectal neoplasia given the potential for intervention prior to the development of invasive cancer in the setting of widespread surveillance programs. Improvement in adenoma detection reduces miss rates and prevents interval cancer development. Advanced imaging technologies aim to enhance detection without significantly increasing procedural time. Accurate polyp characterisation guides resection techniques for larger polyps, as well as providing the platform for the “resect and discard” and “do not resect” strategies for small and diminutive polyps. This review aims to collate and summarise the evidence regarding these technologies to guide colonoscopic practice in both interventional and non-interventional endoscopists.
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Affiliation(s)
- Edward John Young
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Arvinf Rajandran
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
| | - Hamish Lachlan Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Dharshan Sathananthan
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Sophie Fenella Hoile
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
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Díaz-Tasende J. Colonoscopy - When quality matters. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:314-316. [PMID: 35638771 DOI: 10.17235/reed.2022.8942/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Colonoscopy technical quality is a primary determinant of clinical outcome. Unfortunately, there is enough evidence available for significant variability in endoscopists' performance. An assessment of the factors determining these differences will be crucial for designing measures to ensure effectiveness and safety in these procedures.
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Lee A, Tutticci N. Enhancing polyp detection: technological advances in colonoscopy imaging. Transl Gastroenterol Hepatol 2021; 6:61. [PMID: 34805583 DOI: 10.21037/tgh.2020.02.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/27/2022] Open
Abstract
The detection and removal of polyps at colonoscopy is core to the current colorectal cancer (CRC) prevention strategy. However, colonoscopy is flawed with a well described miss rate and variability in detection rates associated with incomplete protection from CRC. Consequently, there is significant interest in techniques and technologies which increase polyp detection with the aim to remedy colonoscopy's ills. Technologic advances in colonoscope imaging are numerous and include; increased definition of imaging, widening field of view, virtual technologies to supplant conventional chromocolonoscopy (CC) and now computer assisted detection. However, despite nearly two decades of technologic advances, data on gains in detection from individual technologies have been modest at best and heterogenous and conflicted as a rule. This state of detection technology science is exacerbated by use of relatively blunt metrics of improvement without consensus, the myopic search for gains over single generations of technology improvement and an unhealthy focus on adenomatous lesions. Yet there remains cause for optimism as detection gains from new technology, while small, may still improve CRC prevention. The technologies are also readily available in current generation colonoscopes and have roles beyond simply detection such as lesion characterization, further improving their worth. Coupled with the imminent expansion of computer assisted detection the detection future from colonoscope imaging advances looks bright. This review aims to cover the major imaging advances and evidence for improvement in polyp detection.
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Affiliation(s)
- Antonio Lee
- Endoscopy Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
| | - Nicholas Tutticci
- Endoscopy Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
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6
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Viscaino M, Torres Bustos J, Muñoz P, Auat Cheein C, Cheein FA. Artificial intelligence for the early detection of colorectal cancer: A comprehensive review of its advantages and misconceptions. World J Gastroenterol 2021; 27:6399-6414. [PMID: 34720530 PMCID: PMC8517786 DOI: 10.3748/wjg.v27.i38.6399] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/26/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) was the second-ranked worldwide type of cancer during 2020 due to the crude mortality rate of 12.0 per 100000 inhabitants. It can be prevented if glandular tissue (adenomatous polyps) is detected early. Colonoscopy has been strongly recommended as a screening test for both early cancer and adenomatous polyps. However, it has some limitations that include the high polyp miss rate for smaller (< 10 mm) or flat polyps, which are easily missed during visual inspection. Due to the rapid advancement of technology, artificial intelligence (AI) has been a thriving area in different fields, including medicine. Particularly, in gastroenterology AI software has been included in computer-aided systems for diagnosis and to improve the assertiveness of automatic polyp detection and its classification as a preventive method for CRC. This article provides an overview of recent research focusing on AI tools and their applications in the early detection of CRC and adenomatous polyps, as well as an insightful analysis of the main advantages and misconceptions in the field.
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Affiliation(s)
- Michelle Viscaino
- Department of Electronic Engineering, Universidad Tecnica Federico Santa Maria, Valpaiso 2340000, Chile
| | - Javier Torres Bustos
- Department of Electronic Engineering, Universidad Tecnica Federico Santa Maria, Valpaiso 2340000, Chile
| | - Pablo Muñoz
- Hospital Clinico, University of Chile, Santiago 8380456, Chile
| | - Cecilia Auat Cheein
- Facultad de Medicina, Universidad Nacional de Santiago del Estero, Santiago del Estero 4200, Argentina
| | - Fernando Auat Cheein
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaiso 2340000, Chile
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Katsumata R, Manabe N, Fujita M, Ayaki M, Sunago A, Kamada T, Monobe Y, Kawamoto H, Haruma K. Colorectal neoplasms in melanosis coli: a survey in Japan and a worldwide meta-analysis. Int J Colorectal Dis 2021; 36:2177-2188. [PMID: 34156546 DOI: 10.1007/s00384-021-03970-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The association between melanosis coli (MC) and colorectal neoplasms remains unclear. Thus, we primarily aimed to clarify the epidemiology of MC in the Japanese population, identify the relationship between the use of anthranoids and MC, and determine the prevalence of detected intestinal lesions in patients with MC. We subsequently conducted a meta-analysis of published data, including our results, to summarize the influence of MC on the prevalence of colonic neoplasms. METHODS We conducted a retrospective survey in Japan to investigate the effects of MC on intestinal disorders. The prevalence of colorectal neoplasms and ileal ulcers was evaluated by colonoscopy, and the clinical characteristics of the participants were investigated using an electronic database. Odds ratios for colorectal neoplasms were calculated. We also performed a meta-analysis using Review Manager to reveal the comprehensive relationship between MC and colorectal neoplasms. RESULTS We enrolled 690 Japanese participants in the primary study. The prevalence of regular anthranoid use was significantly higher in the MC group than in the control group (50.9% vs. 6.5%, p < 0.01). Hyperplastic/inflammatory polyps and adenomas were more frequently detected in the MC group than in the control group. In a meta-analysis of five studies, a significantly higher prevalence of hyperplastic/inflammatory polyps and adenomas was reported in the MC group than in the control group, while the incidence of adenocarcinoma was not significantly different between the two groups. CONCLUSION Although hyperplastic polyps and adenomas were more frequently detected in MC patients, MC was not associated with an elevated risk of colorectal cancer.
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Affiliation(s)
- Ryo Katsumata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan
| | - Noriaki Manabe
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan.
| | - Minoru Fujita
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan
| | - Maki Ayaki
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange Kita-ku, Okayama City, Okayama, 7008505, Japan
| | - Aya Sunago
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yasumasa Monobe
- Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
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Abstract
Mortality from colorectal cancer is reduced through screening and early detection; moreover, removal of neoplastic lesions can reduce cancer incidence. While understanding of the risk factors, pathogenesis, and precursor lesions of colorectal cancer has advanced, the cause of the recent increase in cancer among young adults is largely unknown. Multiple invasive, semi- and non-invasive screening modalities have emerged over the past decade. The current emphasis on quality of colonoscopy has improved the effectiveness of screening and prevention, and the role of new technologies in detection of neoplasia, such as artificial intelligence, is rapidly emerging. The overall screening rates in the US, however, are suboptimal, and few interventions have been shown to increase screening uptake. This review provides an overview of colorectal cancer, the current status of screening efforts, and the tools available to reduce mortality from colorectal cancer.
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Affiliation(s)
- Priyanka Kanth
- Division of Gastroenterology, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - John M Inadomi
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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Joseph J, LePage EM, Cheney CP, Pawa R. Artificial intelligence in colonoscopy. World J Gastroenterol 2021; 27:4802-4817. [PMID: 34447227 PMCID: PMC8371500 DOI: 10.3748/wjg.v27.i29.4802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer remains a leading cause of morbidity and mortality in the United States. Advances in artificial intelligence (AI), specifically computer aided detection and computer-aided diagnosis offer promising methods of increasing adenoma detection rates with the goal of removing more pre-cancerous polyps. Conversely, these methods also may allow for smaller non-cancerous lesions to be diagnosed in vivo and left in place, decreasing the risks that come with unnecessary polypectomies. This review will provide an overview of current advances in the use of AI in colonoscopy to aid in polyp detection and characterization as well as areas of developing research.
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Affiliation(s)
- Joel Joseph
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - Ella Marie LePage
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, United States
| | - Catherine Phillips Cheney
- Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC 27157, United States
| | - Rishi Pawa
- Department of Internal Medicine, Section of Gastroenterology and Hepatology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, United States
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Seppälä TT, Latchford A, Negoi I, Sampaio Soares A, Jimenez-Rodriguez R, Sánchez-Guillén L, Evans DG, Ryan N, Crosbie EJ, Dominguez-Valentin M, Burn J, Kloor M, Knebel Doeberitz MV, Duijnhoven FJBV, Quirke P, Sampson JR, Møller P, Möslein G. European guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender. Br J Surg 2021; 108:484-498. [PMID: 34043773 PMCID: PMC10364896 DOI: 10.1002/bjs.11902] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/16/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lynch syndrome is the most common genetic predisposition for hereditary cancer but remains underdiagnosed. Large prospective observational studies have recently increased understanding of the effectiveness of colonoscopic surveillance and the heterogeneity of cancer risk between genotypes. The need for gene- and gender-specific guidelines has been acknowledged. METHODS The European Hereditary Tumour Group (EHTG) and European Society of Coloproctology (ESCP) developed a multidisciplinary working group consisting of surgeons, clinical and molecular geneticists, pathologists, epidemiologists, gastroenterologists, and patient representation to conduct a graded evidence review. The previous Mallorca guideline format was used to revise the clinical guidance. Consensus for the guidance statements was acquired by three Delphi voting rounds. RESULTS Recommendations for clinical and molecular identification of Lynch syndrome, surgical and endoscopic management of Lynch syndrome-associated colorectal cancer, and preventive measures for cancer were produced. The emphasis was on surgical and gastroenterological aspects of the cancer spectrum. Manchester consensus guidelines for gynaecological management were endorsed. Executive and layperson summaries were provided. CONCLUSION The recommendations from the EHTG and ESCP for identification of patients with Lynch syndrome, colorectal surveillance, surgical management of colorectal cancer, lifestyle and chemoprevention in Lynch syndrome that reached a consensus (at least 80 per cent) are presented.
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Affiliation(s)
- T T Seppälä
- Department of Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland.,Department of Surgical Oncology, Johns Hopkins Hospital, Baltimore Maryland, USA
| | - A Latchford
- Department of Cancer and Surgery, Imperial College London, UK.,St Mark's Hospital, London North West Healthcare NHS Trust, London, UK
| | - I Negoi
- Department of Surgery, Emergency Hospital of Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - R Jimenez-Rodriguez
- Department of Surgery, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - L Sánchez-Guillén
- Colorectal Unit, Department of General Surgery, Elche University General Hospital Elche, Alicante, Spain
| | - D G Evans
- Manchester Centre for Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester University Hospitals NHS Foundation Trust, UK
| | - N Ryan
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK.,Centre for Academic Women's Health, University of Bristol, Bristol, UK
| | - E J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary's Hospital, Manchester, UK
| | - M Dominguez-Valentin
- Department of Tumour Biology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - J Burn
- Faculty of Medical Sciences, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - M Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Germany.,Cooperation Unit Applied Tumour Biology, German Cancer Research Centre, Heidelberg, Germany
| | - M von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Germany.,Cooperation Unit Applied Tumour Biology, German Cancer Research Centre, Heidelberg, Germany
| | - F J B van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - P Quirke
- Pathology and Data Analytics, School of Medicine, University of Leeds, Leeds, UK
| | - J R Sampson
- Institute of Medical Genetics, Division of Cancer and Genetics, Cardiff University School of Medicine, Heath Park, Cardiff, UK
| | - P Møller
- Department of Tumour Biology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,University of Witten/Herdecke, Witten, Germany
| | - G Möslein
- Centre for Hereditary Tumours, Bethesda Hospital, Duisburg, Germany.,University of Witten/Herdecke, Witten, Germany
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Ham NS, Myung SJ. Endoscopic molecular imaging in inflammatory bowel disease. Intest Res 2021; 19:33-44. [PMID: 32299156 PMCID: PMC7873406 DOI: 10.5217/ir.2019.09175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
Molecular imaging is a technique for imaging the processes occurring in a living body at a molecular level in real-time, combining molecular cell biology with advanced imaging technologies using molecular probes and fluorescence. Gastrointestinal endoscopic molecular imaging shows great promise for improving the identification of neoplasms, providing characterization for patient stratification and assessing the response to molecular targeted therapy. In inflammatory bowel disease, endoscopic molecular imaging can be used to assess disease severity and predict therapeutic response and prognosis. Endoscopic molecular imaging is also able to visualize dysplasia in the presence of background inflammation. Several preclinical and clinical trials have evaluated endoscopic molecular imaging; however, this area is just beginning to evolve, and many issues have not been solved yet. In the future, it is expected that endoscopic molecular imaging will be of increasing interest among clinicians as a new technology for the identification and evaluation of colorectal neoplasm and colitis-associated cancer.
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Affiliation(s)
- Nam Seok Ham
- Department of Gastroenterology, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Digestive Diseases Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Correspondence to Seung-Jae Myung, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3917, Fax: +82-2- 476-0824, E-mail:
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12
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Shandro BM, Emrith K, Slabaugh G, Poullis A, Smith ML. Optical imaging technology in colonoscopy: Is there a role for photometric stereo? World J Gastrointest Endosc 2020; 12:138-148. [PMID: 32477448 PMCID: PMC7243575 DOI: 10.4253/wjge.v12.i5.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer. However, up to a third of adenomas may be missed at colonoscopy, and the majority of post-colonoscopy colorectal cancers are thought to arise from these. Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa. However, these topographic features are not enhanced by white light colonoscopy, and the endoscopist must infer these from two-dimensional cues. This may contribute to the number of missed lesions. A variety of optical imaging technologies have been developed commercially to enhance surface topography. However, existing techniques enhance surface topography indirectly, and in two dimensions, and the evidence does not wholly support their use in routine clinical practice. In this narrative review, co-authored by gastroenterologists and engineers, we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate, and review the development of photometric stereo (PS) for colonoscopy. PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography. This imaging technique has several potential clinical applications in colonoscopy, including adenoma detection, polyp classification, and facilitating polypectomy, an inherently three-dimensional task. However, the development of PS for colonoscopy is at an early stage. We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.
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Affiliation(s)
- Benjamin M Shandro
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Khemraj Emrith
- Centre for Machine Vision, University of the West of England, Bristol BS16 1QY, United Kingdom
| | - Gregory Slabaugh
- Department of Computer Science, City, University of London, London EC1V 0HB, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Melvyn L Smith
- Centre for Machine Vision, University of the West of England, Bristol BS16 1QY, United Kingdom
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13
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Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, Ilyas M, Kaur A, Lalloo F, Latchford A, Rutter MD, Tomlinson I, Thomas HJW, Hill J. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG). Gut 2020; 69:411-444. [PMID: 31780574 PMCID: PMC7034349 DOI: 10.1136/gutjnl-2019-319915] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/25/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual's lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.
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Affiliation(s)
- Kevin J Monahan
- Family Cancer Clinic, St Mark's Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - Nicola Bradshaw
- Clinical Genetics, West of Scotland Genetics Services, Glasgow, Glasgow, UK
| | - Sunil Dolwani
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, UK
| | - Bianca Desouza
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Mohammad Ilyas
- Faculty of Medicine & Health Sciences, Nottingham University, Nottingham, UK
| | - Asha Kaur
- Head of Policy and Campaigns, Bowel Cancer UK, London, UK
| | - Fiona Lalloo
- Genetic Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | | | - Matthew D Rutter
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ian Tomlinson
- Nuffield Department of Clinical Medicine, Wellcome Trust Centre for Human Genetics, Birmingham, UK
- Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - Huw J W Thomas
- Family Cancer Clinic, St Mark's Hospital, London, UK
- Faculty of Medicine, Imperial College, London, UK
| | - James Hill
- Genetic Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK
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14
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O’Morain NR, Syafiq MI, Shahin A, Ryan B, Crowther S, McNamara D. Dye-based chromoendoscopy following polypectomy reduces incomplete polyp resection. Endosc Int Open 2020; 8:E13-E19. [PMID: 31921979 PMCID: PMC6949170 DOI: 10.1055/a-1024-3759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 07/29/2019] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The completeness of a polyp resection is an important determinant of quality in colonoscopy, and may reduce incidence of interval cancers. Incomplete resection rates (IRR) vary widely and range from 6.5 % to 22.7 %. Residual disease is more likely with larger polyps, for sessile serrated adenomas, and with more proximal lesions. Chromoendoscopy is increasingly employed in lesion detection. The aims of this study were to assess local IRR, and to determine whether chromoendoscopy could correctly identify residual disease post polypectomy. Patients and methods This was a prospective study examining post polypectomy sites. Chromoendoscopy (0.13 % indigo carmine) was applied to resection bases to identify residual disease. Targeted base biopsies were taken from identified residual disease (positive group) or random base biopsies were taken when a clear base was visualised (negative group). Overall rates of incomplete resection were documented. Reported rates post chromoendoscopy and actual histological rates were documented and compared. Results A total of 102 polyps were identified for inclusion, of which 15 % (n = 16) were excluded. Resection quality was evaluated in 86 polyps of 61 patients (female n = 33 54 %; mean Age 62.3 years). Polyps were mainly removed by cold snare (n = 71, 82.5 %). Most polyps (n = 58, 67 %) measured between 5 to 10 mm. Polyps were largely located in the right colon (n = 57, 66 %). Overall histological residual disease occurred in 17 /86 (19.6 %). Chromoendoscopy correctly identified residual disease in 13 of 17 bases (76.5 %). Only four of /86 (4.6 %) of polyp bases were missclassified post-chromoendoscopy (odds ratio 0.284 (95 % CI 0.0857-0.9409), P = 0.03). Conclusion Indigo carmine chromoendoscopy improves early detection of residual disease post polypectomy, reducing incomplete resection rates.
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Affiliation(s)
- Neil R. O’Morain
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
| | - Mohd I. Syafiq
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
| | - Ammar Shahin
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin
| | - Barbara Ryan
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
| | - Stephen Crowther
- Department of Histopathology, Tallaght University Hospital, Trinity College Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology and Clinical Medicine, Tallaght University Hospital, Trinity College Dublin,Trinity Academic Gastroenterology Group, Tallaght University Hospital, Trinity College Dublin
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15
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Rogalla S, Flisikowski K, Gorpas D, Mayer AT, Flisikowska T, Mandella MJ, Ma X, Casey KM, Felt SA, Saur D, Ntziachristos V, Schnieke A, Contag CH, Gambhir SS, Harmsen S. Biodegradable fluorescent nanoparticles for endoscopic detection of colorectal carcinogenesis. ADVANCED FUNCTIONAL MATERIALS 2019; 29:1904992. [PMID: 33041743 PMCID: PMC7546531 DOI: 10.1002/adfm.201904992] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Early and comprehensive endoscopic detection of colonic dysplasia - the most clinically significant precursor lesion to colorectal adenocarcinoma - provides an opportunity for timely, minimally-invasive intervention to prevent malignant transformation. Here, the development and evaluation of biodegradable near-infrared fluorescent silica nanoparticles (FSN) is described that have the potential to improve adenoma detection during fluorescence-assisted white-light colonoscopic surveillance in rodent and human-scale models of colorectal carcinogenesis. FSNs are biodegradable (t1/2 of 2.7 weeks), well-tolerated, and enable detection and delineation of adenomas as small as 0.5 mm2 with high tumor-to-background ratios. Furthermore, in the human-scale, APC 1311/+ porcine model, the clinical feasibility and benefit of using FSN-guided detection of colorectal adenomas using video-rate fluorescence-assisted white-light endoscopy is demonstrated. Since nanoparticles of similar size (e.g., 100-150-nm) or composition (i.e., silica, silica/gold hybrid) have already been successfully translated to the clinic, and, clinical fluorescent/white light endoscopy systems are becoming more readily available, there is a viable path towards clinical translation of the proposed strategy for early colorectal cancer detection and prevention in high-risk patients.
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Affiliation(s)
- Stephan Rogalla
- Molecular Imaging Program at Stanford University (MIPS), Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Medicine (Gastroenterology & Hepatology), Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Krzysztof Flisikowski
- Chair of Livestock Biotechnology, Technische Universität München, Liesel-Beckmann Str. 1, D-85354 Freising, Germany
| | - Dimitris Gorpas
- Helmholtz Zentrum München, German Researcg Center for Environmental Health, Institute of Biological and Medical Imaging, Ingolstädter Landstr. 1, D-85764, Neuherberg, Germany
- Chair of Biological Imaging, TranslaTUM, Technische Universität München, Einsteinstr. 25, 81675, München, Germany
| | - Aaron T. Mayer
- Molecular Imaging Program at Stanford University (MIPS), Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Bioengineering, Department of Materials Science & Engineering, Stanford University, Stanford, CA 94305, USA
| | - Tatiana Flisikowska
- Chair of Livestock Biotechnology, Technische Universität München, Liesel-Beckmann Str. 1, D-85354 Freising, Germany
| | - Michael J. Mandella
- Molecular Imaging Program at Stanford University (MIPS), Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Institute for Quantitative Health Science and Engineering, Department of Biomedical Engineering, Michigan State University, 775 Woodlot Dr., East Lansing, MI 48824, USA
| | - Xiaopeng Ma
- Helmholtz Zentrum München, German Researcg Center for Environmental Health, Institute of Biological and Medical Imaging, Ingolstädter Landstr. 1, D-85764, Neuherberg, Germany
- Chair of Biological Imaging, TranslaTUM, Technische Universität München, Einsteinstr. 25, 81675, München, Germany
| | - Kerriann M. Casey
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Stephen A. Felt
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dieter Saur
- Department of Internal Medicine II, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Vasilis Ntziachristos
- Helmholtz Zentrum München, German Researcg Center for Environmental Health, Institute of Biological and Medical Imaging, Ingolstädter Landstr. 1, D-85764, Neuherberg, Germany
- Chair of Biological Imaging, TranslaTUM, Technische Universität München, Einsteinstr. 25, 81675, München, Germany
| | - Angelika Schnieke
- Chair of Livestock Biotechnology, Technische Universität München, Liesel-Beckmann Str. 1, D-85354 Freising, Germany
| | - Christopher H. Contag
- Corresponding Authors: Prof. C. H. Contag , Prof. S. S. Gambhir , and Dr. S. Harmsen
| | - Sanjiv S. Gambhir
- Corresponding Authors: Prof. C. H. Contag , Prof. S. S. Gambhir , and Dr. S. Harmsen
| | - Stefan Harmsen
- Corresponding Authors: Prof. C. H. Contag , Prof. S. S. Gambhir , and Dr. S. Harmsen
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16
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Terlouw D, Suerink M, Singh SS, Gille HJJP, Hes FJ, Langers AMJ, Morreau H, Vasen HFA, Vos YJ, van Wezel T, Tops CM, Ten Broeke SW, Nielsen M. Declining detection rates for APC and biallelic MUTYH variants in polyposis patients, implications for DNA testing policy. Eur J Hum Genet 2019; 28:222-230. [PMID: 31527860 DOI: 10.1038/s41431-019-0509-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 12/16/2022] Open
Abstract
This study aimed to determine the prevalence of APC-associated familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP) in a large cohort, taking into account factors as adenoma count and year of diagnosis. All application forms used to send patients in for APC and MUTYH variant analysis between 1992 and 2017 were collected (n = 2082). Using the data provided on the application form, the APC and biallelic MUTYH prevalence was determined and possible predictive factors were examined using multivariate multinomial logistic regression analysis in SPSS. The prevalence of disease causing variants in the APC gene significantly increases with adenoma count while MAP shows a peak prevalence in individuals with 50-99 adenomas. Logistic regression analysis shows significant odds ratios for adenoma count, age at diagnosis, and, interestingly, a decline in the chance of finding a variant in either gene over time. Moreover, in 22% (43/200) of patients with FAP-related extracolonic manifestations a variant was identified. The overall detection rates are above 10% for patients with >10 adenomas aged <60 and >20 adenomas aged <70. Patients with variants outside these criteria had FAP-related extracolonic manifestations, colorectal cancer aged <40, somatic KRAS c.34G > T variant in the tumor or a first-degree relative with >10 adenomas. Therefore, APC and MUTYH testing in patients with >10 adenomas aged <60 and with >20 adenomas aged <70 is advised. Almost all FAP and MAP patients not meeting these criteria showed other characteristics that can be used as an indication to prompt genetic testing.
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Affiliation(s)
- Diantha Terlouw
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Manon Suerink
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sunny S Singh
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hans J J P Gille
- Department of Clinical Genetics, VUMC, Amsterdam, the Netherlands
| | - Frederik J Hes
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra M J Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans Morreau
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.,The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, the Netherlands
| | - Yvonne J Vos
- Department of Clinical Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Tom van Wezel
- Department of Pathology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carli M Tops
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sanne W Ten Broeke
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maartje Nielsen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.
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17
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Sano Y, Chiu H, Li X, Khomvilai S, Pisespongsa P, Co JT, Kawamura T, Kobayashi N, Tanaka S, Hewett DG, Takeuchi Y, Imai K, Utsumi T, Teramoto A, Hirata D, Iwatate M, Singh R, Ng SC, Ho S, Chiu P, Tajiri H. Standards of diagnostic colonoscopy for early-stage neoplasia: Recommendations by an Asian private group. Dig Endosc 2019; 31:227-244. [PMID: 30589103 PMCID: PMC6850515 DOI: 10.1111/den.13330] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/24/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM In recent years, the incidence of colorectal cancer has been increasing, and it is now becoming the major cause of cancer death in Asian countries. The aim of the present study was to develop Asian expert-based consensus to standardize the preparation, detection and characterization for the diagnosis of early-stage colorectal neoplasia. METHODS A professional group was formed by 36 experts of the Asian Novel Bio-Imaging and Intervention Group (ANBI2 G) members. Representatives from 12 Asia-Pacific countries participated in the meeting. The group organized three consensus meetings focusing on diagnostic endoscopy for gastrointestinal neoplasia. The Delphi method was used to develop the consensus statements. RESULTS Through the three consensus meetings with debating, reviewing the literature and regional data, a consensus was reached at third meeting in 2016. The consensus was reached on a total of 10 statements. Summary of statements is as follows: (i) Adequate bowel preparation for high-quality colonoscopy; (ii) Antispasmodic agents for lesion detection; (iii) Image-enhanced endoscopy (IEE) for polyp detection; (iv) Adenoma detection rate for quality indicators; (v) Good documentation of colonoscopy findings; (vi) Complication rates; (vii) Cecal intubation rate; (viii) Cap-assisted colonoscopy (CAC) for polyp detection; (ix) Macroscopic classification using indigocarmine spray for characterization of colorectal lesions; and (x) IEE and/or magnifying endoscopy for prediction of histology. CONCLUSION This consensus provides guidance for carrying out endoscopic diagnosis and characterization for early-stage colorectal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early-stage colorectal neoplasia.
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Affiliation(s)
- Yasushi Sano
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Han‐Mo Chiu
- Department of Internal MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Xiao‐bo Li
- Division of Gastroenterology and HepatologyKey Laboratory of Gastroenterology and HepatologyMinistry of HealthRenji HospitalSchool of MedicineShanghai Institute of Digestive DiseaseShanghai Jiao Tong UniversityShanghaiChina
| | - Supakij Khomvilai
- Surgical EndoscopyColorectal SurgeryDepartment of SurgeryChulalongkorn UniversityBangkokThailand
| | - Pises Pisespongsa
- Digestive Disease CenterBumrungrad International HospitalBangkokThailand
| | - Jonard Tan Co
- St. Luke's Medical Centre ‐ Global CityTaguig City, Metro ManilaPhilippines
| | - Takuji Kawamura
- Department of GastroenterologyKyoto Second Red Cross HospitalKyotoJapan
| | | | - Shinji Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - David G. Hewett
- Faculty of MedicineUniversity of QueenslandBrisbaneAustralia
| | - Yoji Takeuchi
- Department of Gastrointestinal OncologyOsaka International Cancer InstituteOsakaJapan
| | - Kenichiro Imai
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Takahiro Utsumi
- Department of Gastroenterology and HepatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Akira Teramoto
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Daizen Hirata
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Mineo Iwatate
- Gastrointestinal Center and Institute of Minimally invasive Endoscopic Care (iMEC)Sano HospitalHyogo
| | - Rajvinder Singh
- Gastroenterology UnitDivision of MedicineLyell McEwin HospitalSchool of MedicineThe University of AdelaideAdelaideAustralia
| | - Siew C. Ng
- Departments of Medicine and TherapeuticsInstitute of Digestive DiseaseState Key Laboratory of Digestive DiseasesLKS Institute of Health ScienceThe Chinese University of Hong KongHong KongChina
| | - Shiaw‐Hooi Ho
- Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Philip Chiu
- SurgeryInstitute of Digestive DiseaseState Key Laboratory of Digestive DiseasesLKS Institute of Health ScienceThe Chinese University of Hong KongHong KongChina
| | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy ResearchThe Jikei University School of MedicineTokyoJapan
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18
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Li H, Hou X, Lin R, Fan M, Pang S, Jiang L, Liu Q, Fu L. Advanced endoscopic methods in gastrointestinal diseases: a systematic review. Quant Imaging Med Surg 2019; 9:905-920. [PMID: 31281783 DOI: 10.21037/qims.2019.05.16] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopic imaging is the main method for detecting gastrointestinal diseases, which adversely affect human health. White light endoscopy (WLE) was the first method used for endoscopic examination and is still the preliminary step in the detection of gastrointestinal diseases during clinical examination. However, it cannot accurately diagnose gastrointestinal diseases owing to its poor correlation with histopathological diagnosis. In recent years, many advanced endoscopic methods have emerged to improve the detection accuracy by endoscopy. Chromoendoscopy (CE) enhances the contrast between normal and diseased tissues using biocompatible dye agents. Narrow band imaging (NBI) can improve the contrast between capillaries and submucosal vessels by changing the light source acting on the tissue using special filters to realize the visualization of the vascular structure. Flexible spectral imaging color enhancement (FICE) technique uses the reflectance spectrum estimation technique to obtain individual spectral images and reconstructs an enhanced image of the mucosal surface using three selected spectral images. The i-Scan technology takes advantage of the different reflective properties of normal and diseased tissues to obtain images, and enhances image contrast through post-processing algorithms. These abovementioned methods can be used to detect gastrointestinal diseases by observing the macroscopic structure of the digestive tract mucosa, but the ability of early cancer detection is limited with low resolution. However, based on the principle of confocal imaging, probe-based confocal laser endomicroscopy (pCLE) can enable cellular visualization with high-performance probes, which can present cellular morphology that is highly consistent with that shown by biopsy to provide the possibility of early detection of cancer. Other endoscopic imaging techniques including endoscopic optical coherence tomography (EOCT) and photoacoustic endoscopy (PAE), are also promising for diagnosing gastrointestinal diseases. This review focuses on these technologies and aims to provide an overview of different technologies and their clinical applicability.
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Affiliation(s)
- Hua Li
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China.,MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xiaohua Hou
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rong Lin
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mengke Fan
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Suya Pang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Longjie Jiang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China.,MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Qian Liu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China.,MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ling Fu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China.,MoE Key Laboratory for Biomedical Photonics, School of Engineering Sciences, Huazhong University of Science and Technology, Wuhan 430074, China
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19
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Kumagai H, Yamada K, Nakai K, Kitamura T, Mohri K, Ukawa M, Tomono T, Eguchi T, Yoshizaki T, Fukuchi T, Yoshino T, Matsuura M, Tobita E, Pham W, Nakase H, Sakuma S. Tumor recognition of peanut agglutinin-immobilized fluorescent nanospheres in biopsied human tissues. Eur J Pharm Biopharm 2019; 136:29-37. [PMID: 30639308 PMCID: PMC6456895 DOI: 10.1016/j.ejpb.2019.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/21/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
We are investigating an imaging agent for early detection of colorectal cancer. The agent, named the nanobeacon, is coumarin 6-encapsulated polystyrene nanospheres whose surfaces are covered with poly(N-vinylacetamide) and peanut agglutinin that reduces non-specific interactions with the normal mucosa and exhibits high affinity for terminal sugars of the Thomsen-Friedenreich antigen, which is expressed cancer-specifically on the mucosa, respectively. We expect that cancer can be diagnosed by detecting illumination of intracolonically administered nanobeacon on the mucosal surface. In the present study, biopsied human tissues were used to evaluate the potential use of the nanobeacon in the clinic. Prior to the clinical study, diagnostic capabilities of the nanobeacon for detection of colorectal cancer were validated using 20 production batches whose characteristics were fine-tuned chemically for the purpose. Ex vivo imaging studies on 66 normal and 69 cancer tissues removed from the colons of normal and orthotopic mouse models of human colorectal cancer, respectively, demonstrated that the nanobeacon detected colorectal cancer with excellent capabilities whose rates of true and false positives were 91% and 5%, respectively. In the clinical study, normal and tumor tissues on the large intestinal mucosa were biopsied endoscopically from 11 patients with colorectal tumors. Histological evaluation revealed that 9 patients suffered from cancer and the rest had adenoma. Mean fluorescence intensities of tumor tissues treated with the nanobeacon were significantly higher than those of the corresponding normal tissues. Correlation of magnitude relation of the intensity in individuals was observed in cancer patients with a high probability (89%); however, the probability reduced to 50% in adenoma patients. There was a reasonable likelihood for diagnosis of colorectal cancer by the nanobeacon applied to the mucosa of the large intestine.
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Affiliation(s)
- Hironori Kumagai
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan; Life Science Materials Laboratory, ADEKA Corp., Tokyo 116-8554, Japan
| | - Kosuke Yamada
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan
| | - Kanako Nakai
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan
| | - Tokio Kitamura
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan
| | - Kohta Mohri
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan
| | - Masami Ukawa
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan
| | - Takumi Tomono
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan
| | - Takaaki Eguchi
- Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Testuya Yoshizaki
- Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Takumi Fukuchi
- Department of Gastroenterology and Hepatology, Osakafu Saiseikai Nakatsu Hospital, Osaka 530-0012, Japan
| | - Takuya Yoshino
- Division of Inflammatory Bowel Disease, Digestive Disease Center, Tadzuki Kouhuukai Kitano Hospital, Osaka 534-8680, Japan
| | - Minoru Matsuura
- Division of Endoscopy, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Etsuo Tobita
- Life Science Materials Laboratory, ADEKA Corp., Tokyo 116-8554, Japan
| | - Wellington Pham
- Department of Radiology, Vanderbilt University Institute of Imaging Science, Nashville, TN 37232-2310, USA.
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo 060-0061, Japan.
| | - Shinji Sakuma
- Faculty of Pharmaceutical Sciences, Setsunan University, Hirakata 573-0101, Japan.
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20
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Dilly CK, Kahi CJ. Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be? Curr Gastroenterol Rep 2019; 21:9. [PMID: 30815756 DOI: 10.1007/s11894-019-0678-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Colorectal cancer (CRC) is largely preventable with colonoscopy and other screening modalities. However, the effectiveness of screening and surveillance depends on the quality of the colonoscopy exam. Adenoma detection rate (ADR) is the best-validated metric by which we measure individual physicians' performance. RECENT FINDINGS Recent evidence suggests that ADR benchmarks may be inappropriately low. There is proof that improving ADR leads to significant reductions in post-colonoscopy CRC (PCCRC). Two studies have demonstrated that when a colonoscopy is performed by physicians with higher ADRs, patients are less likely to have advanced adenomas on surveillance and less likely to develop or die from PCCRC. Finally, there is at least some evidence that higher ADRs do not lead to more cumulative surveillance exams. The ADR is a useful outcome measure that can provide individual endoscopists and their patients with information about the likelihood of developing PCCRC. To achieve the lowest possible PCCRC rate, we should be striving for higher ADRs. While strategies and innovations may help a bit in improving ADRs, our efforts should focus on ensuring a complete mucosal exam for each patient. Behavioral psychology theories may provide useful frameworks for studying motivating factors that drive a careful exam.
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Affiliation(s)
- Christen K Dilly
- Richard L. Roudebush VA Medical Center, 1481 Street, Indianapolis, IN, 46202, USA. .,Division of Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Charles J Kahi
- Richard L. Roudebush VA Medical Center, 1481 Street, Indianapolis, IN, 46202, USA.,Division of Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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21
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Lee HH, Lee BI. Image-Enhanced Endoscopy in Lower Gastrointestinal Diseases: Present and Future. Clin Endosc 2018; 51:534-540. [PMID: 30508878 PMCID: PMC6283767 DOI: 10.5946/ce.2018.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/14/2018] [Indexed: 12/28/2022] Open
Abstract
From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.
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Affiliation(s)
- Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Photomedicine Research Institute, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Catholic Photomedicine Research Institute, Seoul, Korea
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22
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Fan C, Younis A, Bookhout CE, Crockett SD. Management of Serrated Polyps of the Colon. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2018; 16:182-202. [PMID: 29445907 PMCID: PMC6284520 DOI: 10.1007/s11938-018-0176-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the management of serrated colorectal polyps (SPs), with a particular focus on the most common premalignant SP, sessile serrated adenoma or polyp (SSA/P). These lesions present a challenge for endoscopists with respect to detection and resection, and are also susceptible to pathologic misdiagnosis. RECENT FINDINGS Patients with SSA/Ps are at an increased risk of future colorectal neoplasia, including advanced polyps and cancer. Reasonable benchmarks for SP detection rates are 5-7% for SSA/Ps and 10-12% for proximal SPs. Certain endoscopic techniques such as chromoendoscopy, narrow band imaging, water immersion, and wide-angle viewing may improve SSA/P detection. Emerging endoscopic techniques such as underwater polypectomy, suction pseudopolyp technique, and piecemeal cold snare polypectomy are helpful tools for the endoscopist's armamentarium for removing SSA/Ps. Proper orientation of SSA/P specimens can improve the accuracy of pathology readings. Patients with confirmed SSA/Ps and proximal HPs should undergo surveillance at intervals similar to what is recommended for patients with conventional adenomas. Patients with SSA/Ps may also be able to lower their risk of future polyps by targeting modifiable risk factors including tobacco and alcohol use and high-fat diets. NSAIDs and aspirin appear to be protective agents. SPs and SSA/Ps in particular are important colorectal cancer precursors that merit special attention to ensure adequate detection, resection, and surveillance.
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Affiliation(s)
- Claire Fan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Adam Younis
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Christine E Bookhout
- Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, CB#7080, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
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23
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Ngu WS, Rees C. Can technology increase adenoma detection rate? Therap Adv Gastroenterol 2018; 11:1756283X17746311. [PMID: 29383029 PMCID: PMC5784538 DOI: 10.1177/1756283x17746311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/16/2017] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer is the third most common cancer worldwide and the second most common cause of cancer-related death in Europe and North America. Colonoscopy is the gold standard investigation for the colon but is not perfect, and small or flat adenomas can be missed which increases the risk of patients subsequently developing colorectal cancer. Adenoma detection rate is the most widely used marker of quality, and low rates are associated with increased rates of post-colonoscopy colorectal cancer. Standards of colonoscopy and adenoma detection vary widely between different endoscopists. Interventions to improve adenoma detection rate are therefore required. Many devices have been purported to increase adenoma detection rate. This review looks at current available evidence for device technology to improve adenoma detection rate during colonoscopy.
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Affiliation(s)
- Wee Sing Ngu
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Colin Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, NE34 0PL, UK
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24
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Maida M, Camilleri S, Manganaro M, Garufi S, Scarpulla G. New endoscopy advances to refine adenoma detection rate for colorectal cancer screening: None is the winner. World J Gastrointest Oncol 2017; 9:402-406. [PMID: 29085566 PMCID: PMC5648983 DOI: 10.4251/wjgo.v9.i10.402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the disease and it is mostly performed by colonoscopy. Anyway, effectiveness of endoscopic screening for CRC strictly depends on adequate detection and removal of potentially precancerous lesions, and accuracy of colonoscopy in detection of adenomas is still suboptimal. For this reason, several technological advances have been implemented in order to improve the diagnostic sensitivity of colonoscopy in adenoma detection. Among these: (1) Visual technologies such as chromoendoscopy and narrow band imaging; (2) optical innovation as high definition endoscopy, full-spectrum endoscopy or Third Eye Retroscope; and (3) mechanical advances as Cap assisted colonoscopy, Endocuff, Endoring and G-Eye endoscope. All these technologies advances have been tested over time by clinical studies with mixed results. Which of them is more likely to be successful in the next future?
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Affiliation(s)
- Marcello Maida
- Section of Gastroenterology, S. Elia - M. Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Salvatore Camilleri
- Section of Gastroenterology, S. Elia - M. Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Michele Manganaro
- Section of Gastroenterology, S. Elia - M. Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Serena Garufi
- Section of Gastroenterology, S. Elia - M. Raimondi Hospital, 93100 Caltanissetta, Italy
| | - Giuseppe Scarpulla
- Section of Gastroenterology, S. Elia - M. Raimondi Hospital, 93100 Caltanissetta, Italy
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25
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Allen JE, Sharma P. Polyp characterization at colonoscopy: Clinical implications. Best Pract Res Clin Gastroenterol 2017; 31:435-440. [PMID: 28842053 DOI: 10.1016/j.bpg.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/05/2017] [Indexed: 01/31/2023]
Abstract
Although advancements in endoscopic imaging of colorectal mucosa have outstripped the pace of research in the field, the potential clinical applications of these novel technologies are promising. Chief among these is the ability to diagnose colorectal polyps in vivo. This feature appears most applicable to diminuitive polyps, which have very little malignant potential yet represent over 70% of resected polyps. In an ideal application, the capability to predict diminutive hyperplastic polyp histology in vivo precludes the need for excision whereas dimunitive adenomas do require excision, but not necessarily histopathologic analysis if the diagnosis is made in vivo with adequate confidence. However, the vast array of new advanced imaging modalities and polyp classification tools have been difficult to reconcile. We aim to highlight the current status of real-time colorectal polyp diagnosis and identify the barriers that remain to its widespread implementation.
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Affiliation(s)
- James E Allen
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA
| | - Prateek Sharma
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, USA.
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26
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Matsuda T, Ono A, Sekiguchi M, Fujii T, Saito Y. Advances in image enhancement in colonoscopy for detection of adenomas. Nat Rev Gastroenterol Hepatol 2017; 14:305-314. [PMID: 28293023 DOI: 10.1038/nrgastro.2017.18] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High-quality colonoscopy is mandatory to prevent adenoma recurrence and colorectal cancer. In the past few years, technical advances have been developed with the purpose of improving adenoma detection rate (ADR), one of the most important validated colonoscopy quality benchmarks. Several techniques or devices are used to optimize visualization: observation techniques; add-on devices; auxiliary imaging devices; colonoscopes with increased field of view; and colonoscopes with an integrated inflatable reusable balloon. Image-enhanced endoscopy (IEE) facilitates the detection and characterization of polyps and especially nonpolypoid colorectal neoplasms. Indigo carmine is the most frequently used dye in colonoscopy as it deposits in depressed areas, improving detection of flat and depressed lesions. Virtual chromoendoscopy has emerged as an effective contrast enhancement technology without the limitation of preparing dyes and applying them through the colonoscope working channel. Narrow-band imaging (NBI) enhances the capillary pattern and surface of the mucosa using optical filters, and second-generation NBI provides a twofold brighter image than the previous system, yielding promising ADR results. Moreover, a second-generation blue laser imaging system, LASEREO, has been reported to improve not only polyp detection rate but also ADR, becoming a promising IEE modality. Herein, we describe technical advances in colonoscopy imaging and their effect on ADR.
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Affiliation(s)
- Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Akiko Ono
- Department of Gastroenterology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, El Palmar, 30128, Murcia, Spain
| | - Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
| | - Takahiro Fujii
- TF Clinic, 4-13-11 Ginza, Chuo-ku, Tokyo 104-0061, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
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27
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Abstract
OPINION STATEMENT The adenoma detection rate (ADR), i.e., the proportion of average risk patients with at least one adenoma detected during screening colonoscopy, is inversely associated with the development of interval colorectal cancer. Increasing the ADR is therefore an important proxy for increase in quality and efficacy of (screening) colonoscopy. Several potentially modifiable factors, such as, procedural and technological factors, and quality improvement programs, and their effect on the ADR will be reviewed. Procedural factors, such as, bowel preparation, withdrawal time, and position changes of the patient are associated with the ADR. While the relation of others, such as inspection during insertion, use of antispasmodic agents, and second inspection in the proximal colon, with the ADR is not completely clear. Many new colonoscopy technologies have been evaluated over recent years and are still under evaluation, but no unequivocal positive effect on the ADR has been observed in randomized trials that have mostly been performed by experienced endoscopists with high baseline ADRs. Several quality improvement programs have been evaluated and seem to have a positive effect on endoscopists' ADR. Increase in ADR is important for the protective benefit of colonoscopy. There are now extensive methods to measure, benchmark, and improve ADR but increased awareness of these is critical. We have provided an overview of potential factors that can be used to increase personal ADRs in every day practice.
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Affiliation(s)
- Eelco C Brand
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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