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Kawasaki K, Nakamura S, Eizuka M, Tanaka Y, Kumei T, Yanai S, Toya Y, Urushikubo J, Torisu T, Moriyama T, Umeno J, Sugai T, Matsumoto T. Is barium enema examination negligible for the management of colorectal cancer? Comparison with conventional colonoscopy and magnifying colonoscopy. Jpn J Radiol 2021; 39:1159-1167. [PMID: 34164768 DOI: 10.1007/s11604-021-01157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/12/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this investigation was to evaluate the clinical value of barium enema (BE) examination for the management of colorectal epithelial neoplasms. METHODS We reviewed the colonoscopy records at our institution from 2014 to 2019 and identified cases of endoscopically or surgically resected colorectal epithelial neoplasms evaluated by BE, conventional colonoscopy, magnifying narrow-band imaging colonoscopy (M-NBI), and magnifying chromoendoscopy (MCE). The yield of each modality for the diagnosis of massively submucosal invasive (mSM) colorectal cancer was evaluated by a receiver-operating characteristic analysis including the area under the curve (AUC). RESULTS We analyzed the records of 105 patients (17 adenomas, 53 high-grade dysplasias (HGDs), and 35 cancers). Smooth surface, irregularity in depression, and eccentric deformity on the profile view with BE were observed more frequently in mSM cancers than adenomas/HGDs/slightly submucosal invasive cancers (p < 0.01). The AUC of BE was 0.8355, the value of which was not different from the other three modalities (conventional colonoscopy 0.7678; M-NBI 0.7835; MCE 0.8376). Although the specificity, PPV, and accuracy of BE were lower than those of M-NBI and MCE, the sensitivity and NPV of BE were the highest among the four types of examinations. CONCLUSION BE is still available and may serve as a supplementary modality for the diagnosis of mSM cancers.
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Affiliation(s)
- Keisuke Kawasaki
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan. .,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Shotaro Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Yoshihito Tanaka
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Tomo Kumei
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Shunichi Yanai
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Jun Urushikubo
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiko Moriyama
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tamotsu Sugai
- Department of Diagnostic Pathology, Iwate Medical University, Yahaba, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba, 028-3695, Japan
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Tan EJ, Soh KC, Ngiam KY. Colonic architectural change on colonoscopy in patients taking psychotropic medications. Surg Endosc 2013; 27:1601-6. [PMID: 23076462 DOI: 10.1007/s00464-012-2636-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/23/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patients on psychotropic medications have been clinically observed to have higher rates of abnormal colonic architecture resulting in difficult colonoscopies. This study aims to determine if a correlation between use of psychotropic medications and colonic architectural change seen on colonoscopy exists. METHODS A retrospective case-control study was undertaken with 252 adults selected from the hospital endoscopy database between January 2006 and July 2008. Cases were selected if they had 'capacious', 'megacolon', 'redundant' and/or 'featureless' colonic architecture reported in their first completed colonoscopy (n = 63). Demographic information and medication records were collected for both cases and controls. Logistic regression analysis was performed for each of the medication groups. RESULTS Medication groups associated with increased incidence for colonic architectural changes observed during colonoscopy include: antipsychotic medications [odds ratio (OR) 7.79, confidence interval (CI) 2.59-23.41], benzhexol (OR 23.50, CI 2.83-195.08) and iron tablets (OR 2.97, CI 1.39-6.33). Antidepressants, laxatives, benzodiazepines, gastroprotective medications and antihypertensive medications were not found to have any significant effect on changes to colonic architecture. CONCLUSIONS Use of antipsychotic medications is associated with changes to colonic architecture. This could predispose such a patient to difficult colonoscopy and therefore increase colonoscopy-associated risks. Medication history should be elicited prior to colonoscopy.
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Affiliation(s)
- Eu Jin Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Baker ME, Bogoni L, Obuchowski NA, Dass C, Kendzierski RM, Remer EM, Einstein DM, Cathier P, Jerebko A, Lakare S, Blum A, Caroline DF, Macari M. Computer-aided detection of colorectal polyps: can it improve sensitivity of less-experienced readers? Preliminary findings. Radiology 2007; 245:140-9. [PMID: 17885187 DOI: 10.1148/radiol.2451061116] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine whether computer-aided detection (CAD) applied to computed tomographic (CT) colonography can help improve sensitivity of polyp detection by less-experienced radiologist readers, with colonoscopy or consensus used as the reference standard. MATERIALS AND METHODS The release of the CT colonographic studies was approved by the individual institutional review boards of each institution. Institutions from the United States were HIPAA compliant. Written informed consent was waived at all institutions. The CT colonographic studies in 30 patients from six institutions were collected; 24 images depicted at least one confirmed polyp 6 mm or larger (39 total polyps) and six depicted no polyps. By using an investigational software package, seven less-experienced readers from two institutions evaluated the CT colonographic images and marked or scored polyps by using a five-point scale before and after CAD. The time needed to interpret the CT colonographic findings without CAD and then to re-evaluate them with CAD was recorded. For each reader, the McNemar test, adjusted for clustered data, was used to compare sensitivities for readers without and with CAD; a Wilcoxon signed-rank test was used to analyze the number of false-positive results per patient. RESULTS The average sensitivity of the seven readers for polyp detection was significantly improved with CAD-from 0.810 to 0.908 (P=.0152). The number of false-positive results per patient without and with CAD increased from 0.70 to 0.96 (95% confidence interval for the increase: -0.39, 0.91). The mean total time for the readings was 17 minutes 54 seconds; for interpretation of CT colonographic findings alone, the mean time was 14 minutes 16 seconds; and for review of CAD findings, the mean time was 3 minutes 38 seconds. CONCLUSION Results of this feasibility study suggest that CAD for CT colonography significantly improves per-polyp detection for less-experienced readers.
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Affiliation(s)
- Mark E Baker
- Department of Radiology, the Cleveland Clinic Foundation, 9500 Euclid Ave, Hb6, Cleveland, OH 44195, USA.
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Rosman AS, Korsten MA. Meta-analysis comparing CT colonography, air contrast barium enema, and colonoscopy. Am J Med 2007; 120:203-210.e4. [PMID: 17349438 DOI: 10.1016/j.amjmed.2006.05.061] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2005] [Revised: 05/05/2006] [Accepted: 05/09/2006] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Published studies have reported a wide range of sensitivities and specificities for computed tomographic (CT) colonography for polyp detection, generating controversy regarding its diagnostic accuracy. METHODS A meta-analysis of published studies comparing the accuracies of CT colonography and colonoscopy for polyp detection was performed. The pooled per-patient sensitivities and specificities were calculated at various thresholds for polyp size. Summary receiver operating characteristic (sROC) curves were also constructed. RESULTS Thirty studies were included in the meta-analysis of CT colonography. The pooled per-patient sensitivity of CT colonography was higher for polyps greater than 10 mm (0.82, 95% confidence interval [CI], 0.76-0.88) compared with polyps 6 to 10 mm (0.63, 95% CI, 0.52-0.75) and polyps 0 to 5 mm (0.56, 95% CI, 0.42-0.70). Similarly, the exact area under the sROC curve (area +/- standard error) was higher using a threshold greater than 10 mm (0.898 +/- 0.063) compared with thresholds of greater than 5 mm and any size (0.884 +/- 0.033 and 0.822 +/- 0.059, respectively). There were no significant differences in the diagnostic characteristics of 2-dimensional versus 3-dimensional CT colonography. At a threshold greater than 5 mm, the exact area under the sROC curve was significantly higher for endoscopic colonoscopy compared with CT colonography (0.998 +/- 0.006 vs 0.884 +/- 0.033, P < .005). CONCLUSIONS CT colonography has a reasonable sensitivity and specificity for detecting large polyps but was less accurate than endoscopic colonoscopy for smaller polyps. Thus, CT colonography may not be a reasonable alternative in situations in which a small polyp may be clinically relevant.
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Affiliation(s)
- Alan S Rosman
- Section of Gastroenterology and Medicine Program, James J. Peters VA Medical Center and Mount Sinai School of Medicine, New York, NY 10468, USA.
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