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van Bokhorst QNE, Houwen BBSL, Hazewinkel Y, Fockens P, Dekker E. Advances in artificial intelligence and computer science for computer-aided diagnosis of colorectal polyps: current status. Endosc Int Open 2023; 11:E752-E767. [PMID: 37593158 PMCID: PMC10431975 DOI: 10.1055/a-2098-1999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/08/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Querijn N E van Bokhorst
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Tergooi Medical Center, Hilversum, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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Guarner-Argente C, Ikematsu H, Osera S, Fraile M, Ibañez B, Marra-López C, Jerusalén-Gargallo C, Alonso Aguirre PA, Martinez-Ares D, Soto S, Ramos Zabala F, Alvarez-Gonzalez MA, Rodriguez Sánchez J, Múgica F, Nogales Rincon O, Herreros de Tejada A, Redondo-Cerezo E, Martínez-Cara J, López-Rosés L, Rodriguez-Tellez M, Garcia-Bosch O, de la Peña J, Pellisé M, Rivero-Sanchez L, Saperas E, Pérez-Roldán F, Lopez Viedma B, González-Santiago JM, Álvarez Delgado A, Cobian C, Pardeiro R, Valdivielso Cortázar E, Colan-Hernandez J, Gordillo J, Kaneko K, Albéniz E. Location, morphology and invasiveness of lateral spreading tumors in the colorectum differ between two large cohorts from an eastern and western country. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:440-449. [PMID: 34400187 DOI: 10.1016/j.gastrohep.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND STUDY AIMS Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. PATIENTS AND METHODS Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. RESULTS We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. CONCLUSION This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.
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Affiliation(s)
| | - Hiroaki Ikematsu
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - Shozo Osera
- Gastroenterology Department, Saku Central Hospital Advanced Care Center, Japan
| | - Maria Fraile
- Gastroenterology Department, Hospital de San Pedro, Logroño, Spain
| | - Berta Ibañez
- Statistics, NavarraBiomed-Fundación Miguel Servet-IDISNA, Pamplona, Spain
| | - Carlos Marra-López
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - David Martinez-Ares
- Gastroenterology Department, Complejo Hospitalario de Vigo Hospital Xeral, Spain
| | - Santiago Soto
- Gastroenterology Department, Complexo Hospitalario de Ourense, Spain
| | - Felipe Ramos Zabala
- Gastroenterology Department, HM Monteprincipe University Hospital, Madrid, Spain
| | | | | | - Fernando Múgica
- Gastroenterology Department, Hospital Universitario de Donostia, Spain
| | - Oscar Nogales Rincon
- Department of Gastroenterology and Hepatology, HGU Gregorio Marañon, Madrid, Spain
| | | | | | - Juan Martínez-Cara
- Gastroenterology Department, Virgen de las Nieves Hospital, Granada, Spain
| | | | | | - Orlando Garcia-Bosch
- Gastroenterology Department, Hospital Sant Joan Despi Moises Broggi, Barcelona, Spain
| | | | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Liseth Rivero-Sanchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Esteve Saperas
- Gastroenterology Department, Hospital General de Catalunya, Barcelona, Spain
| | | | | | | | | | - Carol Cobian
- Gastroenterology Department, Hospital Universitario de Donostia, Spain
| | | | | | - Juan Colan-Hernandez
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Gordillo
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kazuhiro Kaneko
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain.
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3
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Cocomazzi F, Gentile M, Perri F, Merla A, Bossa F, Piazzolla M, Ippolito A, Terracciano F, Giuliani AP, Cubisino R, Marra A, Carparelli S, Mileti A, Paolillo R, Fontana A, Copetti M, Di Leo A, Andriulli A. Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study. Endosc Int Open 2021; 9:E388-E394. [PMID: 33655038 PMCID: PMC7895665 DOI: 10.1055/a-1352-3437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08-0.12) or the AC1 statistics (0.59-0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen's κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.
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Affiliation(s)
- Francesco Cocomazzi
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Marco Gentile
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Perri
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Merla
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Fabrizio Bossa
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Mariano Piazzolla
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Antonio Ippolito
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Fulvia Terracciano
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Arcangela Patrizia Giuliani
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Rossella Cubisino
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Antonella Marra
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Sonia Carparelli
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
| | - Alessia Mileti
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Rosa Paolillo
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy,University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Andrea Fontana
- Unit of Biostatistics, Fondazione “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Alfredo Di Leo
- University of Bari, Section of Gastroenterology, Department of Emergency and Organ Transplantation, Bari, Italy
| | - Angelo Andriulli
- Fondazione “Casa Sollievo della Sofferenza”, IRCCS, Gastroenterology and Endoscopy Units, San Giovanni Rotondo, Foggia, Italy
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Diger NR, Kubrusly LF, Nassif PAN, Parada AA, Bolsi GT, Teixeira HCB, Malafaia O. IS SUPERFICIAL COLORECTAL LESIONS WITH LOW AND HIGH GRADES INTRAEPITHELIAL NEOPLASMS MORE PREVALENT IN OLDER ABOVE 65 YEARS? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2019; 32:e1478. [PMID: 31859931 PMCID: PMC6918745 DOI: 10.1590/0102-672020190001e1478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Colorectal cancer has a higher incidence in the rectum and sigmoid. However, with the expansion of the diagnosis of superficial lesions interest in the diagnosis and in the role they play in colorectal carcinogenesis has increased. AIM To verify the behavior of superficial lesions of the colon and rectum, comparing the pathological and endoscopic findings, below and above 65 years. METHODS Cross-sectional study with prospective evaluation of standard protocol, where 200 patients with colorectal superficial lesions were evaluated; they were submitted to colonoscopy and mucosectomy of these lesions. They were divided in two age groups, below and above 65 years. RESULTS One hundred-and-eight were women (54%) and 92 men (46%). Most colon lesions were localized in the right colon (95%) and the remaining (5%) in the rectum. In endoscopy, 77.20% were granular lesions in patients under 65 years and 77.90% above. Colon histology showed low grade intraepithelial neoplasia, being 69.79% in patients under and 73.70% in above 65 years. In rectum, above 65 years the incidence of high-grade intraepithelial neoplasia was higher (66.70%). CONCLUSION The superficial colorectal lesions have been more endoscopically diagnosed today, and the highest incidence is the granular type, both in the colon and rectum, regardless of age. Regardless the age, histologically colon lesions were more as low grade intraepithelial neoplasia. In rectum, there was distinction for both age groups, being more frequent high grade intraepithelial neoplasia in patients over 65 years.
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Affiliation(s)
- Nildete Rodrigues Diger
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
- Digestive Endoscopy Service, 9 de Julho Hospital, São Paulo, SP, Brazil
| | - Luiz Fernando Kubrusly
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
| | - Paulo Afonso Nunes Nassif
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
| | - Artur Adolfo Parada
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
- Digestive Endoscopy Service, 9 de Julho Hospital, São Paulo, SP, Brazil
| | - Giovana Tonello Bolsi
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
| | - Harymy Costa Barros Teixeira
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
| | - Osvaldo Malafaia
- Postgraduate Program in Principles of Surgery, Mackenzie Evangelical School of Medicine - Paraná, Curitiba, PR, Brazil
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Yamashita K, Oka S, Tanaka S, Nagata S, Kuwai T, Furudoi A, Tamura T, Kunihiro M, Okanobu H, Nakadoi K, Kanao H, Higashiyama M, Arihiro K, Kuraoka K, Shimamoto F, Chayama K. Long-term prognosis after treatment for T1 carcinoma of laterally spreading tumors: a multicenter retrospective study. Int J Colorectal Dis 2019; 34:481-490. [PMID: 30607579 DOI: 10.1007/s00384-018-3203-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Long-term prognosis of T1 laterally spreading tumors (LSTs) after treatment have not been clarified. This study compared clinicopathological characteristics and long-term prognosis of T1 LSTs. METHODS We retrospectively assessed 169 patients with 169 T1 LSTs between January 1992 and December 2008 by ten hospitals. Patients who did not meet the Japanese Society for Cancer of the Colon and Rectum (JSCCR) 2016 guidelines for the treatment of colorectal carcinoma (CRC) criteria were defined as non-endoscopically curable. The number of non-endoscopically curable patients with LST-granular/ nodular mixed (LST-G-M) was 61, that with LST-non-granular/ flat elevated (LST-NG-FE) was 23, and that with LST-non-granular/ pseudo depressed (LST-NG-PD) was 23. Clinicopathological variables and long-term prognosis were analyzed. RESULTS For overall patients, tumor size, number of non-endoscopically curable cases, and rate of submucosal invasion depth ≥ 1000 μm for the LST-G-M group were significantly higher than those in the other groups. For non-endoscopically curable patients, the tumor size for those with LST-G-M was significantly larger than those in the other groups. The rate of submucosal invasion width ≥ 4000 μm and type B/C muscularis mucosae with LST-G-M was higher than that with LST-NG-FE. All recurrences occurred in non-endoscopically curable patients with LST-G-M. Five-year overall and disease-free survivals for non-endoscopically curable patients with LST-G-M were significantly shorter than those for patients with non-endoscopically curable LST-NG-FE and PD. CONCLUSIONS Our data supported adequacy of the JSCCR guidelines for the treatment of CRC criteria for endoscopically curable patients after T1 LSTs treatment. Patients with T1 LST-G-M should be followed up more carefully.
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Affiliation(s)
- Ken Yamashita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Akira Furudoi
- Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Tadamasa Tamura
- Department of Internal Medicine, Hiroshima Memorial Hospital, Hiroshima, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hideharu Okanobu
- Department of Gastroenterology, Chugoku Rosai Hospital, Kure, Japan
| | - Koichi Nakadoi
- Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan
| | - Hiroyuki Kanao
- Department of Gastroenterology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Makoto Higashiyama
- Department of Gastroenterology, Shobara Red Cross Hospital, Shobara, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuya Kuraoka
- Department of Anatomical Pathology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Fumio Shimamoto
- Faculty of Health Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Zhang Y, Zhang W, Zhang Y. Laterally spreading tumors: Clinical features and curative effects of endoscopic surgery. Shijie Huaren Xiaohua Zazhi 2018; 26:2102-2108. [DOI: 10.11569/wcjd.v26.i36.2102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the clinical features of laterally spreading tumors (LST) and the curative effects of endoscopic surgery.
METHODS One hundred and twenty LST patients treated at the department of gastroenterology of Affiliated Xiang'an Hospital of Xiamen University from January 2015 to January 2016 were included, and all of then underwent endoscopic surgery. Age, gender, size of lesion, LST classification, location of lesion, pathological pattern, and pit pattern were recorded. The relations of glandular tube opening and pit pattern with pathological classification as well as curative situations were analyzed.
RESULTS The ratio of male to female in 120 patients was 1.61:1, and the most common age groups were 60-69 and 50-59. The lesion diameter was mainly 20-29 cm. The rectum was the most frequently involved location, followed by the sigmoid colon. Villous adenoma was the most common pathological classification, followed by tubular villous adenocarcinoma. Homogeneous granular type was the most common type of lesion, followed by nodular mixed type. The pit pattern was mainly ⅢL type. The nodular mixed type and homogeneous granular type mainly had type Ⅳ openings, the pseudo-depressed type mainly had ⅤA type openings, and the flat elevated type mainly had ⅢL type openings; the difference among them was statistically significant (P < 0.05). The ⅤA type glandular tube opening was intramucosal carcinoma, Ⅳ type was mainly villous adenoma, and ⅢL type was mainly tubular adenoma; the difference among them was statistically significant (P < 0.05). There were 9(7.50%) cases who underwent endoscopic submucosal dissection (ESD), 61(50.83%) who underwent endoscopic mucosal resection (EMR), and 50(41.67%) who underwent endoscopic piecemeal mucosal resection (EPMR). The lesion locations of LST in the EMR and EPMR groups were mainly the colon and rectum, and that in the ESD group was mainly the rectum; the difference was statistically significant (P < 0.05). The LST diameter in the EMR group was mainly 10-19 cm and 20-29 cm, while that in the ESD group and EPMR group was mainly > 20-29 cm; the difference was statistically significant (P < 0.05). The postoperative recurrence rate in the EPMR group was significantly higher than those in the EMR group and ESD group (P < 0.05). There was no statistical difference in the bleeding rates among the three groups (P > 0.05).
CONCLUSION LST occurs mainly in males, and middle-aged and elderly people are susceptible to the disease. The size of lesion is mainly 20-29 cm, and the rectum is its predilection site. The lesion classification is mainly homogeneous granular type and nodular mixed type. The pit pattern is mainly ⅢL type, and the pathological pattern is mostly villous adenoma. Pathological classification and pit pattern have a significant difference. EMR and EPMR are common procedures for treatment of LST, and ESD is usually used to treat rectal lesions. EPMR is suitable for treatment of larger colon and rectum lesions, but it has a higher recurrence rate. EMR is suitable for treatment of smaller colon and rectum lesions.
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Affiliation(s)
- Yan Zhang
- Department of Gastroenterology, Affiliated Xiang'an Hospital of Xiamen University, Xiamen 361005, Fujian Province, China
| | - Wei Zhang
- Department of General Surgery, Anyang Tumor Hospital, Anyang 455000, Henan Province, China
| | - Ying Zhang
- Department of Gastroenterology, Anyang People's Hospital, Anyang 455002, Henan Province, China
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7
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Lee JM, Kang YJ, Kim ES, Lee YJ, Park KS, Cho KB, Jeon SW, Jung MK, Lee HS, Kim EY, Jung JT, Jang BI, Kim KO, Chung YJ, Yang CH. A wide variation of the quality of colonoscopy reporting system in the real clinical practice in southeastern area of Korea. Intest Res 2016; 14:351-357. [PMID: 27799886 PMCID: PMC5083264 DOI: 10.5217/ir.2016.14.4.351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 12/22/2022] Open
Abstract
Background/Aims Establishment of a colonoscopy reporting system is a prerequisite to determining and improving quality. This study aimed to investigate colonoscopists' opinions and the actual situation of a colonoscopy reporting system in a clinical practice in southeastern area of Korea and to assess the factors predictive of an inadequate reporting system. Methods Physicians who performed colonoscopies in the Daegu-Gyeongbuk province of Korea and were registered with the Korean Society of Gastrointestinal Endoscopy (KSGE) were interviewed via mail about colonoscopy reporting systems using a standardized questionnaire. Results Of 181 endoscopists invited to participate, 125 responded to the questionnaires (response rate, 69%). Most responders were internists (105/125, 84%) and worked in primary clinics (88/125, 70.4%). Seventy-one specialists (56.8%) held board certifications for endoscopy from the KSGE. A median of 20 colonoscopies (interquartile range, 10–47) was performed per month. Although 88.8% of responders agreed that a colonoscopy reporting system is necessary, only 18.4% (23/125) had achieved the optimal reporting system level recommended by the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. One-third of endoscopists replied that they did not use a reporting document for the main reasons of "too busy" and "inconvenience." Non-endoscopy specialists and primary care centers were independent predictive factors for failure to use a colonoscopy reporting system. Conclusions The quality of colonoscopy reporting systems varies widely and is considerably suboptimal in actual clinical practice settings in southeastern Korea, indicating considerable room for quality improvements in this field.
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Affiliation(s)
- Jung Min Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Jin Kang
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Eun Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Sik Park
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seong Woo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Min Kyu Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Seok Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Eun Young Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Jin Tae Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Byung Ik Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Yun Jin Chung
- Division of Gastroenterology, Department of Internal Medicine, Fatima Hospital of Daegu, Daegu, Korea
| | - Chang Hun Yang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Dongguk University School of Medicine, Gyeongju, Korea
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Shigita K, Oka S, Tanaka S, Sumimoto K, Hirano D, Tamaru Y, Ninomiya Y, Asayama N, Hayashi N, Nagata S, Arihiro K, Chayama K. Clinical significance and validity of the subclassification for colorectal laterally spreading tumor granular type. J Gastroenterol Hepatol 2016; 31:973-9. [PMID: 26601626 DOI: 10.1111/jgh.13238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/04/2015] [Accepted: 11/13/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Colorectal laterally spreading tumor granular type (LST-G) is generally divided into two subtypes based on morphology. Here, we retrospectively investigated the clinical significance of a concrete, objective LST-G subclassification. METHODS This study examined 636 consecutive cases that were resected endoscopically or surgically. LST-G was subclassified as follows: Type 1, a lesion with homogenous uniform granules with uniform (<5 mm) nodules; Type 2, a lesion with granules and small nodules (≥5 mm, <10 mm); or Type 3, a lesion accompanied by large nodules (≥10 mm). For the validation study, 194 images were compiled from 97 cases investigated using conventional colonoscopy and chromoendoscopy with indigo carmine dye spraying. Images were distributed in a randomized order to students without prior endoscopy experience, less-experienced endoscopists (LEE group), and highly experienced endoscopists (HEE group). Diagnostic accuracy and interobserver agreement were then evaluated. RESULTS There was no submucosal invasion in Type 1 lesions. The incidence of deep submucosal invasive carcinoma was higher for Type 3 lesions than for Type 2 lesions. Interobserver agreement was good in each group. Diagnostic accuracy was higher in the HEE group than in the student and LEE groups. Chromoendoscopy had a higher accuracy rate than conventional colonoscopy in the LEE and HEE groups (LEE, 0.74 vs 0.69, P < 0.05; HEE, 0.84 vs 0.78, P < 0.05). CONCLUSIONS This subclassification of LST-G according to the diameters of granules and nodules was both useful for choosing therapeutic strategies in the clinical setting and universally applicable.
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Affiliation(s)
- Kenjiro Shigita
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Daiki Hirano
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuzuru Tamaru
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Ninomiya
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Asayama
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Nana Hayashi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Endoscopy, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Departments of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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