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Malik TF, Sabesan V, Mohan BP, Rahman AU, Othman MO, Draganov PV, Kochhar GS. Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis. Clin Endosc 2024; 57:317-328. [PMID: 38419168 PMCID: PMC11133987 DOI: 10.5946/ce.2023.205] [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] [Received: 08/11/2023] [Revised: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND/AIMS In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD). METHODS Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity. RESULTS Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%-95.4%; I2=0%), 81.5% (95% CI, 72.5%-88%; I2=43%), and 48.9% (95% CI, 32.1%-65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%-7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%-13%; I2=10%) and 5.3% (95% CI, 3.1%-8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%-18.2%; I2=55%) and 13% (95% CI, 8.5%-19.3%; I2=54%), respectively. CONCLUSIONS ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.
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Affiliation(s)
- Talia F. Malik
- Department of Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Vaishnavi Sabesan
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Babu P. Mohan
- Department of Gastroenterology & Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA
| | - Asad Ur Rahman
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL, USA
| | - Mohamed O. Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
| | - Peter V. Draganov
- Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Gursimran S. Kochhar
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
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Zhao C, Li H, Gao C, Tian H, Guo Y, Liu G, Li Y, Liu D, Sun B. Moringa oleifera leaf polysaccharide regulates fecal microbiota and colonic transcriptome in calves. Int J Biol Macromol 2023; 253:127108. [PMID: 37776927 DOI: 10.1016/j.ijbiomac.2023.127108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
This study investigated the effects of Moringa oleifera polysaccharide on growth performance indicators, serum biochemical indicators, immune organ indicators, colonic morphology, colonic microbiomics and colonic transcriptomics in newborn calves. 21 newborn calves were randomly divided into three groups of 7 calves per treatment group: control group (no Moringa oleifera polysaccharide addition); low-dose group (Moringa oleifera polysaccharide 0.5 g/kg); and high-dose group (Moringa oleifera polysaccharide 1 g/kg). This trial used gavage to feed MOP to calves. The test lasted 8 weeks. Calves were humanely electroshocked on the last day of the trial and slaughtered afterwards. Thymus, spleen, blood and colonic contents were collected for further testing. The results of this trial showed that MOP significantly increased the body weight of newborn calves and reduced the rate of calf diarrhea, thus promoting calf growth. Fecal scores showed a linear decrease with the addition of MOP. In terms of serum biochemistry, feeding MOP significantly increased serum ALB levels in a linear fashion. In terms of serum antioxidants, feeding MOP linearly increased CAT and T-AOC levels and decreased MDA concentrations, and in terms of serum immunity, feeding MOP linearly increased IgA, IgG, and IgM levels. At the same time, MOP regulated the abundance of Firmicutes and Bacteroidetes in the intestinal tract of calves, which reduced the occurrence of diarrhea. In addition, moringa polysaccharide could regulate genes related to inflammatory signaling pathways such as MAPK signaling pathway, TGF-beta signaling pathway, PI3K-Akt signaling pathway and TNF signaling pathway in calves' intestine to reduce the occurrence of intestinal inflammation. In conclusion, MOP can be used as a novel ruminant additive for the prevention of enteritis in calves.
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Affiliation(s)
- Chao Zhao
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Hangfan Li
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Chongya Gao
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Hanchen Tian
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Yongqing Guo
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Guangbin Liu
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Yaokun Li
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Dewu Liu
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China
| | - Baoli Sun
- College of Animal Science, South China Agricultural University, Guangzhou 510642, China.
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Zhan Y, Cheng X, Mei P, Wu J, Ou Y, Cui Y. Risk and incidence of colorectal stricture progressing to colorectal neoplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2023; 35:1075-1087. [PMID: 37577790 DOI: 10.1097/meg.0000000000002614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
This study aims to assess the risk of colorectal stricture progressing to colorectal neoplasia (CRN) in patients with inflammatory bowel disease (IBD). The literature from PubMed, Embase, Web of Science, and Cochrane Library databases was searched from the date of databases' creation to 5 November 2022. The Newcastle-Ottawa Scale was used to evaluate the quality of the included literature. Meta-analysis was conducted using the Stata 15 software and R 4.04 software. Two case-control studies and 12 cohort studies were eventually included. Colorectal stricture in patients with IBD increased the risk of progressing to CRN [odds ratio (OR): 1.52, 95% confidence interval (CI): 1.02-2.29, P = 0.042], but was irrelevant to the risk of progressing to ACRN (OR: 3.56, 95% CI 0.56-22.70, P = 0.180). The risk of CRN were further distinguished in patients with ulcerative colitis (UC) and Crohn's disease (CD) Our findings showed that colorectal stricture may increase the risk of progressing to CRN in patients with UC (OR = 3.53, 95%CI 1.62-7.68, P = 0.001), but was irrelevant to the risk of progressing to CRN in patients with CD (OR = 1.09, 95% CI 0.54-2.21, P = 0.811). In conclusion, colorectal stricture in patients with IBD can be used as a risk factor for predicting CRN but cannot be used as a risk factor for predicting ACRN. Stricture is a risk factor for CRN in patients with UC but not in patients with CD. More prospective, multi-center studies with large samples are expected to confirm our findings.
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Affiliation(s)
- Yanrong Zhan
- Shaanxi University of Chinese Medicine, Xianyang
| | - Xianwen Cheng
- Ankang Hospital of Traditional Chinese Medicine, Ankang
| | - Pingping Mei
- Shaanxi University of Chinese Medicine, Xianyang
| | - Jiyun Wu
- Shaanxi University of Chinese Medicine, Xianyang
| | - Yan Ou
- Shaanxi University of Chinese Medicine, Xianyang
| | - Yaping Cui
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
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Yang MM, Usiskin K, Ahmad HA, Ather S, Sreih A, Canavan JB, Farraye FA, Ma C. Considerations for Colorectal Neoplasia Detection in Inflammatory Bowel Disease Clinical Trials. Dig Dis 2023; 42:12-24. [PMID: 37757769 PMCID: PMC10836758 DOI: 10.1159/000533395] [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] [Received: 01/30/2023] [Accepted: 07/25/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND High-quality colonoscopic surveillance can lead to earlier and increased detection of colorectal neoplasia in patients with inflammatory bowel disease (IBD). In IBD clinical trials, endoscopy is used to assess mucosal disease activity before and after treatment but also provides an opportunity to surveil for colorectal neoplasia during follow-up. SUMMARY Best practices for colorectal cancer identification in IBD clinical trials require engagement and collaboration between the clinical trial sponsor, site endoscopist and/or principal investigator, and central read team. Each team member has unique responsibilities for maximizing dysplasia detection in IBD trials. KEY MESSAGES Sponsors should work in accordance with scientific guidelines to standardize imaging procedures, design the protocol to ensure the trial population is safeguarded, and oversee trial conduct. The site endoscopist should remain updated on best practices to tailor sponsor protocol-required procedures to patient needs, examine the mucosa for disease activity and potential dysplasia during all procedures, and provide optimal procedure videos for central read analysis. Central readers may detect dysplasia or colorectal cancer and a framework to report these findings to trial sponsors is essential. Synergistic relationships between all team members in IBD clinical trials provide an important opportunity for extended endoscopic evaluation and colorectal neoplasia identification.
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Affiliation(s)
- Mira M Yang
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Keith Usiskin
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Harris A Ahmad
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Shabana Ather
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Antoine Sreih
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - James B Canavan
- Division of Immunology and Fibrosis Development, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Center, Mayo Clinic, Jacksonville, Florida, USA
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Medical Research and Development, Alimentiv Inc (formerly Robarts Clinical Trials, Inc.), London, Ontario, Canada
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5
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Nardone OM, Iacucci M. Image-Enhanced Endoscopy in the Surveillance of Colitis-Associated Neoplasia. Gastrointest Endosc Clin N Am 2022; 32:845-862. [PMID: 36202520 DOI: 10.1016/j.giec.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Advances in endoscopic technology have allowed for improved detection and management of dysplasia. These developments have also raised the question of the optimal methods for surveillance. Promising data showed that virtual chromoendoscopy (VCE) is comparable to dye-based chromoendoscopy (DCE). However, the usefulness of DCE and VCE in the surveillance of longstanding inflammatory bowel disease colitis when compared with high-definition white-light endoscopy has been recently questioned. Confocal laser endomicroscopy is a highly innovative endoscopic procedure but is still far from the routine adoption for surveillance. Thus, a personalized approach should guide the most appropriate surveillance strategy.
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Affiliation(s)
- Olga Maria Nardone
- Institute of Immunology and Immunotherapy, Heritage Building for Research and Development, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TT, United Kingdom.
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, Heritage Building for Research and Development, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham B15 2TT, United Kingdom.
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Pai RK, Hartman DJ, Leighton JA, Pasha SF, Rivers CR, Regueiro M, Binion DG, Pai RK. Validated Indices for Histopathologic Activity Predict Development of Colorectal Neoplasia in Ulcerative Colitis. J Crohns Colitis 2021; 15:1481-1490. [PMID: 33687061 DOI: 10.1093/ecco-jcc/jjab042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS To correlate histologic activity in surveillance colonoscopies with the development of colorectal neoplasia in ulcerative colitis [UC]. METHODS Colorectal biopsies during surveillance [N = 764] from 52 UC patients with colorectal neoplasia were compared to 122 patients without neoplasia enrolled in a prospective natural history registry. All biopsies were scored using validated histologic scoring systems (Geboes score, Nancy histopathologic index [NHI], and Robarts histopathologic index [RHI]). Clinical, endoscopic, and histologic data were correlated with the development of colorectal neoplasia. RESULTS In multivariable analysis, mean RHI (hazard ratio [HR] 1.07 for each 1-unit increase in RHI, 95% confidence interval [CI] 1.03-1.12, p = 0.002) and mean NHI [HR 1.89 for each 1-unit increase in NHI, 95% CI 1.34-2.67, p = 0.002] for the entire surveillance period were significantly associated with colorectal neoplasia development. Shorter surveillance interval and increasing age were associated with increased risk of neoplasia development whereas mean Mayo endoscopic score was not significant. To generate a clinically useful measure of neoplasia risk, mean histologic activity in the preceding 5 years before the study endpoint was correlated with neoplasia development. In the preceding 5 years of surveillance, a mean RHI ≥ 8 had a 7.53-fold increased risk [95% CI 2.56-12.16, p < 0.001] and mean NHI ≥ 1.9 had a 5.89-fold increased risk [95% CI 2.18-15.92, p < 0.001] of developing colorectal neoplasia. CONCLUSIONS Persistent histologic activity during multiple surveillance episodes is an independent predictor of colorectal neoplasia. Mean RHI and mean NHI during a 5-year colonoscopic surveillance period can be used to assess risk for colorectal neoplasia and optimize UC surveillance.
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Affiliation(s)
- Rish K Pai
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Douglas J Hartman
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan A Leighton
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Shabana F Pasha
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Claudia Ramos Rivers
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Miguel Regueiro
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Yalchin M, Baker AM, Graham TA, Hart A. Predicting Colorectal Cancer Occurrence in IBD. Cancers (Basel) 2021; 13:2908. [PMID: 34200768 PMCID: PMC8230430 DOI: 10.3390/cancers13122908] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with colonic inflammatory bowel disease (IBD) are at an increased risk of developing colorectal cancer (CRC), and are therefore enrolled into a surveillance programme aimed at detecting dysplasia or early cancer. Current surveillance programmes are guided by clinical, endoscopic or histological predictors of colitis-associated CRC (CA-CRC). We have seen great progress in our understanding of these predictors of disease progression, and advances in endoscopic technique and management, along with improved medical care, has been mirrored by the falling incidence of CA-CRC over the last 50 years. However, more could be done to improve our molecular understanding of CA-CRC progression and enable better risk stratification for patients with IBD. This review summarises the known risk factors associated with CA-CRC and explores the molecular landscape that has the potential to complement and optimise the existing IBD surveillance programme.
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Affiliation(s)
- Mehmet Yalchin
- Inflammatory Bowel Disease Department, St. Mark’s Hospital, Watford R.d., Harrow HA1 3UJ, UK
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse S.q., London EC1M 6BQ, UK; (A.-M.B.); (T.A.G.)
| | - Ann-Marie Baker
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse S.q., London EC1M 6BQ, UK; (A.-M.B.); (T.A.G.)
| | - Trevor A. Graham
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse S.q., London EC1M 6BQ, UK; (A.-M.B.); (T.A.G.)
| | - Ailsa Hart
- Inflammatory Bowel Disease Department, St. Mark’s Hospital, Watford R.d., Harrow HA1 3UJ, UK
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Recommendations of the Spanish Working Group on Crohn's disease and Ulcerative Colitis (Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa - GETECCU) on dysplasia screening in inflammatory bowel disease patients. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:435-447. [PMID: 33592179 DOI: 10.1016/j.gastrohep.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Colonic inflammatory bowel diseases have a higher risk of developing colorectal cancer compared to the general population, which is why they require endoscopic screening techniques with specific follow-up intervals based on the different risk factors described on the literature. This position paper analyzes the current scientific evidence for the different endoscopic techniques available today, how their implementation should be carried out in endoscopic units and describes in detail how their implementation should be carried out, in which patients and with what interval, and finally, what should be the response to finding dysplasia, proposing a specific follow-up algorithm.
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10
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Ibrahim S, Zhu X, Luo X, Feng Y, Wang J. PIK3R3 regulates ZO-1 expression through the NF-kB pathway in inflammatory bowel disease. Int Immunopharmacol 2020; 85:106610. [PMID: 32473571 DOI: 10.1016/j.intimp.2020.106610] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) are the major risk factor for developing colitis associated cancer (CAC). Previously, we have reported that Phosphoinositide-3-kinase regulatory subunit 3 (PIK3R3) was overexpressed in colorectal cancer (CRC), but we don't know the role of PIK3R3 in IBD. METHODS We investigated the differential expression of PIK3R3 and ZO-1 in IBD patients by using Immunohistochemical (IHC) and Gene Expression Omnibus (GEO) database analysis. Caco-2 cells were exposed to different conditions to assess protein level changes of PIK3R3 and ZO-1. Caco-2 cell monolayers were transfected with PIK3R3/siPIK3R3 to assess transepithelial electrical resistance. Tight junction protein integrity was assessed by immunoblot and immunofluorescence. For further, intestinal permeability and tight junction protein integrity were assessed in animal study to assess the treatment role of PIK3R3 specific inhibitor TAT-N 15 (N15). RESULTS PIK3R3 was increased in IBD patients, and negatively controlled the expression of ZO-1. In vitro, PIK3R3 regulates ZO-1 by activating NF-kB pathway. Overexpression of PIK3R3 in Caco-2 cells decreased transepithelial electrical resistance (TEER), an opposite result was observed in siPIK3R3 cells. In animal study, inhibition of PIK3R3 by N15 contributed to amelioration of DSS-induced intestinal permeability. Mice treated with N15 exhibited less disruption of TJs in colon tissues. CONCLUSIONS PIK3R3 was increased in clinical IBD patients with accompanying disruption of ZO-1 expression. Inhibition of PIK3R3 attenuated DSS-induced IBD symptoms in a mouse model. These findings indicated that PIK3R3 could be a therapeutic target for IBD.
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Affiliation(s)
- Sidikjan Ibrahim
- Department of Gastrointestinal Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Xu Zhu
- Department of Gastrointestinal Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China; Renmin Hospital, Wuhan University, Wuhan 430060, China.
| | - Xuelai Luo
- Department of Gastrointestinal Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Yongdong Feng
- Department of Gastrointestinal Surgery Center, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Jing Wang
- Department of Immunology, Basic Medicine School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
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Loss of SATB2 Expression Is a Biomarker of Inflammatory Bowel Disease-associated Colorectal Dysplasia and Adenocarcinoma. Am J Surg Pathol 2020; 43:1314-1322. [PMID: 31318711 DOI: 10.1097/pas.0000000000001330] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SATB2 is a sensitive immunohistochemistry marker of colorectal carcinoma and non-neoplastic colorectal epithelium that is complementary to CDX2. However, its expression is affected by molecular alterations. Inflammatory bowel disease-associated neoplasia demonstrates molecular alterations that are different from those in sporadic colorectal neoplasia. Given these differences, we examined SATB2 expression in 73 cases of inflammatory bowel disease-associated neoplasia including 37 dysplasia cases and 36 carcinomas and compared the expression patterns with 50 cases of nondysplastic colorectal mucosa in patients with active inflammatory bowel disease, 40 sporadic colonic polyps (20 conventional adenomas and 20 sessile serrated lesions/polyps), and 343 sporadic colorectal adenocarcinomas to assess SATB2 immunohistochemistry as a biomarker of inflammatory bowel disease-associated neoplasia. Loss of SATB2 expression was only identified in colorectal dysplasia arising in inflammatory bowel disease (15/37, 41%) and was not seen in nondysplastic colorectal mucosa with active inflammatory bowel disease or sporadic colonic polyps (P<0.001). Loss of SATB2 expression was identified in both endoscopically visible dysplasia (11/28, 39%) and invisible (4/9, 44%) dysplasia. Loss of SATB2 expression was identified in 67% (24/36) of inflammatory bowel disease-associated carcinomas and was significantly more frequent compared with sporadic colorectal carcinomas (47/343, 14%, P<0.001). There was no difference in positive CDX2 expression between inflammatory bowel disease-associated colorectal carcinoma and sporadic colorectal carcinoma (89% vs. 85%, P=1.0). In conclusion, loss of SATB2 expression is common in inflammatory bowel disease-associated colorectal dysplasia and adenocarcinoma and may be a helpful ancillary biomarker when evaluating for inflammatory bowel disease-associated dysplasia.
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Yadav S, Loftus EV, Harmsen WS, Wong Kee Song LM, Coelho-Prabhu N. Outcome of endoscopic resection of colonic polyps larger than 10 mm in patients with inflammatory bowel disease. Endosc Int Open 2019; 7:E994-E1001. [PMID: 31404424 PMCID: PMC6687483 DOI: 10.1055/a-0953-2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/08/2019] [Indexed: 12/12/2022] Open
Abstract
Background and study aims There are limited published data on endoscopic removal of colorectal polyps by endoscopic mucosal resection (EMR) and endoscopic mucosal dissection (ESD) in patients with inflammatory bowel disease (IBD). Patients and methods We performed a retrospective review of patients with colonic IBD and colonic polyps >10mm who underwent EMR and/or ESD at our institution between January 1, 2012 and June 31, 2016. Results Ninety-seven patients with pathology-confirmed IBD (median disease duration 16 years) were included. Mild or moderate active colitis (in background biopsies) was seen in 85 %. Of the total 124 polyps, location was ascending colon in 44 %, transverse in 15 % and sigmoid in 18.5 %; of the total, 55 % were < 20 mm and 45 % were ≥20mm in maximal diameter. Using the Paris classification, 56 % of polyps were polypoid sessile (Is) polyps, while 38 % were non-polypoid (IIa, IIb, IIc). EMR was used in 118 polyps, three required ESD, and three by combined EMR-ESD. Seventy-two percent were resected en-bloc; 28 % underwent piecemeal resection. Histology included low-grade dysplasia in 75, serrated adenoma in 31, and tubular adenoma in 14 polyps. Chromoendoscopy was used in 33 (26.6 %). Adverse events occurred in three patients. Colectomy was performed in 11 patients within 12 months. Recurrence was seen in 20 polyps, 11 of which were successfully resected en-bloc using EMR. Polyps ≥ 20 mm and polyps treated with APC were found to have a statistically significantly higher risk of recurrence. Conclusion This study demonstrates the efficacy and safety of endoscopic resection of large polyps in patients with IBD, making them effective alternatives to colectomy.
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Affiliation(s)
- Siddhant Yadav
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, United States,Division of Internal Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, United States
| | - Edward V. Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, United States
| | - W. Scott Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, Minnesota, United States
| | - Louis M. Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, United States
| | - Nayantara Coelho-Prabhu
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Minnesota, United States,Corresponding author Nayantara Coelho-Prabhu MD Division of Gastroenterology and HepatologyMayo Clinic200 First Street SWRochester, MN 55905+1-507-284-0538
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Fast stimulated Raman and second harmonic generation imaging for intraoperative gastro-intestinal cancer detection. Sci Rep 2019; 9:10052. [PMID: 31296917 PMCID: PMC6624250 DOI: 10.1038/s41598-019-46489-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/25/2019] [Indexed: 01/26/2023] Open
Abstract
Conventional haematoxylin, eosin and saffron (HES) histopathology, currently the 'gold-standard' for pathological diagnosis of cancer, requires extensive sample preparations that are achieved within time scales that are not compatible with intra-operative situations where quick decisions must be taken. Providing to pathologists a close to real-time technology revealing tissue structures at the cellular level with HES histologic quality would provide an invaluable tool for surgery guidance with evident clinical benefit. Here, we specifically develop a stimulated Raman imaging based framework that demonstrates gastro-intestinal (GI) cancer detection of unprocessed human surgical specimens. The generated stimulated Raman histology (SRH) images combine chemical and collagen information to mimic conventional HES histopathology staining. We report excellent agreements between SRH and HES images acquire on the same patients for healthy, pre-cancerous and cancerous colon and pancreas tissue sections. We also develop a novel fast SRH imaging modality that captures at the pixel level all the information necessary to provide instantaneous SRH images. These developments pave the way for instantaneous label free GI histology in an intra-operative context.
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Kisiel JB, Klepp P, Allawi HT, Taylor WR, Giakoumopoulos M, Sander T, Yab TC, Moum BA, Lidgard GP, Brackmann S, Mahoney DW, Roseth A, Ahlquist DA. Analysis of DNA Methylation at Specific Loci in Stool Samples Detects Colorectal Cancer and High-Grade Dysplasia in Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2019; 17:914-921.e5. [PMID: 29775793 PMCID: PMC6368476 DOI: 10.1016/j.cgh.2018.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 03/08/2018] [Accepted: 05/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn's disease, are at increased risk for colorectal cancer (CRC). Analyses of DNA methylation patterns in stool samples have been reported to detect CRC in patients with IBD. We sought to validate these findings in larger cohorts and assess the accuracy of analysis of DNA methylation patterns in stool for detection of CRC and high-grade dysplasia (HGD) normalized to methylation level at ZDHHC1. METHODS We obtained buffered, frozen stool samples from a US case-control study and from 2 European surveillance cohorts (referral or population based) of patients with chronic ulcerative colitis (n = 248), Crohn's disease (n = 82), indeterminate colitis (n = 2), or IBD with primary sclerosing cholangitis (n = 38). Stool samples were collected before bowel preparation for colonoscopy or at least 1 week after colonoscopy. Among the study samples, stools from individuals with IBD but without neoplasia were used as controls (n = 291). DNA was isolated from stool, exposed to bisulfite, and then assayed by multiplex quantitative allele-specific real-time target and signal amplification. We analyzed methylation levels of BMP3, NDRG4, VAV3, and SFMBT2 relative to the methylation level of ZDHHC1, and compared these between patients with CRC or HGD and controls. RESULTS Levels of methylation at BMP3 and VAV3, relative to ZDHHC1 methylation, identified patients with CRC and HGD with an area under the curve value of 0.91 (95% CI, 0.77-1.00). Methylation levels at specific promotor regions of these genes identified 11 of the 12 patients with CRC and HGD, with 92% sensitivity (95% CI, 60%-100%) and 90% specificity (95% CI, 86%-93%). The proportion of false-positive results did not differ significantly among the case-control, referral cohort, and population cohort studies (P = .60) when the 90% specificity cut-off from the whole sample set was applied. CONCLUSIONS In an analysis of stool samples from 3 independent studies of 332 patients with IBD, we associated levels of methylation at 2 genes (BMP3 and VAV3), relative to level of methylation at ZDHHC1, with detection of CRC and HGD. These methylation patterns identified patients with CRC and HGD with more than 90% specificity, and might be used in CRC surveillance.
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Affiliation(s)
- John B Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
| | - Pasquale Klepp
- Department of Internal Medicine, Lovisenberg Hospital, Oslo, Norway; Clinical Medicine, University Hospital, University of Oslo, Oslo, Norway
| | - Hatim T Allawi
- Department of Gastroenterology, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - William R Taylor
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | | | - Tracy C Yab
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Bjorn A Moum
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | | | - Stephan Brackmann
- Department of Gastroenterology, Akershus University Hospital, University of Oslo, Oslo, Norway; Clinical Medicine, University Hospital, University of Oslo, Oslo, Norway
| | - Douglas W Mahoney
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Arne Roseth
- Department of Internal Medicine, Lovisenberg Hospital, Oslo, Norway
| | - David A Ahlquist
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Al Bakir I, Curtius K, Graham TA. From Colitis to Cancer: An Evolutionary Trajectory That Merges Maths and Biology. Front Immunol 2018; 9:2368. [PMID: 30386335 PMCID: PMC6198656 DOI: 10.3389/fimmu.2018.02368] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
Patients with inflammatory bowel disease have an increased risk of developing colorectal cancer, and this risk is related to disease duration, extent, and cumulative inflammation burden. Carcinogenesis follows the principles of Darwinian evolution, whereby somatic cells acquire genomic alterations that provide them with a survival and/or growth advantage. Colitis represents a unique situation whereby routine surveillance endoscopy provides a serendipitous opportunity to observe somatic evolution over space and time in vivo in a human organ. Moreover, somatic evolution in colitis is evolution in the ‘fast lane': the repeated rounds of inflammation and mucosal healing that are characteristic of the disease accelerate the evolutionary process and likely provide a strong selective pressure for inflammation-adapted phenotypic traits. In this review, we discuss the evolutionary dynamics of pre-neoplastic clones in colitis with a focus on how measuring their evolutionary trajectories could deliver a powerful way to predict future cancer occurrence. Measurements of somatic evolution require an interdisciplinary approach that combines quantitative measurement of the genotype, phenotype and the microenvironment of somatic cells–paying particular attention to spatial heterogeneity across the colon–together with mathematical modeling to interpret these data within an evolutionary framework. Here we take a practical approach in discussing how and why the different “evolutionary ingredients” can and should be measured, together with our viewpoint on subsequent translation into clinical practice. We highlight the open questions in the evolution of colitis-associated cancer as a stimulus for future work.
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Affiliation(s)
- Ibrahim Al Bakir
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, United Kingdom.,Inflammatory Bowel Disease Unit, St Mark's Hospital, Harrow, United Kingdom
| | - Kit Curtius
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, United Kingdom
| | - Trevor A Graham
- Evolution and Cancer Laboratory, Centre for Tumour Biology, Barts Cancer Institute, London, United Kingdom
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16
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Flynn AD, Valentine JF. Chromoendoscopy for Dysplasia Surveillance in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:1440-1452. [PMID: 29668929 DOI: 10.1093/ibd/izy043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Indexed: 02/07/2023]
Abstract
Long-standing ulcerative colitis (UC) and extensive Crohn's colitis confer increased risk for development of colorectal cancer. Screening and surveillance colonoscopy programs aim to identify, resect, or detect dysplasia or colorectal cancer. Dysplastic lesions can be removed by endoscopic resection and patients with unresectable lesions can be referred for colectomy at an earlier stage, with the goal of reducing overall morbidity and mortality from colorectal cancer. Surveillance colonoscopy for patients with inflammatory bowel disease (IBD) is endorsed by multiple specialty societies. High-definition endoscopy systems provide improved image resolution, and application of dilute indigo carmine or methylene blue for chromoendoscopy can provide increased contrast. International specialty society guidelines differ in their recommendations regarding use of chromoendoscopy for dysplasia surveillance, with some guidelines advocating a risk-stratified surveillance strategy. In this review, we discuss chromoendoscopy technique, training, implementation, yield as compared with standard-definition and high-definition white light colonoscopy, and positioning of this technique in clinical practice.
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Affiliation(s)
- Ann D Flynn
- University of Utah, Division of Gastroenterology, Hepatology, and Nutrition, Salt Lake City, UT
| | - John F Valentine
- University of Utah, Division of Gastroenterology, Hepatology, and Nutrition, Salt Lake City, UT
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17
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The role of colorectal endoscopic submucosal dissection in patients with ulcerative colitis. Gastrointest Endosc 2018; 87:1079-1084. [PMID: 29122603 DOI: 10.1016/j.gie.2017.10.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Patients with ulcerative colitis have an increased risk of colorectal dysplasia. Endoscopic submucosal dissection (ESD) for neoplastic lesions in ulcerative colitis remains controversial. The aim of this study was to clarify the role of ESD in the treatment strategy for ulcerative colitis. METHODS We retrospectively investigated 25 patients with ulcerative colitis in clinical remission who underwent colorectal ESD at 2 referral centers. We analyzed short-term and long-term outcomes. Preoperative diagnoses based on biopsy or endoscopy were also compared with the histologic diagnoses of resected specimens. RESULTS The mean size of the resected specimens was 34.9 ± 17.1 mm. The mean procedure time for ESD was 71.3 minutes. En bloc resection and R0 resection rates were achieved in 100% (25/25) and 76% (19/25), respectively. Postoperative bleeding and perforation during the procedure occurred in 0% and 4%, respectively. Five patients with noncurative resection underwent additional surgery. During a median 21 months (range, 8-80 months) follow-up, local recurrence did not occur. Metachronous high-grade dysplasia occurred in 1 case (4%). The biopsy predicted a final histologic diagnosis of carcinoma with a sensitivity of 72.2% (95% confidence interval [CI], 46.5-90.3), accuracy of 78.2% (95% CI, 56.3-92.5). The endoscopic findings predicted a final histologic diagnosis of carcinoma with a sensitivity of 72.2% (95% CI, 46.5-90.3), accuracy of 76% (95% CI, 54.9-90.6). CONCLUSION ESD for neoplasms in ulcerative colitis is feasible by expert endoscopists and may avoid unnecessary surgery. Because the biopsy and endoscopic findings had relatively low accuracy for the final histology, ESD could have a curative as well as a diagnostic purpose.
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Abstract
PURPOSE OF REVIEW Patients with long-standing ulcerative colitis have an increased risk for the development of colorectal cancer (CRC). Colitis-related dysplasia appears to confer the greatest risk. Colonoscopic surveillance to detect dysplasia has been advocated by gastrointestinal societies. The aim of surveillance is the reduction of mortality and morbidity of CRC through detection and resection of dysplasia or detecting CRC at an earlier and potentially curable stage. Traditional surveillance has relied on mucosal assessment with targeted biopsy of visible lesions and random biopsy sampling on the premise that dysplasia was not visible at endoscopy. Advances in optical technology permitting increased detection of dysplasia and evidence that most dysplasia is visible has had practice-changing implications. RECENT FINDINGS Emerging evidence favours chromoendoscopy (CE) for dysplasia detection and is gaining wider acceptance through recent international (International Consensus Statement on Surveillance and Management of Dysplasia in Inflammatory Bowel Disease (SCENIC)) recommendations and endorsed by many gastrointestinal societies. Adoption of CE as the gold standard of surveillance has been met with by scepticism, from conflicting data, operational barriers and the need to understand the true impact of increasingly higher dysplasia detection on overall CRC mortality. Valid debate notwithstanding, implementation of a risk stratification protocol that includes CE is an effective approach allowing earlier detection of dysplasia and colorectal neoplasia, determination of surveillance intervals with appropriate allocation of resources and limiting morbidity from CRC and colonoscopy itself. Further prospective data should define the true and long-term impact of dysplasia detection with modern techniques.
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Shawki S, Ashburn J, Signs SA, Huang E. Colon Cancer: Inflammation-Associated Cancer. Surg Oncol Clin N Am 2017; 27:269-287. [PMID: 29496089 DOI: 10.1016/j.soc.2017.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Colitis-associated cancer is a relatively rare form of cancer with an unclear pathogenesis. Colitis-associated cancer serves as a prototype of inflammation-associated cancers. Advanced colonoscopic techniques are considered standard of care for surveillance in patients with long-standing colitis, especially those with other risk factors, including sclerosing cholangitis and a family history of colorectal cancer. When colitis-associated cancer is diagnosed, the standard operation involves total proctocolectomy. Restorative procedures and surveillance after colectomy require special considerations. In these contexts, new 3-dimensional human models may be used to usher in personalized medicine.
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Affiliation(s)
- Sherief Shawki
- Department of Colorectal Surgery, Cleveland Clinic, A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jean Ashburn
- Department of Colorectal Surgery, Cleveland Clinic, A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven A Signs
- Department of Stem Cell Biology and Regenerative Medicine, Cleveland Clinic, Cleveland Clinic Lerner Research Institute, NE3, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Emina Huang
- Department of Colorectal Surgery, Cleveland Clinic, A30, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Stem Cell Biology and Regenerative Medicine, Cleveland Clinic, NE3, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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20
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Flores BM, O'Connor A, Moss AC. Impact of mucosal inflammation on risk of colorectal neoplasia in patients with ulcerative colitis: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86:1006-1011.e8. [PMID: 28750838 DOI: 10.1016/j.gie.2017.07.028] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/14/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Long-standing ulcerative colitis is an established risk factor for colorectal neoplasia. A number of observational studies have suggested that evidence of mucosal inflammation (endoscopic or histologic) is associated with a greater risk for colorectal neoplasia than is mucosal healing. Our goal was to systematically analyze the risk of colorectal neoplasia in patients with ulcerative colitis who have ongoing mucosal inflammation to better inform surveillance strategies. METHODS We performed a systematic review and meta-analysis of the effect of endoscopic and/or histologic inflammation on the risk of colorectal neoplasia in cohort and case-control studies. Sensitivity analyses for study setting and case definition were performed. RESULTS Six studies met the inclusion criteria, incorporating outcomes in 1443 patients. No study used a single validated measure for mucosal inflammation. The pooled odds ratio for colorectal neoplasia was 3.5 (95% confidence interval [CI], 2.6-4.8; P < .001) in those with any mucosal inflammation and 2.6 (95% CI, 1.5-4.5; P = .01) in those with histologic inflammation, when compared with those with mucosal healing. The overall quality of the studies was good. CONCLUSION The presence of objective evidence of mucosal inflammation during follow-up in patients with ulcerative colitis is associated with a greater risk of subsequent colorectal neoplasia than in those with mucosal healing. This risk factor should be considered in guidelines on surveillance intervals for these patients.
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Affiliation(s)
- Brisas M Flores
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony O'Connor
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom
| | - Alan C Moss
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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21
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Ten Hove JR, Mooiweer E, Dekker E, van der Meulen-de Jong AE, Offerhaus GJA, Ponsioen CY, Siersema PD, Oldenburg B. Low Rate of Dysplasia Detection in Mucosa Surrounding Dysplastic Lesions in Patients Undergoing Surveillance for Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2017; 15:222-228.e2. [PMID: 27613257 DOI: 10.1016/j.cgh.2016.08.035] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/22/2016] [Accepted: 08/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS When dysplastic lesions are encountered during surveillance colonoscopy of patients with inflammatory bowel disease (IBD), guidelines recommend collection of additional biopsies from the surrounding mucosa to ensure the lesion has been adequately circumscribed. We aimed to determine the rate of dysplasia in mucosa biopsies collected from tissues surrounding dysplastic lesions during IBD surveillance. METHODS In a retrospective study, we collected endoscopy and pathology reports from 1065 patients undergoing colonoscopic surveillance for IBD from 2000 through 2015 at 3 centers in the Netherlands. We analyzed reports from all patients with dysplastic lesions from whom biopsies of surrounding mucosa were collected. Among 194 patients with 1 or more visible dysplastic lesions, mucosal biopsies were collected from tissues adjacent to 140 dysplastic lesions from 71 patients (63% male; 48% with ulcerative colitis, 42% with Crohn's disease, and 10% with indeterminate colitis). RESULTS The mean number of surrounding mucosa biopsies collected per lesion was 3.4 (range, 1-6). Dysplasia was detected in 7 biopsies surrounding 140 areas of dysplasia (5.0%) and 5 biopsies surrounding 136 areas of low-grade dysplasia (3.7%). Dysplasia in biopsies of surrounding mucosa could be observed during 5 of 87 white light endoscopies and during 2 of 53 chromoendoscopies. In patients with dysplasia in mucosa surrounding lesions of low-grade dysplasia, post-resection surveillance did not reveal high-grade dysplasia or colorectal cancer. CONCLUSIONS Dysplasia is detected in only 5% of biopsies collected from mucosa surrounding dysplastic lesions. This observation indicates that endoscopists accurately delineate the borders of dysplastic lesions during surveillance of patients with IBD. The lack of clinical consequences from routinely collecting biopsies from areas surrounding dysplastic lesions casts doubt on the usefulness and cost-effectiveness of this practice.
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Affiliation(s)
- Joren R Ten Hove
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik Mooiweer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - G Johan A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Utrecht, Nijmegen, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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22
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Kisiel JB, Konijeti GG, Piscitello AJ, Chandra T, Goss TF, Ahlquist DA, Farraye FA, Ananthakrishnan AN. Stool DNA Analysis is Cost-Effective for Colorectal Cancer Surveillance in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol 2016; 14:1778-1787.e8. [PMID: 27464589 PMCID: PMC5108686 DOI: 10.1016/j.cgh.2016.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/17/2016] [Accepted: 07/10/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with chronic ulcerative colitis are at increased risk for colorectal neoplasia (CRN). Surveillance by white-light endoscopy (WLE) or chromoendoscopy may reduce risk of CRN, but these strategies are underused. Analysis of DNA from stool samples (sDNA) can detect CRN with high levels of sensitivity, but it is not clear if this approach is cost-effective. We simulated these strategies for CRN detection to determine which approach is most cost-effective. METHODS We adapted a previously published Markov model to simulate the clinical course of chronic ulcerative colitis, the incidence of cancer or dysplasia, and costs and benefits of care with 4 surveillance strategies: (1) analysis of sDNA and diagnostic chromoendoscopy for patients with positive results, (2) analysis of sDNA with diagnostic WLE for patients with positive results, (3) chromoendoscopy with targeted collection of biopsies, or (4) WLE with random collection of biopsies. Costs were based on 2014 Medicare reimbursement. The primary outcome was the incremental cost-effectiveness ratio (incremental cost/incremental difference in quality-adjusted life-years) compared with no surveillance and a willingness-to-pay threshold of $50,000. RESULTS All strategies fell below the willingness-to-pay threshold at 2-year intervals. Incremental cost-effectiveness ratios were $16,362 per quality-adjusted life-year for sDNA analysis with diagnostic chromoendoscopy; $18,643 per quality-adjusted life-year for sDNA analysis with diagnostic WLE; $23,830 per quality-adjusted life-year for chromoendoscopy alone; and $27,907 per quality-adjusted life-year for WLE alone. In sensitivity analyses, sDNA analysis with diagnostic chromoendoscopy was more cost-effective than chromoendoscopy alone, up to a cost of $1135 per sDNA test. sDNA analysis remained cost-effective at all rates of compliance; when combined with diagnostic chromoendoscopy, this approach was preferred over chromoendoscopy alone, when the specificity of the sDNA test for CRN was >65%. CONCLUSIONS Based on a Markov model, surveillance for CRN is cost-effective for patients with chronic ulcerative colitis. Analysis of sDNA with chromoendoscopies for patients with positive results was more cost-effective than chromoendoscopy or WLE alone.
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Affiliation(s)
- John B. Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN
| | - Gauree G. Konijeti
- Division of Gastroenterology, Scripps Clinic, La Jolla CA,Scripps Translational Science Institute, La Jolla, CA
| | | | | | | | - David A. Ahlquist
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester MN
| | - Francis A. Farraye
- Center for Digestive Disorders, Boston Medical Center, Section of Gastroenterology, Boston University School of Medicine, Boston MA
| | - Ashwin N. Ananthakrishnan
- Division of Gastroenterology and Hepatology, Massachusetts General Hospital and Harvard Medical School, Boston MA
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23
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Wanders LK, Kuiper T, Kiesslich R, Karstensen JG, Leong RW, Dekker E, Bisschops R. Limited applicability of chromoendoscopy-guided confocal laser endomicroscopy as daily-practice surveillance strategy in Crohn's disease. Gastrointest Endosc 2016; 83:966-71. [PMID: 26358329 DOI: 10.1016/j.gie.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 09/01/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with longstanding ulcerative colitis have an increased risk for developing colorectal cancer (CRC). Although the risk for ulcerative colitis is well-established, for Crohn's disease data are contradictory. This study aimed to determine the number of patients with Crohn's disease with dysplasia who are undergoing surveillance and to assess the diagnostic accuracy of chromoendoscopy (CE) combined with integrated confocal laser endomicroscopy (iCLE) for differentiating dysplastic versus nondysplastic lesions. METHODS Patients with longstanding Crohn's colitis undergoing surveillance colonoscopy were included in this multicenter, prospective, cohort study. Surveillance was performed with CE, and lesions were assessed with iCLE for differentiation. All lesions were removed and sent for pathology as the reference standard. RESULTS Between 2010 and 2014, a total of 61 patients with Crohn's colitis were included in 5 centers. Seventy-two lesions, of which 7 were dysplastic, were detected in 6 patients (dysplasia detection rate 9.8%); none included high-grade dysplasia or cancer. Combined CE with iCLE for differentiating neoplastic from nonneoplastic lesions had accuracy of 86.7% (95% confidence interval [CI], 78.1-95.3), sensitivity of 42.9% (95% CI, 11.8-79.8), and specificity of 92.4% (95% CI, 80.9-97.6). For CE alone, this was 80.3% (95% CI, 70.7-89.9), 28.6% (95% CI, 5.1-69.7), and 86.4% (95% CI, 80.9-97.6). The study terminated early because of frequent failure of the endoscopic equipment. CONCLUSIONS This study shows a low incidence of dysplastic lesions found during surveillance colonoscopy in patients with longstanding extensive Crohn's colitis. The accuracy of both CE alone and CE in combination with iCLE was relatively good, although the sensitivity for both was poor. Because of frequent equipment failure, iCLE has limited applicability in daily practice as a surveillance strategy.
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Affiliation(s)
- Linda K Wanders
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Teaco Kuiper
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ralf Kiesslich
- Department of Gastroenterology, Dr. Horst Schmidt Klinik, Wiesbaden, Germany
| | - John G Karstensen
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Rupert W Leong
- Gastroenterology and Liver Services, Bankstown-Lidcombe Hospital, Sydney, Australia
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
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Buchner AM. Challenges in detection and real-time diagnosis of dysplasia in Crohn's colitis: the search still continues. Gastrointest Endosc 2016; 83:972-4. [PMID: 27102530 DOI: 10.1016/j.gie.2015.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 02/08/2023]
Affiliation(s)
- Anna M Buchner
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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25
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Rosa I, Fidalgo P, Filipe B, Albuquerque C, Fonseca R, Chaves P, Pereira AD. Sporadic colorectal cancer: Studying ways to an end. United European Gastroenterol J 2016; 4:288-96. [PMID: 27087959 DOI: 10.1177/2050640615599329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 06/14/2015] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Although colorectal cancer (CRC) has often been regarded as a single entity, different pathways may lead to macroscopically similar cancers. These pathways may evolve into a patchy colonic field defect that we aimed to study in consecutive CRC patients. METHODS In a single-center, observational, prospective study, consecutive CRC patients were included if surgery and a perioperative colonoscopy were planned. Personal and familial history data were collected. Tumors were studied for microsatellite instability (MSI) status, DNA repair protein expression (DRPE) and presence of BRAF and/or APC mutations. Macroscopically normal mucosa samples were tested for APC mutations. Presence and location of synchronous and metachronous adenomas and patient follow-up were analyzed. The association of two categorical variables was tested through the Fisher's exact test (SPSS 19). RESULTS Twenty-four patients (12 male, mean age 69 years) were studied. High-grade MSI (MSI-H) was found in eight tumors-these were significantly more common in the right colon (p = 0.047) and more likely to have an altered DRPE (p = 0.007). BRAF mutation was found in two of six tested MSI-H tumors. APC gene mutations were found in nine of 16 non-MSI-H tumors and absent in normal mucosa samples. There was a nonsignificant co-localization of CRC and synchronous adenomas and a significant co-localization (p = 0.05) of synchronous and metachronous adenomas. DISCUSSION Sporadic CRCs evolve through distinct pathways, evidenced only by pathological and molecular analysis, but clinically relevant both for patients and their families. In non-MSI-H tumors, the expected APC gene mutations were not detected by the most commonly used techniques in a high number of cases. More studies are needed to fully characterize these tumors and to search for common early events in normal mucosa patches, which might explain the indirect evidence found here for a field defect in the colon.
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Affiliation(s)
- Isadora Rosa
- Serviço de Gastrenterologia do Instituto Português de Oncologia de Lisboa, Francisco Gentil (IPOLFG), EPE, Lisboa, Portugal; Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
| | - Paulo Fidalgo
- Serviço de Gastrenterologia, Fundação Champalimaud, Lisboa, Portugal
| | - Bruno Filipe
- Unidade de Investigação em Patobiologia Molecular, IPOLFG, EPE, Lisboa, Portugal
| | - Cristina Albuquerque
- Unidade de Investigação em Patobiologia Molecular, IPOLFG, EPE, Lisboa, Portugal
| | - Ricardo Fonseca
- Serviço de Anatomia Patológica do IPOLFG, EPE, Lisboa, Portugal
| | - Paula Chaves
- Serviço de Anatomia Patológica do IPOLFG, EPE, Lisboa, Portugal; Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
| | - António D Pereira
- Serviço de Gastrenterologia do Instituto Português de Oncologia de Lisboa, Francisco Gentil (IPOLFG), EPE, Lisboa, Portugal; Faculdade de Ciências da Saúde da Universidade da Beira Interior, Covilhã, Portugal
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Sanduleanu S, Kaltenbach T, Barkun A, McCabe RP, Velayos F, Picco MF, Laine L, Soetikno R, McQuaid KR. A roadmap to the implementation of chromoendoscopy in inflammatory bowel disease colonoscopy surveillance practice. Gastrointest Endosc 2016; 83:213-22. [PMID: 26364967 DOI: 10.1016/j.gie.2015.08.076] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/26/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Silvia Sanduleanu
- Division of Gastroenterology, Department of Medicine and GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Tonya Kaltenbach
- Stanford University and VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | | | - Fernando Velayos
- Department of Medicine, University of California, San Francisco, California, USA
| | - Michael F Picco
- Division of Gastroenterology, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Loren Laine
- Yale School of Medicine, New Haven and VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Roy Soetikno
- Stanford University and VA Palo Alto Healthcare System, Palo Alto, California, USA
| | - Kenneth R McQuaid
- University of California, San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
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Viana Veloso GG, Franco OH, Ruiter R, de Keyser CE, Hofman A, Stricker BC, Kiefte-de Jong JC. Baseline dietary glutamic acid intake and the risk of colorectal cancer: The Rotterdam study. Cancer 2015; 122:899-907. [DOI: 10.1002/cncr.29862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 01/28/2023]
Affiliation(s)
| | - Oscar H. Franco
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Rikje Ruiter
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
- Department of Internal Medicine; Groene Hart Hospital; Gouda the Netherlands
| | | | - Albert Hofman
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
| | - Bruno C. Stricker
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
- Health Care Inspectorate; the Hague the Netherlands
- Department of Internal Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| | - Jessica C. Kiefte-de Jong
- Department of Epidemiology; Erasmus Medical Center; Rotterdam the Netherlands
- Leiden University College; the Hague the Netherlands
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Iacopini F, Saito Y, Yamada M, Grossi C, Rigato P, Costamagna G, Gotoda T, Matsuda T, Scozzarro A. Curative endoscopic submucosal dissection of large nonpolypoid superficial neoplasms in ulcerative colitis (with videos). Gastrointest Endosc 2015; 82:734-8. [PMID: 25982856 DOI: 10.1016/j.gie.2015.02.052] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/18/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic resection of superficial neoplasms in inflammatory bowel disease (IBD) is appropriate if a complete resection can be achieved. However, EMR is ineffective for large, nonpolypoid neoplasms in IBD due to submucosal fibrosis, and no data are available on the efficacy of endoscopic submucosal dissection (ESD). OBJECTIVE To assess ESD feasibility and efficacy for large, nonpolypoid neoplasms in patients with IBD. DESIGN Prospective case series. SETTING Multicenter: Italian and Japanese centers. PATIENTS Consecutive patients with long-standing ulcerative colitis and a superficial nonpolypoid neoplasm, >20 mm within the colitic mucosa. INTERVENTION Neoplasm characterization and delineation by chromoscopy and narrow-band imaging. ESD performed according to the standard technique. MAIN OUTCOME MEASUREMENTS Feasibility, safety, curative resection rates. RESULTS Nine patients with 10 neoplasms were included (7 and 3 in the Italian and Japanese centers, respectively). Neoplasms were laterally spreading tumors-non-granular in 5 cases, in the left side of the colon in 7, had median size of 33 mm, and were associated with scar in 5 cases. Margin delineation was difficult in 5 cases. Submucosal fibrosis was present in 9 cases. ESD was en bloc with negative margins (R0) in 8 cases, and curative in 7. No endoscopic invisible dysplasia or cancer was found during the follow-up (median 24 months, range 6-72 months) at the resection site and elsewhere within the colitic mucosa. LIMITATIONS Small series. CONCLUSION ESD achieves curative resections in patients with IBD, but the procedure is difficult because of the high prevalence of submucosal fibrosis. Patients need to be accurately evaluated before resection and adhere to strict long-term follow-ups.
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Affiliation(s)
- Federico Iacopini
- Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe-ASL Roma H, Albano L, Italy
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Cristina Grossi
- Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe-ASL Roma H, Albano L, Italy
| | - Patrizia Rigato
- Pathology Unit, Ospedale S. Giuseppe-ASL Roma H, Marino, Italy
| | | | - Takuji Gotoda
- Department of Gastroenterology & Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Agostino Scozzarro
- Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe-ASL Roma H, Albano L, Italy
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Sonnenberg A, Genta RM. Epithelial Dysplasia and Cancer in IBD Strictures. J Crohns Colitis 2015; 9:769-75. [PMID: 26079724 DOI: 10.1093/ecco-jcc/jjv108] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/08/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Colonic strictures and epithelial dysplasia are both known risk factors for the occurrence of colorectal cancer in inflammatory bowel disease (IBD) patients. The aim of the present work was to study colonic stricture as a risk factor for the occurrence of epithelial dysplasia and colonic adenocarcinoma. METHODS In a case-control study among 53568 IBD patients undergoing colonoscopy, we compared the prevalence of strictures among cases with dysplasia or adenocarcinoma and controls without such complications by calculating odds ratios (ORs) and their 95% confidence intervals (CIs). Multivariate logistic regressions were used to assess the joint influence of multiple predictor variables (age, sex, IBD type and stricture) on the occurrence of colonic dysplasia or adenocarcinoma. RESULTS The prevalence of strictures was 1.06% in ulcerative colitis (UC) and 8.71% in Crohn's disease (CD, OR 11.09, 95% CI 9.72-12.70). The prevalence of dysplasia was 3.22% in UC and 2.08% in CD (OR 0.75, 95% CI 0.65-0.86). The prevalence of dysplasia was similar in IBD patients with and without stricture: 2.82 and 2.41%, respectively. The prevalence of cancer was higher in IBD patients with than without stricture: 0.78 and 0.11%, respectively (OR 6.87, 95% CI 3.30-12.89). In the multivariate analysis, old age, male sex and UC, but not stricture, were all significantly and independently associated with dysplasia. Old age, dysplasia and stricture were significantly and independently associated with cancer. CONCLUSION The prevalence of epithelial dysplasia is not generally increased in IBD patients with strictures.
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Affiliation(s)
- Amnon Sonnenberg
- Oregon Health & Science University, Portland, OR, USA Oregon Health & Science University, Portland, OR, USA
| | - Robert M Genta
- University of Texas Southwestern Medical Center, Dallas, TX, USA University of Texas Southwestern Medical Center, Dallas, TX, USA
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30
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Surveillance of long-standing colitis: the role of image-enhanced endoscopy. Best Pract Res Clin Gastroenterol 2015; 29:687-97. [PMID: 26381312 DOI: 10.1016/j.bpg.2015.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/22/2015] [Accepted: 06/08/2015] [Indexed: 01/31/2023]
Abstract
Patients with long-standing inflammatory bowel disease of the colon are at an increased risk of developing colorectal carcinoma. Surveillance programs have been implemented with the aim of detecting neoplastic lesions in an early stage. Due to limitations of conventional white light endoscopy, several new techniques to enhance the detection of dysplastic lesions in this setting have been explored. These advanced endoscopic techniques use a variety of methods to improve visualization, such as pancolonic dye-spraying (chromoendoscopy), optical filters (narrow-band imaging) and autofluorescence of mucosal tissue (autofluorescence imaging). At present, most guidelines have adopted chromoendoscopy as the preferred method for surveillance, based on several controlled studies. It is currently unknown if widespread implementation of chromoendoscopy will lead to an improved clinical outcome. This review explores the current evidence on image-enhanced endoscopic techniques used in the detection of neoplastic lesions in patients with long standing colitis.
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31
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Shergill AK, Lightdale JR, Bruining DH, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, Early DS, Evans JA, Fanelli RD, Fisher DA, Fonkalsrud L, Foley K, Hwang JH, Jue TL, Khashab MA, Muthusamy VR, Pasha SF, Saltzman JR, Sharaf R, Cash BD, DeWitt JM. The role of endoscopy in inflammatory bowel disease. Gastrointest Endosc 2015; 81:1101-21.e1-13. [PMID: 25800660 DOI: 10.1016/j.gie.2014.10.030] [Citation(s) in RCA: 230] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 10/27/2014] [Indexed: 02/08/2023]
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32
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Herszényi L, Barabás L, Miheller P, Tulassay Z. Colorectal cancer in patients with inflammatory bowel disease: the true impact of the risk. Dig Dis 2014; 33:52-7. [PMID: 25531497 DOI: 10.1159/000368447] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with long-standing inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). The association between IBD and CRC is well supported, but reported risk estimates vary widely. Although recent evidence from population-based studies reports a decline in risk, CRC accounts for 10-15% of all deaths in IBD. The potential causes of recent epidemiological trends and the real magnitude of risk of CRC in IBD are subjects of debate. The molecular pathway leading to CRC differs from the classic adenoma-to-CRC sequence. Chronic inflammation contributes to the development of low- and high-grade dysplasia which may further convert into CRC. Patients with a young age at onset, long-standing and extensive colitis with severe inflammatory burden, a family history of sporadic CRC, and concomitant primary sclerosing cholangitis are at greatest risk. The CRC risk in patients with colonic Crohn's disease is similar to that of ulcerative colitis. IBD-associated CRC can frequently be detected at late stages and at a younger age. The long-term prognosis of CRC may be poorer in patients with IBD than in those with sporadic CRC. Regular surveillance colonoscopies may permit earlier detection of CRC, with a corresponding improved prognosis. The interval between surveillance colonoscopies is dependent on each patient's personal risk profile.
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Affiliation(s)
- László Herszényi
- Second Departments of Internal Medicine, Semmelweis University, Budapest, Hungary
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34
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Shah SA, Rubin DT, Farraye FA. Chromoendoscopy for colorectal cancer surveillance in patients with inflammatory bowel disease. Curr Gastroenterol Rep 2014; 16:407. [PMID: 25113042 DOI: 10.1007/s11894-014-0407-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chromoendoscopy utilizes colorimetric techniques to increase detection of lesions that are difficult to see or cannot be seen with conventional white light endoscopy. Multiple studies have demonstrated that chromoendoscopy with dye spraying significantly increases the detection of dysplastic lesions in patients with chronic inflammatory bowel disease (IBD) of the colon undergoing colonoscopy. Furthermore, chromoendoscopy may obviate the need for random biopsies and pending additional studies and may allow increased intervals between surveillance exams, reducing costs while increasing the sensitivity for detection of dysplasia per exam. Despite convincing data supporting the use of chromoendoscopy for IBD colonic surveillance, it is seldom utilized outside of academic centers. Here, we review the current approach to colorectal cancer surveillance in IBD focusing on the data supporting the use of chromoendoscopy including its use in a community setting and offer practical recommendations for incorporating chromoendoscopy as a routine part of surveillance in IBD regardless of practice setting.
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Affiliation(s)
- Samir A Shah
- Gastroenterology Associates, Inc., 44 West River Street, Providence, RI, 02904, USA,
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35
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Rutter MD. Importance of nonpolypoid (flat and depressed) colorectal neoplasms in screening for CRC in patients with IBD. Gastrointest Endosc Clin N Am 2014; 24:327-35. [PMID: 24975524 DOI: 10.1016/j.giec.2014.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Patients with inflammatory bowel disease colitis have an increased risk of developing colorectal cancer compared with the general population. Colonoscopic surveillance remains challenging because the cancer precursor (dysplasia) can have a varied and subtle endoscopic appearance. Although historically the dysplasia was often considered endoscopically invisible, today with advanced endoscopic understanding, technique, and imaging, it is almost always visible. The frequency of different dysplasia morphologies and true clinical significance of such lesions are difficult to determine from retrospective series, many of which were performed prior to the current endoscopic era.
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Affiliation(s)
- Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Hardwick, Stockton-on-Tees, Cleveland TS19 8PE, UK; Durham University School of Medicine, Pharmacy and Health Queen's Campus, University Boulevard, Stockton-on-Tees, TS17 6BH, UK.
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36
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Interval colorectal cancers in inflammatory bowel disease: the grim statistics and true stories. Gastrointest Endosc Clin N Am 2014; 24:337-48. [PMID: 24975525 DOI: 10.1016/j.giec.2014.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Interval colorectal cancers (CRCs) may account for approximately one half of all CRCs identified during IBD surveillance. The etiology of interval CRCs is multifactorial, with procedural factors likely to play a major role. Molecular events promoted by inflamed mucosa may augment the cancer risk and perhaps explain some interval CRCs. This article reviews key studies relating to CRC risk in the patient with IBD, paying particular attention to the occurrence of interval CRCs. The most common factors implicated in the etiology of interval CRCs, in particular missed, incompletely resected lesions, the adherence to recommended surveillance intervals and biologic pathways associated with a faster progression to cancer are examined. Basic concepts for quality and effectiveness of colonoscopic surveillance in IBD are summarized.
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37
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Shergill AK, Farraye FA. Toward a consensus on endoscopic surveillance of patients with colonic inflammatory bowel disease. Gastrointest Endosc Clin N Am 2014; 24:469-81. [PMID: 24975537 DOI: 10.1016/j.giec.2014.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Surveillance colonoscopy in patients with inflammatory bowel disease (IBD) with colonic involvement is recommended by multiple national and international gastrointestinal societies. Recommendations differ on the timing of initial screening colonoscopy, recommended surveillance intervals, optimal technique for dysplasia detection, and management of endoscopically visible and nonvisible dysplasia. This article reviews current society guidelines, highlighting similarities and differences, in an attempt to summarize areas of consensus on surveillance protocols in IBD, while drawing attention to controversial areas in need of further research.
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Affiliation(s)
- Amandeep K Shergill
- Department of Medicine, University of California, San Francisco, San Francisco VA Medical Center, 4150 Clement Street (VA 111B), San Francisco, CA 94121, USA.
| | - Francis A Farraye
- Department of Medicine, Boston University School of Medicine, Section of Gastroenterology Boston Medical Center, 85 East Concord Street, 7th Floor Boston, MA 02118, USA
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