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Cheung KS. Big data approach in the field of gastric and colorectal cancer research. J Gastroenterol Hepatol 2024; 39:1027-1032. [PMID: 38413187 DOI: 10.1111/jgh.16527] [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: 01/28/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
Big data is characterized by three attributes: volume, variety,, and velocity. In healthcare setting, big data refers to vast dataset that is electronically stored and managed in an automated manner and has the potential to enhance human health and healthcare system. In this review, gastric cancer (GC) and postcolonoscopy colorectal cancer (PCCRC) will be used to illustrate application of big data approach in the field of gastrointestinal cancer research. Helicobacter pylori (HP) eradication only reduces GC risk by 46% due to preexisting precancerous lesions. Apart from endoscopy surveillance, identifying medications that modify GC risk is another strategy. Population-based cohort studies showed that long-term use of proton pump inhibitors (PPIs) associated with higher GC risk after HP eradication, while aspirin and statins associated with lower risk. While diabetes mellitus conferred 73% higher GC risk, metformin use associated with 51% lower risk, effect of which was independent of glycemic control. Nonetheless, nonsteroidal anti-inflammatory drugs (NA-NSAIDs) are not associated with lower GC risk. CRC can still occur after initial colonoscopy in which no cancer was detected (i.e. PCCRC). Between 2005 and 2013, the rate of interval-type PCCRC-3y (defined as CRC diagnosed between 6 and 36 months of index colonoscopy which was negative for CRC) was 7.9% in Hong Kong, with >80% being distal cancers and higher cancer-specific mortality compared with detected CRC. Certain clinical and endoscopy-related factors were associated with PCCRC-3 risk. Medications shown to have chemopreventive effects on PCCRC include statins, NA-NSAIDs, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
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Affiliation(s)
- Ka Shing Cheung
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
- Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
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2
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Yang K, Cao Y, Gurjao C, Liu Y, Guo CG, Lo CH, Zong X, Drew D, Geraghty C, Prezioso E, Moore M, Williams C, Riley T, Saul M, Ogino S, Giannakis M, Bass A, Schoen RE, Chan AT. Clinical and Genomic Characterization of Interval Colorectal Cancer in 3 Prospective Cohorts. Gastroenterology 2022; 163:1522-1530.e5. [PMID: 35970241 PMCID: PMC9691567 DOI: 10.1053/j.gastro.2022.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Interval colorectal cancers (CRCs), cancers diagnosed after a screening/surveillance examination in which no cancer is detected, and before the date of next recommended examination, reflect an unprecedented challenge in CRC detection and prevention. To better understand this poorly characterized CRC variant, we examined the clinical and mutational characteristics of interval CRCs in comparison with screen detected CRCs. METHODS We included 1175 CRCs documented in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial and 3661 CRCs in the Nurses' Health Study (NHS) and Health Professionals Follow-up Study (HPFS). Multivariable Cox models were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of death risk. Whole exome sequencing was conducted in 147 PLCO cases and 796 NHS/HPFS cases. RESULTS A total of 619 deaths (312 CRC-specific) and 2404 deaths (1904 CRC-specific) were confirmed during follow-up of PLCO and NHS/HPFS, respectively. Compared with screen detected CRCs, interval CRCs had a multivariate-adjusted HR (95% CI) of 1.47 (1.21-1.78) for CRC-specific mortality and 1.27 (1.09-1.47) for overall mortality (meta-analysis combining all 3 cohorts). However, we did not observe significant differences in mutational features between interval and screen detected CRCs (false discovery rate adjusted P > .05). CONCLUSION Interval CRCs had a significantly increased risk of death compared with screen detected CRCs that were not explained by established clinical prognostic factors, including stage at diagnosis. The survival disadvantage of interval CRCs did not appear to be explained by differences in the genomic landscape of tumors characterized by whole exome sequencing.
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Affiliation(s)
- Keming Yang
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri; Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Carino Gurjao
- Department of Medical Oncology, Dana-Farber Cancer Institute, and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Yang Liu
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chuan-Guo Guo
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chun-Han Lo
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Xiaoyu Zong
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David Drew
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Connor Geraghty
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Prezioso
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matt Moore
- Information Management Services, Inc., Rockville, Maryland
| | - Craig Williams
- Information Management Services, Inc., Rockville, Maryland
| | - Tom Riley
- Information Management Services, Inc., Rockville, Maryland
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Marios Giannakis
- Department of Medical Oncology, Dana-Farber Cancer Institute, and Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Adam Bass
- Herbert Irving Comprehensive Cancer Center and Center for Precision Cancer Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York
| | - Robert E Schoen
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Gastroenterology, Hepatology and Nutrition, and Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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3
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Shanahan JJ, LeBlanc DM, Courage ER, Benesch MGK, Hickey KE, Hartwig KA, Armstrong CD, Engelbrecht R, Fagan MG, Borgaonkar MR, Pace DE. Characteristics of Interval Colorectal Cancer: A Canadian Retrospective Population-Level Analysis from Newfoundland and Labrador. Curr Oncol 2022; 29:9150-9162. [PMID: 36547130 PMCID: PMC9776431 DOI: 10.3390/curroncol29120716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
Interval colorectal cancers (I-CRCs) arise during the interval time period between scheduled colonoscopies. Predicting which patients are at risk of I-CRCs remains an elusive undertaking, but evidence would suggest that most I-CRCs arise from lesions missed on index endoscopy. The procedural factors that lead to missed lesions are numerous and lack consensus in the literature. In Canada, the province of Newfoundland and Labrador has the highest incidence of CRCs. In this study our aim was to examine I-CRCs (3-60 months after last colonoscopy) in NL through a population-level analysis covering 67% of the province from 2001-2018. We estimated the I-CRC rate to be up to 9.3%. Median age of I-CRC diagnosis was 67.1 years with an interval time of 2.9 years. About 57% of these tumors occurred proximal to the splenic flexure, with 53% presenting as local disease. No temporal differences were observed in interval time or tumor distribution. On univariate and multivariable logistical regression, risk of right-sided I-CRC did not correlate to the index colonoscopy indication, bowel preparation quality, size of largest polyp removed, colonoscopy completion rate, or stage at presentation. Improvements in synoptic reporting utilization and national registries are needed to identity risk factors and reduce I-CRC frequency.
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Affiliation(s)
- Jessica J. Shanahan
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Danielle M. LeBlanc
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Emily R. Courage
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Matthew G. K. Benesch
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Kala E. Hickey
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Katia A. Hartwig
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Casey D. Armstrong
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Reniel Engelbrecht
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Mitchell G. Fagan
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - Mark R. Borgaonkar
- Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
| | - David E. Pace
- Discipline of Surgery, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada
- Correspondence:
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Macaron C, Rouphael C, Burke CA. Setting a benchmark for serrated polyp detection rate: defining the target and terminology comes first. Gastrointest Endosc 2022; 96:318-320. [PMID: 35715237 DOI: 10.1016/j.gie.2022.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Carole Macaron
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol Rouphael
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carol A Burke
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
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5
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Tseng CW, Hsieh YH, Koo M, Leung FW. Comparing right colon adenoma detection rate during water exchange and air insufflation: a double-blind randomized controlled trial. Tech Coloproctol 2021; 26:35-44. [PMID: 34705136 DOI: 10.1007/s10151-021-02537-1] [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] [Received: 06/04/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) have reported that water exchange (WE) produced the highest adenoma detection rate (ADR) but did not evaluate right colon adenoma detection rate (rADR) as a primary outcome and only one of the trials employed blinded colonoscopists. The aim of our study was to determine whether, compared with air insufflation, WE significantly increases rADR and right colon serrated lesion detection rate (rSLDR) and decreases adenoma miss rate (rAMR). METHODS This prospective, double-blind RCT was conducted at a regional hospital in Taiwan between December 2015 and February 2020. Standard WE and air insufflation were performed. After cecal intubation, the second blinded endoscopist examined the right colon and obtained rADR (primary outcome) and rSLDR. Then, the primary colonoscopist reinserted the scope to the cecum with WE in both groups and performed a tandem examination of the right colon to obtain rAMR. RESULTS There were 284 patients (50.9% male, mean age 58.9 ± 9.4 years) who were randomized to WE (n = 144) or air insufflation (n = 140). The baseline characteristics were similar. The rADR (34.7% vs. 22.3%, p = 0.025), Boston Bowel Preparation Scale scores (mean, 2.6 ± 0.6vs. 2.2 ± 0.6, p < 0.001), rSLDR (18.1% vs. 7.1%, p = 0.007), and rAMR (31.5% vs. 45.2%, p = 0.038) were significantly different between WE and air insufflation. CONCLUSIONS The current study demonstrated a significantly higher rADR and rSLDR with the WE method performed by blinded colonoscopists. The impact of the significant findings in this report on the occurrence of interval cancers deserves to be studied.
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Affiliation(s)
- C- W Tseng
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, Chiayi, 62247, Taiwan.,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Y- H Hsieh
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2 Minsheng Road, Dalin, Chiayi, 62247, Taiwan. .,School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan.
| | - M Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien, Taiwan.,Dalla Lana School of Public Health, University of Toronto, Ontario, ON, Canada
| | - F W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hill, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Abstract
BACKGROUND Screening for colorectal cancer (CRC) with colonoscopy has been credited for the majority of the decline in mortality over the past 40 years. However, colonoscopy is hampered by frequent interval cancers (ICs) occurring within 36 months after the last examination. Risk factors for IC imply that most misses are amenable to improved colonoscopic techniques. This study had two primary objectives: (1) to determine whether the proportion of persons with ICs has declined in association with improved approaches to the quality of colonoscopy and (2) to determine unrecognized causes for missed diagnoses. METHODS This is a retrospective, single-center study of persons with CRC having been diagnosed within 6-36 months since the most recent colonoscopy between 2006 and 2015. Participants, ages 50 and 89 years, were evaluated specifically for technical features and findings of the most recent colonoscopy. RESULTS Thirty-nine persons met the inclusion criteria for IC. Mean age was 69.3 years, range 50-86 years, women were 58%, races included 95% Caucasian, 2.5% Asian, and 2.5% African-American, and history of a first-degree relative with CRC was 26%. Symptoms led to the interval diagnosis in 83%, including iron-deficient anemia (38%), bleeding (25%), abdominal/pelvic pain (18%), and change in bowel habit (2.5%). Preexisting neoplasia was present in 72%. The CRC was located in the proximal colon in 51%. Late-stage disease was present in 45%. When compared to persons with an initial diagnosis of screen-detected late-onset CRC, differences were noted for older age, more women, more with a family history of CRC, and more with late-stage disease. The ratio of interval cancers to new cancers ranged between 6 and 11.5%. Findings indicating a "difficult examination" were observed in 14 cases (36%) compared to "easy or no difficulty" examinations in 25 (65%) cases. In a biennial analysis of IC rates between 2006 and 2015, the percentage of IC remained stable between 6 and 11.5%. CONCLUSIONS ICs have been stable constituting 6-11.5% of all CRCs. A "difficult examination" was often associated with IC, may be a risk factor for this problem, and may be an important clue warranting further study.
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ACG Clinical Guidelines: Colorectal Cancer Screening 2021. Am J Gastroenterol 2021; 116:458-479. [PMID: 33657038 DOI: 10.14309/ajg.0000000000001122] [Citation(s) in RCA: 308] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer in men and women in the United States. CRC screening efforts are directed toward removal of adenomas and sessile serrated lesions and detection of early-stage CRC. The purpose of this article is to update the 2009 American College of Gastroenterology CRC screening guidelines. The guideline is framed around several key questions. We conducted a comprehensive literature search to include studies through October 2020. The inclusion criteria were studies of any design with men and women age 40 years and older. Detailed recommendations for CRC screening in average-risk individuals and those with a family history of CRC are discussed. We also provide recommendations on the role of aspirin for chemoprevention, quality indicators for colonoscopy, approaches to organized CRC screening and improving adherence to CRC screening. CRC screening must be optimized to allow effective and sustained reduction of CRC incidence and mortality. This can be accomplished by achieving high rates of adherence, quality monitoring and improvement, following evidence-based guidelines, and removing barriers through the spectrum of care from noninvasive screening tests to screening and diagnostic colonoscopy. The development of cost-effective, highly accurate, noninvasive modalities associated with improved overall adherence to the screening process is also a desirable goal.
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8
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Colonoscopy and polypectomy: beside age, size of polyps main factor for long-term risk of colorectal cancer in a screening population. J Cancer Res Clin Oncol 2021; 147:2645-2658. [PMID: 33543329 PMCID: PMC8310861 DOI: 10.1007/s00432-021-03532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/10/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE Despite national and international guideline recommendations, few studies have been conducted to estimate the impact of colonoscopy screening on long-term colorectal cancer incidence. Aim of this study was to determine the long-term impact of a full colonoscopy with polypectomy on colorectal cancer incidence in a large screening population. METHODS In this prospective observational cohort study, a total of 10,947 colonoscopy screening participants from within the scope of the Munich Cancer Registry were consecutively recruited from participating gastroenterology practices and their subsequent colorectal cancer incidence assessed. Predictive factors associated with colorectal cancer were also evaluated in univariate and multivariate analyses. RESULTS After a median follow-up of 14.24 years (95% CI [14.21-14.25]), 93 colorectal cancer cases were observed. This is equivalent to a truncated age-standardized rate of 69.0 (95% CI [43.3-94.7]) for male and 43.4 (95% CI [29.4-57.5]) for female participants (≥ 50 years at colonoscopy). The ratio of this observed to the expected rate from cancer registry data showed a 67% decrease in colorectal cancer incidence in the male and 65% in the female participants (p < 0.0001). In multivariate analysis of screening patients, age at screening (p < 0.0001) was the main predictive factor for colorectal cancer. In the subgroup with positive polyp findings, age (p < 0.0001) and the polyp size (p = 0.0002) were associated with colorectal cancer. CONCLUSION These results underline the significance of a full colonoscopy screening combined with polypectomy in reducing the total disease burden of colorectal cancer.
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Attardo S, Chandrasekar VT, Spadaccini M, Maselli R, Patel HK, Desai M, Capogreco A, Badalamenti M, Galtieri PA, Pellegatta G, Fugazza A, Carrara S, Anderloni A, Occhipinti P, Hassan C, Sharma P, Repici A. Artificial intelligence technologies for the detection of colorectal lesions: The future is now. World J Gastroenterol 2020; 26:5606-5616. [PMID: 33088155 PMCID: PMC7545398 DOI: 10.3748/wjg.v26.i37.5606] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/30/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
Several studies have shown a significant adenoma miss rate up to 35% during screening colonoscopy, especially in patients with diminutive adenomas. The use of artificial intelligence (AI) in colonoscopy has been gaining popularity by helping endoscopists in polyp detection, with the aim to increase their adenoma detection rate (ADR) and polyp detection rate (PDR) in order to reduce the incidence of interval cancers. The efficacy of deep convolutional neural network (DCNN)-based AI system for polyp detection has been trained and tested in ex vivo settings such as colonoscopy still images or videos. Recent trials have evaluated the real-time efficacy of DCNN-based systems showing promising results in term of improved ADR and PDR. In this review we reported data from the preliminary ex vivo experiences and summarized the results of the initial randomized controlled trials.
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Affiliation(s)
- Simona Attardo
- Department of Endoscopy and Digestive Disease, AOU Maggiore della Carità, Novara 28100, Italy
| | | | - Marco Spadaccini
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Roberta Maselli
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Harsh K Patel
- Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, LA 70124, United States
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
| | - Antonio Capogreco
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
| | - Matteo Badalamenti
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | | | - Gaia Pellegatta
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Alessandro Fugazza
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Silvia Carrara
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Andrea Anderloni
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
| | - Pietro Occhipinti
- Department of Endoscopy and Digestive Disease, AOU Maggiore della Carità, Novara 28100, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Roma 00153, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO 66045, United States
| | - Alessandro Repici
- Department of Endoscopy, Humanitas Research Hospital, Rozzano 20089, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano 20089, Italy
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10
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Forbes N, Boyne DJ, Mazurek MS, Hilsden RJ, Sutherland RL, Pader J, Ruan Y, Shaheen AA, Wong C, Lamidi M, Lorenzetti DL, Brenner DR, Heitman SJ. Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:2192-2208.e12. [PMID: 32240836 DOI: 10.1016/j.cgh.2020.03.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In addition to monitoring adverse events (AEs) and post-colonoscopy colorectal cancers (PCCRC), indicators for assessing colonoscopy quality include adenoma detection rate (ADR) and cecal intubation rate (CIR). It is unclear whether there is an association between annual colonoscopy volume and ADR, CIR, AEs, or PCCRC. METHODS We searched publication databases through March 2019 for studies assessing the relationship between annual colonoscopy volume and outcomes, including ADR, CIR, AEs, or PCCRC. Pooled odds ratios (ORs) were calculated using DerSimonian and Laird random effects models. Sensitivity analyses were performed to assess for potential methodological or clinical factors associated with outcomes. RESULTS We performed a systematic review of 9235 initial citations, generating 27 retained studies comprising 11,276,244 colonoscopies. There was no association between procedural volume and ADR (OR, 1.00; 95% CI, 0.98-1.02 per additional 100 annual procedures). CIR improved with each additional 100 annual procedures (OR, 1.17; 95% CI, 1.08-1.28). There was a non-significant trend toward decreased overall AEs per additional 100 annual procedures (OR, 0.95; 95% CI, 0.90-1.00). There was considerable heterogeneity among most analyses. CONCLUSIONS In a systematic review and meta-analysis, we found higher annual colonoscopy volumes to correlate with higher CIR, but not with ADR or PCCRC. Trends toward fewer AEs were associated with higher annual colonoscopy volumes. There are few data available from endoscopists who perform fewer than 100 annual colonoscopies. Studies are needed on extremes in performance volumes to more clearly elucidate associations between colonoscopy volumes and outcomes.
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Affiliation(s)
- Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta
| | - Devon J Boyne
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - Matthew S Mazurek
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - R Liam Sutherland
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Abdel Aziz Shaheen
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Clarence Wong
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Mubasiru Lamidi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta.
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Connecting colonoscopy quality improvement initiatives with reduced rates of interval colorectal cancers. Gastrointest Endosc 2020; 92:365-367. [PMID: 32703370 DOI: 10.1016/j.gie.2020.03.3860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/29/2020] [Indexed: 12/11/2022]
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Tehranian S, Klinge M, Saul M, Morris M, Diergaarde B, Schoen RE. Prevalence of colorectal cancer and advanced adenoma in patients with acute diverticulitis: implications for follow-up colonoscopy. Gastrointest Endosc 2020; 91:634-640. [PMID: 31521778 PMCID: PMC7039754 DOI: 10.1016/j.gie.2019.08.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/31/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Guidelines recommend colonoscopy after an episode of diverticulitis to exclude neoplasia but the effectiveness of testing is uncertain. Patients with complicated diverticulitis may be at higher risk for neoplasia, but most patients have uncomplicated disease. We examined the incidence of colorectal cancer (CRC) and advanced adenoma (AA) in patients with diverticulitis compared with patients undergoing screening colonoscopy. METHODS CT scans from January 1, 2008, to May 1, 2013, at the University of Pittsburgh Medical Center (UPMC) were reviewed to identify those with confirmed acute diverticulitis. Subsequent surgical, colonoscopy, and pathology reports were abstracted to identify those with a diagnosis of AA and CRC. The incidence of neoplasia was compared with that reported for screening colonoscopy from a meta-analysis (n = 68,324), and from colonoscopy examinations at UPMC between 2013 and 2015 (n = 28,573). RESULTS A total of 5167 abdominal/pelvic CT scan reports identified 978 patients with acute diverticulitis, among which 474 (48.5%) patients had undergone at least 1 colonoscopy or gastrointestinal surgery to April 2015. The CRC rate in patients with diverticulitis (13/474, 2.7%) was significantly higher (P < .0001) compared with both the meta-analysis (0.8%) and UPMC (0.3%). The AA rate (19/474, 4.0%) was similar to the rate in the meta-analysis (5.0%, P = .39) but significantly lower than at UPMC (7.7%, P = .003). The incidence of AA or CRC in complicated diverticulitis (10/141, 7.1%) did not differ significantly (P = .85) from the incidence of AA or CRC in uncomplicated diverticulitis (22/332, 6.6%). CONCLUSIONS CRC after diverticulitis was significantly higher than that observed at screening colonoscopy and was not limited to complicated disease. Colonoscopy is advisable after the diagnosis of diverticulitis.
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Affiliation(s)
- Shahrzad Tehranian
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Matthew Klinge
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA
| | - Melissa Saul
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Brenda Diergaarde
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, and UPMC Hillman Cancer Center, Pittsburgh, PA
| | - Robert E. Schoen
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pittsburgh, PA,Corresponding author: Robert E. Schoen, MD, MPH, Division of Gastroenterology, Hepatology and Nutrition, Mezzanine Level, C Wing, PUH, 200 Lothrop St, Pittsburgh, PA 15213-2582,
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Cheung KS, Chen L, Seto WK, Leung WK. Epidemiology, characteristics, and survival of post-colonoscopy colorectal cancer in Asia: A population-based study. J Gastroenterol Hepatol 2019; 34:1545-1553. [PMID: 30932240 DOI: 10.1111/jgh.14674] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/24/2019] [Accepted: 03/23/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Population-based studies on post-colonoscopy colorectal cancer (CRC) from Asia are sparse. We aimed to determine the characteristics and predictive factors and survival of post-colonoscopy CRC in Hong Kong. METHODS This is a territory-wide retrospective cohort study. Patients aged ≥ 40 years with colonoscopies performed between 2005 and 2013 without history of CRCs, inflammatory bowel disease, and prior colectomy were included. Post-colonoscopy colorectal cancer for an interval of 3 years (PCCRC-3y) was defined as CRC diagnosed between 6 and 36 months after index colonoscopy, whereas CRC diagnosed within 6 months of index colonoscopy was regarded as "detected CRC." We used multivariable logistic regression to derive adjusted odds ratio (aOR) of PCCRC-3y and Cox model for adjusted hazard ratio (aHR) of cancer-specific mortality after CRC diagnosis. RESULTS Of the 197 902 eligible patients, 10 005 (92.1%) were detected CRC and 854 (7.9%) PCCRC-3y. The median age at PCCRC-3y diagnosis was 75.9 years (interquartile range: 65.5-83.8)-a delay of 1.2 years (interquartile range: 0.8-1.9) from index colonoscopy-and 60.1% were male. Predictive factors for PCCRC-3y included older age (aOR: 1.07), male sex (aOR: 1.45), history of colonic polyps (aOR: 1.31), polypectomy/biopsy at index colonoscopy (aOR: 3.97), surgical endoscopists (aOR: 1.53), and a higher center annual endoscopy volume. Independent predictive factors for cancer-specific mortality after CRC diagnosis included PCCRC-3y (aHR: 1.32), proximal cancer location (aHR: 1.80), and certain patient factors. CONCLUSION The PCCRC-3y rate was 7.9% in Hong Kong, with a high proportion (> 80%) of distal cancers and a higher cancer-specific mortality compared with detected CRC.
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Affiliation(s)
- Ka Shing Cheung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Lijia Chen
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai Kay Seto
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Wai K Leung
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Burr NE, Morris EJA, Rutter MD, Valori R. Predictions of an individual's chance of postcolonoscopy colorectal cancer gives false reassurance both within and outside the United States. Gastrointest Endosc 2019; 89:896. [PMID: 30902211 DOI: 10.1016/j.gie.2018.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 09/24/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Nicholas E Burr
- Cancer Epidemiology Group, Institute of Cancer & Pathology and Institute of Data Analytics, University of Leeds, Leeds, UK
| | - Eva J A Morris
- Cancer Epidemiology Group, Institute of Cancer & Pathology and Institute of Data Analytics, University of Leeds, Leeds, UK
| | | | - Roland Valori
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
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Ertem FU, Ladabaum U, Schoen RE. Response. Gastrointest Endosc 2019; 89:896-897. [PMID: 30902210 DOI: 10.1016/j.gie.2018.12.001] [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: 11/30/2018] [Accepted: 12/02/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Furkan U Ertem
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Uri Ladabaum
- Division of Gastroenterology, Stanford Medical School, Palo Alto, California, USA
| | - Robert E Schoen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvana, USA
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Lund M, Erichsen R, Valori R, Møller Jensen T, Helle Njor S, Laurberg S, Andersen B. Data quality and colonoscopy performance indicators in the prevalent round of a FIT-based colorectal cancer screening program. Scand J Gastroenterol 2019; 54:471-477. [PMID: 30978128 DOI: 10.1080/00365521.2019.1597158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: From the prevalent round of the Danish FIT-based colorectal cancer (CRC) screening program, we aimed (i) to evaluate the quality of recorded data and (ii) to characterize the colonoscopies by measuring variation in performance indicators between colonoscopists and assessing the ratio between adenoma detection rate (ADR) and polyp detection rate (PDR). Materials and methods: This study included screening colonoscopies performed in Central Denmark Region within 60 days of a positive FIT-result from 1 July 2015 through 30 June 2017. The participants were the colonoscopists, performing these procedures. The quality indicators cecal intubation rate (CIR), PDR, polyp retrieval rate (PRR), ADR and withdrawal time (WT) were evaluated. ADR/PDR ratios were calculated. Results: The concordance between the recorded data and the colonoscopy reports showed Kappa values in the range of 0.47-0.97. The overall CIR was 90.6% (range 73.7%-100%), PDR: 51.9% (range 18.4%-70.2%), PRR: 94.6% (range 69.6%-100%), ADR (conventional adenomas): 50.6% (range 18.4%-70.2%), ADRx (conventional adenomas, traditional serrated adenomas and sessile serrated lesions with dysplasia): 50.9% (range 18.4%-70.2%) and the mean WT was 11.3 min (range 4.5-24.9 min). The ADR/PDR ratio was 92.8% (95% CI: 92.0%-93.6%) and the ADRx/PDR ratio was 93.2% (95% CI: 92.4%-93.9%). Conclusion: Data quality was generally high. We found considerable variation in performance indicators between colonoscopists reflecting the potential for improvement. Further, our findings revealed that the PDR might be a good proxy for ADR in the context of the prevalent round of FIT-based CRC screening programs.
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Affiliation(s)
- Martin Lund
- a Department of Public Health Programmes , Randers Regional Hospital , Randers , Denmark
| | - Rune Erichsen
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
| | - Roland Valori
- c Department of Gastroenterology , Gloucestershire Hospitals NHS Foundation Trust , Gloucester , UK
| | | | - Sisse Helle Njor
- a Department of Public Health Programmes , Randers Regional Hospital , Randers , Denmark
| | - Søren Laurberg
- e Department of Surgery , Section for Colorectal Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Berit Andersen
- a Department of Public Health Programmes , Randers Regional Hospital , Randers , Denmark.,f Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Ma K, Melson J. Postcolonoscopy colorectal cancer rates: monitoring and reducing the worst-case scenario. Gastrointest Endosc 2018; 88:712-714. [PMID: 30217244 DOI: 10.1016/j.gie.2018.07.006] [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: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Karen Ma
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Joshua Melson
- Department of Medicine, Division of Digestive Diseases, Rush University Medical Center, Chicago, Illinois, USA
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