1
|
Antonelli G, Correale L, Spadaccini M, Maselli R, Bhandari P, Bisschops R, Cereatti F, Dekker E, East JE, Iacopini F, Jover R, Kiesslich R, Pellise M, Sharma P, Rex DK, Repici A, Hassan C. Dye-based chromoendoscopy for the detection of colorectal neoplasia: meta-analysis of randomized controlled trials. Gastrointest Endosc 2022; 96:411-422. [PMID: 35588768 DOI: 10.1016/j.gie.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Dye-based chromoendoscopy (DBC) could be effective in increasing the adenoma detection rate (ADR) in patients undergoing colonoscopy, but the technique is time-consuming and its uptake is limited. We aimed to assess the effect of DBC on ADR based on available randomized controlled trials (RCTs). METHODS Four databases were searched up to April 2022 for RCTs comparing DBC with conventional colonoscopy (CC) in terms of ADR, advanced ADR, and sessile serrated adenoma detection rate as well as the mean adenomas per patient and non-neoplastic lesions. Relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes were calculated using random-effect models. The I2 test was used for quantifying heterogeneity. Risk of bias was evaluated with the Cochrane tool. RESULTS Overall, 10 RCTs (5334 patients) were included. Indication for colonoscopy was screening or surveillance (3 studies) and mixed (7 studies). Pooled ADR was higher in the DBC group versus the CC group (95% CI, 48.1% [41.4%-54.8%] vs 39.3% [33.5%-46.4%]; RR, 1.20 [1.11-1.29]), with low heterogeneity (I2 = 29%). This effect was consistent for advanced ADR (RR, 1.21 [1.03-1.42]; I2 = .0%), sessile serrated adenomas (6.1% vs 3.5%; RR, 1.68 [1.15-2.47]; I2 = 9.8%), and mean adenomas per patient (MD, .24 [.17-.31]) overall and in the right-sided colon (MD, .28 [.14-.43]). A subgroup analysis considering only trials using high-definition white-light endoscopy reduced the heterogeneity while still showing a significant increase in adenoma detection with DBC: 51.6% (95% confidence interval [CI], 47.1%-56.1%) and 59.1% (95% CI, 54.7-63.3%), RR = 1.14 (95% CI, 1.06-1.23), P = .0004, I2 = .0%, P = .50. CONCLUSIONS Meta-analysis of RCTs showed that DBC increases key quality parameters in colonoscopy, supporting its use in everyday clinical practice.
Collapse
Affiliation(s)
- Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Loredana Correale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven, (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Federico Iacopini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Rodrigo Jover
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Ralph Kiesslich
- Department of Internal Medicine II Gastroenterology, Hepatology and Endocrinology, Helios Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Maria Pellise
- Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| |
Collapse
|
3
|
McGill SK, Soetikno R, Rouse RV, Lai H, Kaltenbach T. Patients With Nonpolypoid (Flat and Depressed) Colorectal Neoplasms at Increased Risk for Advanced Neoplasias, Compared With Patients With Polypoid Neoplasms. Clin Gastroenterol Hepatol 2017; 15:249-256.e1. [PMID: 27639328 DOI: 10.1016/j.cgh.2016.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/21/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Nonpolypoid colorectal neoplasms (NP-CRNs) are more likely to contain high-grade dysplasia or early-stage cancer than polypoid neoplasms. We aimed to determine the long-term outcomes of patients with at least 1 NP-CRN. METHODS We performed a longitudinal cohort study of 4454 patients at a Veterans' Affairs hospital who underwent colonoscopy from 2000 through 2005; 341 were found to have 1 or more NP-CRNs and were matched (3:1) with patients found to have 1 or more polypoid neoplasms (controls, n = 1025). We collected and analyzed data on baseline colonoscopy findings and first follow-up colonoscopy results through August 2014. We calculated the incidence of advanced neoplasia at first follow-up colonoscopy, as defined by the presence of ≥1 tubular or sessile serrated adenomas ≥10 mm in diameter, tubulovillous adenoma, high-grade dysplasia, or invasive cancer. RESULTS A significantly higher proportion of patients with 1 or more NP-CRNs (16.0%) were found to have advanced neoplasia at their first follow-up colonoscopy than controls (8.6%); the adjusted risk ratio was 1.6 (95% confidence interval, 1.05-2.6; P = .03). A significantly higher proportion of patients with 1 or more NP-CRNs were found to have additional NP-CRNs at the follow-up colonoscopy (17%) than controls (7%; relative risk, 2.3; 95% confidence interval, 1.5-3.5; P < .001). Similar proportions of patients in each group developed cancers after colonoscopy. CONCLUSIONS In a longitudinal cohort study, we found that patients with NP-CRN were more likely to develop additional NP-CRNs and to have advanced neoplasms at their first follow-up colonoscopy than patients with only polypoid neoplasms. However, patients with NP-CRN were not more likely to develop cancers after colonoscopy when surveillance guidelines were followed. Larger studies are needed to determine risk of colorectal cancer in patients with NP-CRN.
Collapse
Affiliation(s)
- Sarah K McGill
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California; University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Roy Soetikno
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California
| | - Robert V Rouse
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California
| | - Hobart Lai
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Tonya Kaltenbach
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
4
|
Shi Z, Qiu H, Liu H, Yu H. Should antibiotics be administered after endoscopic mucosalresection in patients with colon polyps? Turk J Med Sci 2016; 46:1486-1490. [PMID: 27966318 DOI: 10.3906/sag-1507-147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/28/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Endoscopic mucosal resection (EMR) is widely used for treating gastrointestinal polypoid lesions. However, it is currently unclear whether antibiotic administration is necessary after EMR of colon polyps to prevent infection. We aimed to assess whether antibiotic administration is essential in such conditions. MATERIALS AND METHODS In total, 115 patients with colon polyps were randomly assigned to 3 groups based on the treatment given after EMR: Group A, no antibiotics treatment after EMR (n = 38); Group B, administration of levofloxacin after EMR (n = 38); and Group C, administration of ceftazidime after EMR (n = 39). RESULTS The colon polyps were completely removed by EMR in all cases without any serious complications. Although infection developed in 2 cases in Group A, it was resolved via levofloxacin injection over 3 days; infection did not develop in any cases in Group B and C. The postoperative infection rate was not significantly different among Groups A, B, and C. After 6 months, we noted that the wound surface had properly healed and there was no relapse of colon polyps in any patients. CONCLUSION The use of antibiotics after EMR of colon polyps to prevent infection did not affect the prognosis of patients.
Collapse
Affiliation(s)
- Zhimeng Shi
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
| | - Hui Qiu
- Department of Oncology, Xintai Municipal People's Hospital, Taian, Shandong Province, P.R. China
| | - Huangang Liu
- Department of Gastroenterology, Xintai Municipal People's Hospital, Taian, Shandong Province, P.R. China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
| |
Collapse
|
5
|
Patel N, Patel K, Ashrafian H, Athanasiou T, Darzi A, Teare J. Colorectal endoscopic submucosal dissection: Systematic review of mid-term clinical outcomes. Dig Endosc 2016; 28:405-416. [PMID: 26710317 DOI: 10.1111/den.12597] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 10/27/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023]
Abstract
With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.
Collapse
Affiliation(s)
- Nisha Patel
- Department of Gastroenterology, St Mary's Hospital, Imperial College London, London, UK
| | - Kinesh Patel
- Department of Gastroenterology, St Mark's Hospital, North West Hospitals NHS Trust, Harrow, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Thanos Athanasiou
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | - Julian Teare
- Department of Gastroenterology, St Mary's Hospital, Imperial College London, London, UK
| |
Collapse
|
6
|
Voudoukis E, Tribonias G, Tavernaraki A, Theodoropoulou A, Vardas E, Paraskeva K, Chlouverakis G, Paspatis GA. Use of a double-channel gastroscope reduces procedural time in large left-sided colonic endoscopic mucosal resections. Clin Endosc 2015; 48:136-41. [PMID: 25844341 PMCID: PMC4381140 DOI: 10.5946/ce.2015.48.2.136] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/23/2014] [Accepted: 10/11/2014] [Indexed: 12/27/2022] Open
Abstract
Background/Aims Endoscopic mucosal resection (EMR) of large colorectal lesions is associated with increased procedural time. The objective of this study was to evaluate the effect of double-channel gastroscope (DCG) use on the procedural time of EMRs in the rectosigmoid area. Methods All EMRs for sessile or flat rectosigmoid lesions ≥2 cm performed between July 2011 and September 2012 were retrospectively analyzed. Results There were 55 lesions ≥2 cm in the rectosigmoid area in 55 patients, of which 26 were removed by EMR using a DCG (DC group) and 29 by using an ordinary colonoscope or gastroscope (OS group). The mean size of the removed polyps, morphology, adverse effects, and other parameters were similar between the two groups. The mean procedural time was significantly lower in the DC group than in the OS group (24.4±18.3 minutes vs. 36.3±24.4 minutes, p=0.015). Moreover, in a subgroup of patients with polyps >40 mm, the statistical difference in the mean procedural time between the DC and OS groups was even more pronounced (33±21 minutes vs. 58.7±20.6 minutes, p=0.004). Conclusions Our data suggest that the use of a DCG in the resection of large nonpedunculated rectosigmoid lesions significantly reduces the procedural time.
Collapse
Affiliation(s)
- Evangelos Voudoukis
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Greece
| | - Georgios Tribonias
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Greece
| | | | | | - Emmanouil Vardas
- Department of Gastroenterology, Benizelion General Hospital, Heraklion, Greece
| | | | | | | |
Collapse
|