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Minakata N, Ikematsu H, Kiyomi F, Inoue S, Akutagawa T, Watanabe T, Yano T, Shimoda R. Usefulness of virtual scale endoscope for early gastrointestinal lesions. DEN OPEN 2025; 5:e386. [PMID: 38903962 PMCID: PMC11187934 DOI: 10.1002/deo2.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 06/22/2024]
Abstract
Objectives For early gastrointestinal lesions, size is an important factor in the selection of treatment. Virtual scale endoscope (VSE) is a newly developed endoscope that can measure size more accurately than visual measurement. This study aimed to investigate whether VSE measurement is accurate for early gastrointestinal lesions of various sizes and morphologies. Methods This study prospectively enrolled patients with early gastrointestinal lesions ≤20 mm in size visually. Lesion sizes were measured in the gastrointestinal tract visually, on endoscopic resection specimens with VSE, and finally on endoscopic resection specimens using a ruler. The primary endpoint was the normalized difference (ND) of VSE measurement. The secondary endpoints were the ND of visual measurement and the variation between NDs of VSE and visual measurements. ND was calculated as (100 × [measured size - true size] / true size) (%). True size was defined as size measured using a ruler. Results This study included 60 lesions from April 2022 to December 2022, with 20 each in the esophagus, stomach, and colon. The lesion size was 14.0 ± 6.3 mm (mean ± standard deviation). Morphologies were protruded, slightly elevated, and flat or slightly depressed type in 8, 24, and 28 lesions, respectively. The primary endpoint was 0.3 ± 8.8%. In the secondary endpoints, the ND of visual measurement was -1.7 ± 29.3%, and the variability was significantly smaller in the ND of VSE measurement than in that of visual measurement (p < 0.001, F-test). Conclusions VSE measurement is accurate for early gastrointestinal lesions of various sizes and morphologies.
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Affiliation(s)
- Nobuhisa Minakata
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Fumiaki Kiyomi
- Department of Statistics and Data CenterClinical Research Support Center KyushuFukuokaJapan
| | - Suma Inoue
- Department of Internal MedicineDivision of GastroenterologySaga UniversitySagaJapan
| | - Takashi Akutagawa
- Department of Endoscopic Diagnostics and TherapeuticsSaga University HospitalSagaJapan
| | - Takashi Watanabe
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Tomonori Yano
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Ryo Shimoda
- Department of Endoscopic Diagnostics and TherapeuticsSaga University HospitalSagaJapan
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Lee M, Ko HM, Kudose S, Remotti H, Choi WT, Salomao MA, Zhao L, Isidro RA, Liao X, Ettel MG, Chen IY, Liu X, Pai R, Alpert L, Setia N, Wu E, Henn P, Westbrook L, Lagana SM. High risk features in colorectal adenomatous polyps: A multi-institutional study. Ann Diagn Pathol 2024; 72:152323. [PMID: 38733674 DOI: 10.1016/j.anndiagpath.2024.152323] [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: 03/08/2024] [Revised: 04/25/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
High risk features in colorectal adenomatous polyps include size >1 cm and advanced histology: high-grade dysplasia and villous architecture. We investigated whether the diagnostic rates of advanced histology in colorectal adenomatous polyps were similar among institutions across the United States, and if not, could differences be explained by patient age, polyp size, and/or CRC rate. Nine academic institutions contributed data from three pathologists who had signed out at least 100 colorectal adenomatous polyps each from 2018 to 2019 taken from patients undergoing screening colonoscopy. For each case, we recorded patient age and sex, polyp size and location, concurrent CRC, and presence or absence of HGD and villous features. A total of 2700 polyps from 1886 patients (mean age: 61 years) were collected. One hundred twenty-four (5 %) of the 2700 polyps had advanced histology, including 35 (1 %) with HGD and 101 (4 %) with villous features. The diagnostic rate of advanced histology varied by institution from 1.7 % to 9.3 % (median: 4.3 %, standard deviation [SD]: 2.5 %). The rate of HGD ranged from 0 % to 3.3 % (median: 1 %, SD: 1.2 %), while the rate of villous architecture varied from 1 % to 8 % (median: 3.7 %, SD: 2.5 %). In a multivariate analysis, the factor most strongly associated with advanced histology was polyp size >1 cm with an odds ratio (OR) of 31.82 (95 % confidence interval [CI]: 20.52-50.25, p < 0.05). Inter-institutional differences in the rate of polyps >1 cm likely explain some of the diagnostic variance, but pathologic subjectivity may be another contributing factor.
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Affiliation(s)
- Michael Lee
- Columbia University Medical Center, United States of America.
| | | | - Satoru Kudose
- Columbia University Medical Center, United States of America
| | - Helen Remotti
- Columbia University Medical Center, United States of America
| | - Won-Tak Choi
- University of California San Francisco, United States of America
| | | | - Lei Zhao
- Brigham and Women's Hospital, Harvard Medical School, United States of America
| | - Raymond A Isidro
- Brigham and Women's Hospital, Harvard Medical School, United States of America
| | - Xiaoyan Liao
- University of Rochester Medical Center, United States of America
| | - Mark G Ettel
- University of Rochester, United States of America
| | - Irene Y Chen
- University of Rochester Medical Center, United States of America
| | - Xiaoqin Liu
- University of Rochester Medical Center, United States of America
| | - Reetesh Pai
- UPMC Presbyterian Hospital, United States of America
| | | | | | - Elizabeth Wu
- Rhode Island Hospital, Brown University, United States of America
| | - Patrick Henn
- University of Colorado Anschutz Medical Campus, United States of America
| | - Lindsey Westbrook
- University of Colorado Anschutz Medical Campus, United States of America
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Tran TH, Nguyen VH, Vo DTN. How to "pick up" colorectal serrated lesions and polyps in daily histopathology practice: From terminologies to diagnostic pitfalls. World J Clin Oncol 2024; 15:1157-1167. [DOI: 10.5306/wjco.v15.i9.1157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/27/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
Over the last decade, our knowledge of colorectal serrated polyps and lesions has significantly improved due to numerous studies on this group of precursor lesions. Serrated lesions were misleading as benign before 2010, but they are currently reclassified as precancerous lesions that contribute to 30% of colorectal cancer through the serrated neoplasia pathway. The World Health Organization updated the classification for serrated lesions and polyps of the colon and rectum in 2019, which is more concise and applicable in daily practice. The responsible authors prescribe that “colorectal serrated lesions and polyps are characterized by a serrated (sawtooth or stellate) architecture of the epithelium.” From a clinical standpoint, sessile serrated lesion (SSL) and SSL with dysplasia (SSLD) are the two most significant entities. Despite these advancements, the precise diagnosis of SSL and SSLD based mainly on histopathology remains challenging due to various difficulties. This review describes the nomenclature and the terminology of colorectal serrated polyps and lesions and highlights the diagnostic criteria and obstacles encountered in the histopathological diagnosis of SSL and SSLD.
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Affiliation(s)
- Thai H Tran
- Department of Pathology, Da Nang Hospital, Da Nang 50000, Viet Nam
| | - Vinh H Nguyen
- Department of Pathology, University Medical Center Ho Chi Minh City, Ho Chi Minh 70000, Viet Nam
| | - Diem TN Vo
- Department of Pathology, University Medical Center Ho Chi Minh City, Ho Chi Minh 70000, Viet Nam
- Department of Histology-Embryology and Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh 70000, Viet Nam
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Zuberi SA, Burdine L, Dong J, Feuerstein JD. Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines. J Clin Gastroenterol 2024; 58:800-804. [PMID: 38019081 DOI: 10.1097/mcg.0000000000001940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/18/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND/AIMS Clinical guidelines should ideally be formulated from data representative of the population they are applicable to; however, historically, studies have disproportionally enrolled non-Hispanic White (NHW) patients, leading to potential inequities in care for minority groups. Our study aims to evaluate the extent to which racial minorities were represented in the United States Colorectal Cancer Surveillance Guidelines. METHODS We reviewed US guidelines between 1997 and 2020 and all identified studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps, and hyperplastic polyps. We analyzed the proportion of studies reporting race, and among these studies, we calculated the racial distribution of patients and compared the proportion of Non-NHW patients between each subtype. RESULTS For all guidelines, we reviewed 75 studies encompassing 9,309,955 patients. Race was reported in 24% of studies and 14% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for adenomas, 22% for sessile serrated polyps, and 15% for hyperplastic polyps. For the 2020 guidelines, we reviewed 33 studies encompassing 5,930,722 patients. Race was reported in 15% of studies and 21% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for tubular adenomas. Race was not cited for any other 2020 guideline. CONCLUSION Racial minorities are significantly underrepresented in US Colorectal Cancer Surveillance Guidelines, which may contribute to disparities in care. Future studies should prioritize enrolling a diverse patient population to provide data that accurately reflects their population.
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Affiliation(s)
| | | | | | - Joseph D Feuerstein
- Department of Internal Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
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Hang D, Sun D, Du L, Huang J, Li J, Zhu C, Wang L, He J, Zhu X, Zhu M, Song C, Dai J, Yu C, Xu Z, Li N, Ma H, Jin G, Yang L, Chen Y, Du H, Cheng X, Chen Z, Lv J, Hu Z, Li L, Shen H. Development and evaluation of a risk prediction tool for risk-adapted screening of colorectal cancer in China. Cancer Lett 2024; 597:217057. [PMID: 38876387 DOI: 10.1016/j.canlet.2024.217057] [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: 03/01/2024] [Revised: 06/03/2024] [Accepted: 06/10/2024] [Indexed: 06/16/2024]
Abstract
Risk prediction tools for colorectal cancer (CRC) have potential to improve the efficiency of population-based screening by facilitating risk-adapted strategies. However, such an applicable tool has yet to be established in the Chinese population. In this study, a risk score was created using data from the China Kadoorie Biobank (CKB), a nationwide cohort study of 409,854 eligible participants. Diagnostic performance of the risk score was evaluated in an independent CRC screening programme, which included 91,575 participants who accepted colonoscopy at designed hospitals in Zhejiang Province, China. Over a median follow-up of 11.1 years, 3136 CRC cases were documented in the CKB. A risk score was created based on nine questionnaire-derived variables, showing moderate discrimination for 10-year CRC risk (C-statistic = 0.68, 95 % CI: 0.67-0.69). In the CRC screening programme, the detection rates of CRC were 0.25 %, 0.82 %, and 1.93 % in low-risk (score <6), intermediate-risk (score: 6-19), and high-risk (score >19) groups, respectively. The newly developed score exhibited a C-statistic of 0.65 (95 % CI: 0.63-0.66), surpassing the widely adopted tools such as the Asia-Pacific Colorectal Screening (APCS), modified APCS, and Korean Colorectal Screening scores (all C-statistics = 0.60). In conclusion, we developed a novel risk prediction tool that is useful to identify individuals at high risk of CRC. A user-friendly online calculator was also constructed to encourage broader adoption of the tool.
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Affiliation(s)
- Dong Hang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Dianjianyi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Lingbin Du
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China; Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jianv Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jiacong Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chen Zhu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China; Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Le Wang
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China; Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jingjing He
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xia Zhu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Meng Zhu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Ci Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Juncheng Dai
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ni Li
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongxia Ma
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Guangfu Jin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Huaidong Du
- Medical Research Council Population Health Research Unit, University of Oxford, Oxford, United Kingdom; Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Xiangdong Cheng
- Department of Cancer Prevention, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China; Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Zhibin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China.
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China; Peking University Center for Public Health and Epidemic Preparedness and Response, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China.
| | - Hongbing Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China; Research Units of Cohort Study on Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences, Beijing, China.
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D’Antonio DL, Fantini F, Moscatello C, Ferrone A, Scaringi S, Valanzano R, Ficari F, Efthymakis K, Neri M, Aceto GM, Curia MC. The Interplay among Wnt/β-catenin Family Members in Colorectal Adenomas and Surrounding Tissues. Biomedicines 2024; 12:1730. [PMID: 39200196 PMCID: PMC11352173 DOI: 10.3390/biomedicines12081730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND The colorectal adenoma undergoes neoplastic progression via the normal epithelium-adenoma-adenocarcinoma sequence as reported in the Vogelgram. The hazard of developing a tumor is deeply associated with the number and size of adenomas and their subtype. Adenomatous polyps are histologically categorized as follows: approximately 80-90% are tubular, 5-15% are villous, and 5-10% are tubular/villous. Given the higher risk of a malignant transformation observed in tubular/villous adenomas, patients diagnosed with adenomatous polyposis are at an improved risk of developing CRC. The Wnt/β-catenin pathway plays a key role in the onset of colorectal adenoma; in particular, intestinal cells first acquire loss-of-function mutations in the APC gene that induce the formation of adenomas. METHODS Wnt/β-catenin pathway APC, Wnt3a, Wnt5a, LEF1, and BCL9 genes and protein expression analyses were conducted by qRT-PCR and western blot in 68 colonic samples (polyps and adjacent mucosa) from 41 patients, of which 17 were affected by FAP. Ten normal colonic mucosal samples were collected from 10 healthy donors. RESULTS In this study, both the APC gene and protein were less expressed in the colon tumor compared to the adjacent colonic mucosa. Conversely, the activated β-catenin was more expressed in polyps than in the adjacent mucosa. All results confirmed the literature data on carcinomas. A statistically significant correlation between Wnt3a and BCL9 both in polyps and in the adjacent mucosa underlines that the canonical Wnt pathway is activated in early colon carcinogenesis and that the adjacent mucosa is already altered. CONCLUSION This is the first study analyzing the difference in expression of the Wnt/β-catenin pathway in human colorectal adenomas. Understanding the progression from adenomas to colorectal carcinomas is essential for the development of new therapeutic strategies and improving clinical outcomes with the use of APC and β-catenin as biomarkers.
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Affiliation(s)
- Domenica Lucia D’Antonio
- Department of Medical, Oral and Biotechnological Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.L.D.); (F.F.); (C.M.); (A.F.); (G.M.A.)
- Villa Serena Foundation for Research, Via Leonardo Petruzzi 42, 65013 Città Sant’Angelo, Italy
| | - Fabiana Fantini
- Department of Medical, Oral and Biotechnological Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.L.D.); (F.F.); (C.M.); (A.F.); (G.M.A.)
| | - Carmelo Moscatello
- Department of Medical, Oral and Biotechnological Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.L.D.); (F.F.); (C.M.); (A.F.); (G.M.A.)
| | - Alessio Ferrone
- Department of Medical, Oral and Biotechnological Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.L.D.); (F.F.); (C.M.); (A.F.); (G.M.A.)
| | - Stefano Scaringi
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy; (S.S.); (R.V.); (F.F.)
| | - Rosa Valanzano
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy; (S.S.); (R.V.); (F.F.)
| | - Ferdinando Ficari
- Department of Clinical and Experimental Medicine, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy; (S.S.); (R.V.); (F.F.)
| | - Konstantinos Efthymakis
- Department of Medicine and Aging Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (K.E.); (M.N.)
| | - Matteo Neri
- Department of Medicine and Aging Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (K.E.); (M.N.)
| | - Gitana Maria Aceto
- Department of Medical, Oral and Biotechnological Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.L.D.); (F.F.); (C.M.); (A.F.); (G.M.A.)
| | - Maria Cristina Curia
- Department of Medical, Oral and Biotechnological Sciences, “Gabriele d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy; (D.L.D.); (F.F.); (C.M.); (A.F.); (G.M.A.)
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Maida M, Dahiya DS, Shah YR, Tiwari A, Gopakumar H, Vohra I, Khan A, Jaber F, Ramai D, Facciorusso A. Screening and Surveillance of Colorectal Cancer: A Review of the Literature. Cancers (Basel) 2024; 16:2746. [PMID: 39123473 PMCID: PMC11312202 DOI: 10.3390/cancers16152746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
Colorectal cancer (CRC) has the highest mortality rate among men and is the second highest among women under fifty, with incidence and mortality rates rising in younger populations. Studies indicate that up to one-third of patients diagnosed before fifty have a family history or genetic factors, highlighting the need for earlier screening. Contrariwise, diagnosis in healthy subjects through screening strategies enables early-stage detection of the tumor and better clinical outcomes. In recent years, mortality rates of CRC in Western countries have been on a steady decline, which is largely attributed to widespread screening programs and advancements in treatment modalities. Indeed, early detection through screening significantly improves prognosis, with stark differences in survival rates between localized and metastatic disease. This article aims to provide a comprehensive review of the existing literature, delving into the performance and efficacy of various CRC screening strategies. It navigates through available screening tools, evaluating their efficacy and cost-effectiveness. The discussion extends to delineating target populations for screening, emphasizing the importance of tailored approaches for individuals at heightened risk.
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Affiliation(s)
- Marcello Maida
- Department of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy;
| | - Dushyant Singh Dahiya
- Division of Gastroenterology, Hepatology and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, USA
| | - Yash R. Shah
- Department of Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, MI 48341, USA
| | - Angad Tiwari
- Department of Internal Medicine, Maharani Laxmi Bai Medical College, Jhansi 284001, India;
| | - Harishankar Gopakumar
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA; (H.G.); (I.V.)
| | - Ishaan Vohra
- Division of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL 61605, USA; (H.G.); (I.V.)
| | - Aqsa Khan
- Department of Internal Medicine, Parkview Health, Fort Wayne, IN 46805, USA;
| | - Fouad Jaber
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, KS 64110, USA;
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The University of Utah School of Medicine, Salt Lake City, UT 84132, USA;
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Biomedical Science, Foggia University Hospital, 71122 Foggia, Italy
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8
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Sorbello MP, Ribeiro Júnior U, Eluf-Neto J, Pfuetzenreiter V, da Silva E Sousa Júnior AH, Kawaguti FS, Cohen DD, de Mello ES, Nahas SC, Safatle-Ribeiro AV. Feasibility and Colonoscopy Yield Using the Fecal Immunochemical Test (FIT)-Based Colorectal Cancer Screening in a Latin America Country. Clin Gastroenterol Hepatol 2024; 22:1719-1727.e1. [PMID: 38342277 DOI: 10.1016/j.cgh.2024.01.033] [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: 06/10/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND & AIMS Organized colorectal cancer (CRC) screening is not widely practiced in Latin America and the results of regional studies may help overcome barriers for implementation of national screening programs. We aimed to describe the implementation and findings of a fecal immunochemical test (FIT)-based program in Brazil. METHODS In a prospective population-based study, asymptomatic individuals (50-75 years old) from Sao Paulo city were invited to undergo FIT for CRC screening. Participants with positive FIT (≥10 μg Hb/g feces) were referred for colonoscopy. Subjects were classified into groups according to the presence of CRC, precursor lesions, and other benign findings, possibly related to bleeding. RESULTS Of a total of 9881 subjects, 7.8% had positive FIT and colonoscopy compliance was 68.9% (n = 535). Boston scale was considered adequate in 99% and cecal intubation rate was 99.4%. CRC was diagnosed in 5.9% of the cases, adenoma in 63.2%, advanced adenoma in 31.4%, and advanced neoplasia in 33.0%. Age was positively associated with CRC (P = .03). Higher FIT concentrations were associated with increased detection of CRC (P < .008), advanced adenoma (P < .001), and advanced neoplasia (P < .001). CONCLUSIONS Implementation of a FIT-based CRC screening program was feasible in a low-resource setting, and there was a high yield for neoplasia in individuals with a positive FIT. This approach could be used as a model to plan and disseminate organized CRC screening more broadly in Brazil and Latin America.
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Affiliation(s)
- Mauricio Paulin Sorbello
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Colonoscopy Unit of the Colorectal Surgical Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Ulysses Ribeiro Júnior
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José Eluf-Neto
- Department of Epidemiology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Fundação Oncocentro de São Paulo, São Paulo, Brazil
| | - Vinicius Pfuetzenreiter
- Colonoscopy Unit of the Colorectal Surgical Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Afonso Henrique da Silva E Sousa Júnior
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Colonoscopy Unit of the Colorectal Surgical Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Shiguehissa Kawaguti
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Endoscopy Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Sergio Carlos Nahas
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Adriana Vaz Safatle-Ribeiro
- Department of Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Colonoscopy Unit of the Colorectal Surgical Division, Department of Gastroenterology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Endoscopy Unit, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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9
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Meester RG, Lansdorp-Vogelaar I, Winawer SJ, Church TR, Allen JI, Feld AD, Mills G, Jordan PA, Corley DA, Doubeni CA, Hahn AI, Lobaugh SM, Fleisher M, O’Brien MJ, Zauber AG. Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening. Am J Gastroenterol 2024; 119:1392-1401. [PMID: 38318949 PMCID: PMC11222052 DOI: 10.14309/ajg.0000000000002693] [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] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Modeling supporting recommendations for colonoscopy and stool-based colorectal cancer (CRC) screening tests assumes 100% sequential participant adherence. The impact of observed adherence on the long-term effectiveness of screening is unknown. We evaluated the effectiveness of a program of screening colonoscopy every 10 years vs annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data. METHODS The MIcrosimulation SCreening ANalysis (MISCAN) model used observed sequential screening adherence, HSgFOBT positivity, and diagnostic colonoscopy adherence in HSgFOBT-positive individuals from the National Colonoscopy Study (single-screening colonoscopy vs ≥4 HSgFOBT sequential rounds). We compared CRC incidence and mortality over 15 years with no screening or 10 yearly screening colonoscopy vs annual HSgFOBT with 100% and differential observed adherence from the trial. RESULTS Without screening, simulated incidence and mortality over 15 years were 20.9 (95% probability interval 15.8-26.9) and 6.9 (5.0-9.2) per 1,000 participants, respectively. In the case of 100% adherence, only screening colonoscopy was predicted to result in lower incidence; however, both tests lowered simulated mortality to a similar level (2.1 [1.6-2.9] for screening colonoscopy and 2.5 [1.8-3.4] for HSgFOBT). Observed adherence for screening colonoscopy (83.6%) was higher than observed sequential HSgFOBT adherence (73.1% first round; 49.1% by round 4), resulting in lower simulated incidence and mortality for screening colonoscopy (14.4 [10.8-18.5] and 2.9 [2.1-3.9], respectively) than HSgFOBT (20.8 [15.8-28.1] and 3.9 [2.9-5.4], respectively), despite a 91% adherence to diagnostic colonoscopy with FOBT positivity. The relative risk of CRC mortality for screening colonoscopy vs HSgFOBT was 0.75 (95% probability interval 0.68-0.80). Findings were similar in sensitivity analyses with alternative assumptions for repeat colonoscopy, test performance, risk, age, and projection horizon. DISCUSSION Where sequential adherence to stool-based screening is suboptimal and colonoscopy is accessible and acceptable-as observed in the national colonoscopy study, microsimulation, comparative effectiveness, screening recommendations.
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Affiliation(s)
| | | | - Sidney J. Winawer
- Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Timothy R. Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, and Masonic Cancer Center, Minneapolis, MN, United States
| | - John I. Allen
- Gastroenterology and Hepatology, University of Michigan School of Medicine
| | - Andrew D. Feld
- Gastroenterology Clinic, Kaiser Permanente Washington (KPWA), Seattle, WA, United States
| | - Glenn Mills
- Feist-Weiller Cancer Center, Health Department, Louisiana State University, Shreveport, LA, United States
| | - Paul A. Jordan
- Feist-Weiller Cancer Center, Health Department, Louisiana State University, Shreveport, LA, United States
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente, San Francisco, CA, United States
| | | | - Anne I. Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Stephanie M. Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Martin Fleisher
- Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Michael J. O’Brien
- Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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10
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Medawar E, Djinbachian R, Crainic IP, Safih W, Battat R, Mccurdy J, Lakatos PL, von Renteln D. Serrated Polyps in Inflammatory Bowel Disease Indicate a Similar Risk of Metachronous Colorectal Neoplasia as in the General Population. Dig Dis Sci 2024; 69:2595-2610. [PMID: 38700631 DOI: 10.1007/s10620-024-08456-z] [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: 09/13/2023] [Accepted: 04/17/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The risk of metachronous advanced neoplasia after diagnosing serrated polyps in patients with IBD is poorly understood. METHODS A retrospective multicenter cohort study was conducted between 2010 and 2019 at three tertiary centers in Montreal, Canada. From pathology databases, we identified 1587 consecutive patients with serrated polyps (sessile serrated lesion, traditional serrated adenoma, or serrated epithelial change). We included patients aged 45-74 and excluded patients with polyposis, colorectal cancer, or no follow-up. The primary outcome was the risk of metachronous advanced neoplasia (advanced adenoma, advanced serrated lesion, or colorectal cancer) after index serrated polyp, comparing patients with and without IBD. RESULTS 477 patients with serrated polyps were eligible (mean age 61 years): 37 with IBD, totaling 45 serrated polyps and 440 without IBD, totaling 586 serrated polyps. The median follow-up was 3.4 years. There was no difference in metachronous advanced neoplasia (HR 0.77, 95% CI 0.32-1.84), metachronous advanced adenoma (HR 0.54, 95% CI 0.11-2.67), and metachronous advanced serrated lesion (HR 0.76, 95% CI 0.26-2.18) risk. When comparing serrated polyps in mucosa involved or uninvolved with IBD, both groups had similar intervals from IBD to serrated polyp diagnosis (p > 0.05), maximal therapies (p > 0.05), mucosal inflammation, inflammatory markers, and fecal calprotectin (p > 0.05). CONCLUSION The risk of metachronous advanced neoplasia after serrated polyp detection was similar in patients with and without IBD. Serrated polyps in IBD occurred independently of inflammation. This helps inform surveillance intervals for patients with IBD diagnosed with serrated polyps.
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Affiliation(s)
- Edgard Medawar
- Department of Medicine, University of Ottawa, Ottawa, Canada
- University of Montreal Hospital Research Center (CRCHUM), 900 Saint-Denis St., Montreal, QC, H2X 0A9, Canada
| | - Roupen Djinbachian
- University of Montreal Hospital Research Center (CRCHUM), 900 Saint-Denis St., Montreal, QC, H2X 0A9, Canada
- Division of Gastroenterology, Department of Medicine, University of Montreal Hospital Center, Montreal, Canada
| | - Ioana Popescu Crainic
- University of Montreal Hospital Research Center (CRCHUM), 900 Saint-Denis St., Montreal, QC, H2X 0A9, Canada
| | - Widad Safih
- University of Montreal Hospital Research Center (CRCHUM), 900 Saint-Denis St., Montreal, QC, H2X 0A9, Canada
| | - Robert Battat
- University of Montreal Hospital Research Center (CRCHUM), 900 Saint-Denis St., Montreal, QC, H2X 0A9, Canada
- Division of Gastroenterology, Department of Medicine, University of Montreal Hospital Center, Montreal, Canada
| | - Jeffrey Mccurdy
- Division of Gastroenterology and Hepatology, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Center, Montreal, Canada
- First Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Daniel von Renteln
- University of Montreal Hospital Research Center (CRCHUM), 900 Saint-Denis St., Montreal, QC, H2X 0A9, Canada.
- Division of Gastroenterology, Department of Medicine, University of Montreal Hospital Center, Montreal, Canada.
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11
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Qureshi A, Vestal CC, Tanare M, Ajumobi AB. Online Educational Module Improves Knowledge of Nurses on Bowel Preparation for Colonoscopy. Gastroenterol Nurs 2024; 47:277-285. [PMID: 39087993 DOI: 10.1097/sga.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/16/2023] [Indexed: 08/02/2024] Open
Abstract
The effectiveness of colonoscopy is limited by the adequacy of bowel preparation. Nurses are essential in providing bowel cleansing agents and instructions for hospitalized patients before colonoscopy. This study aims to assess and improve the knowledge of nurses on bowel preparation for inpatient colonoscopy. Participants were asked to complete the survey before and after completing an educational module. The module and survey questions were placed in the NetLearning environment of the hospital intranet. A minimum post-test score of 80% was required to pass the course. A total of 1,107 nurses participated in the survey. Overall, the average score improved from 87% to 93% after the module (p < .0495). Knowledge of the different ways of consuming bowel cleansing agents improved from 54.3% to 83.6% (p = .0001). Only 56.2% of nurses knew how to carry out a split-dose bowel preparation regimen, which increased to 80.1% after the educational module (p = .0001). Nurses' knowledge about the different ways of consuming bowel cleansing agents before colonoscopy and the split-dose regimen is inadequate. A simple online educational module significantly improved the knowledge of nurses on bowel preparation for colonoscopy.
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Affiliation(s)
- Ammar Qureshi
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
| | - Crystal C Vestal
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
| | - Marie Tanare
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
| | - Adewale B Ajumobi
- Ammar Qureshi, MD, Gastroenterology and Hepatology Fellow, University of California, Riverside
- Crystal C. Vestal, DNP, RN, CNOR, RN-Manager Perioperative Informatics & Education, Eisenhower Health, Rancho Mirage, California
- Marie Tanare, BSN, RN, Eisenhower Health, Rancho Mirage, California
- Adewale B. Ajumobi, MD, MBA, FACP, FACG, Associate Professor of Medicine, University of California, Riverside
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12
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Tsurumaru D, Nishimuta Y, Nanjo K, Kai S, Miyasaka M, Muraki T, Ishigami K. CT colonography has advantages over colonoscopy for size measurement of colorectal polyps. Jpn J Radiol 2024:10.1007/s11604-024-01625-0. [PMID: 38949727 DOI: 10.1007/s11604-024-01625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/25/2024] [Indexed: 07/02/2024]
Abstract
PURPOSE The aim of this study was to compare the accuracy of colonoscopy (CS) and CT colonography (CTC) in the measurement of colorectal polyps using pathological size as a reference. MATERIALS AND METHODS The analysis included 61 colorectal polyps in 28 patients who underwent preoperative CTC at our institution. All polyps were endoscopically resected. Polyp sizes were measured by CS and CTC. Endoscopic polyp size was extracted from endoscopy records written by one of two endoscopists (A with 11 and B with 6 years of endoscopic experience, respectively), who estimated the size visually/categorically without any measuring devices. After matching the location, the polyp size was measured on CTC using manual three-dimensional (3D) measurement on a workstation. The sizes of resected polyps were also measured after pathological inspection. Differences of the polyp size between CTC and histology, and between CS and histology were compared using paired t tests. Differences in measurement between the two endoscopists were also analyzed. RESULTS The mean diameters of polyps measured using CS, CTC, and pathology were 10.5 mm, 9.2 mm, and 8.4 mm, respectively. There was a significant correlation between CS and pathology, as well as between CTC and pathology (both P < 0.0001). The correlation coefficient for CS (r = 0.86) was lower than that for CTC (r = 0.96). The correlations between CS and pathology for endoscopists A and B were 0.90 and 0.89, respectively. CONCLUSION Measurements of polyp size using CTC were closer to the pathological measurements compared to those by CS, which exhibited greater variability. This suggests that CTC may be more suitable for polyp size measurements in the clinical setting if patients undergo CTC concurrently with colonoscopy.
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Affiliation(s)
- Daisuke Tsurumaru
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan.
| | - Yusuke Nishimuta
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Katsuya Nanjo
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Satohiro Kai
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
| | - Mitsutoshi Miyasaka
- Department of Gastrointestinal Endoscopy, National Hospital Organization, Kyushu Cancer Center, Fukuoka city, Japan
| | - Toshio Muraki
- Department of Gastrointestinal Endoscopy, National Hospital Organization, Kyushu Cancer Center, Fukuoka city, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, Japan
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13
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He D, Chen J, Jiang X, Chen H, Huang J, Chen Z. Risk factors for synchronous high-risk polyps in patients with colorectal cancer. Front Surg 2024; 11:1424809. [PMID: 38978992 PMCID: PMC11228258 DOI: 10.3389/fsurg.2024.1424809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose Colorectal cancer (CRC) patients may experience inadequate preoperative colonoscopy due to bowel obstruction or inadequate bowel preparation, leading to potential oversight of other polyps. We aimed to identify risk factors for CRC complicated with synchronous high-risk polyps. Methods A retrospective analysis of 6,674 CRC patients from December 2014 to September 2018 was conducted. High-risk polyps were defined as adenomas or serrated polyps that were ≥10 mm, or with tubulovillous/villous components or high-grade dysplasia. All other polyps were defined as low-risk polyps. Patients with complete pathological and clinical information were categorized into three groups: the no polyp group, the low-risk polyp group, and the high-risk polyp group. Univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for all potential risk factors. Results Among the 4,659 eligible patients, 848 (18.2%) were found to have low-risk polyps, while 675 (14.5%) were diagnosed with high-risk polyps. In a multivariate logistic regression model, compared to patients without polyps, those with synchronous high-risk polyps were more likely to be male (OR = 2.07), aged 50 or older (OR = 2.77), have early-stage tumors (OR = 1.46), colon tumors (OR = 1.53), NRAS mutant tumors (OR = 1.66), and BRAF wild-type tumors (OR = 2.43). Conclusion Our study has identified several risk factors associated with the presence of synchronous high-risk polyps in CRC patients. Based on these findings, we recommend that patients who exhibit these high-risk factors undergo early follow-up of colonoscopy to detect synchronous polyps early.
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Affiliation(s)
- Degao He
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Anorectal Surgery, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
| | - Junguo Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuefei Jiang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hao Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Juanni Huang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zexian Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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14
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Christakis A, Nowak J, Hamilton MJ, Goldblum JR, Parrack P, Lindeman NI, Odze R, Patil DT. Molecular profiling of visible polypoid and invisible conventional intestinal-type low-grade dysplasia in patients with idiopathic inflammatory bowel disease. J Clin Pathol 2024:jcp-2024-209601. [PMID: 38886044 DOI: 10.1136/jcp-2024-209601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/21/2024] [Indexed: 06/20/2024]
Abstract
AIMS Little is known about the molecular features of visible polyps with low-grade intestinal-type dysplasia in patients with inflammatory bowel disease (IBD). To better understand their origins and biological potential, we sought to genomically profile these lesions and compare them with invisible low-grade dysplasia and sporadic adenomas from non-IBD patients. METHODS 22 polyps within areas of colitis, 13 polyps outside areas of colitis, 10 foci of invisible dysplasia from patients with IBD and 6 sporadic tubular adenomas from non-IBD patients were analysed using the OncoPanel assay. RESULTS Polyps arising in areas of colitis showed a greater spectrum of mutations, including APC, KRAS, FBXW7, TP53, ARID1A and TCF7L2. Polyps outside colitis and non-IBD sporadic adenomas showed a limited mutational profile, with APC and CTNNB1 mutations. Invisible dysplasia was characterised by TP53, CTNNB1 and KRAS alterations. Compared with dysplastic polyps, none of the invisible dysplastic foci showed APC alterations (73%-within colitis; p=0.0001, 92%-outside colitis; p<0.0001, 83%-sporadic adenomas; p=0.001). TP53 mutations were significantly higher in invisible dysplasia (50%) compared with polyps within colitis (9%; p=0.02) and outside colitis (8%; p=0.03). CONCLUSIONS Molecular alterations in visible low-grade dysplastic polyps with conventional intestinal-type dysplasia from patients with IBD and sporadic adenomas from non-IBD patients overlap significantly. APC alterations appear to play a major role in the development of visible low-grade dysplastic lesions in patients with IBD, regardless of background colitis. As with IBD-associated colorectal cancers, TP53 mutations are an early event in the development of invisible, low-grade conventional intestinal-type dysplasia in patients with IBD.
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Affiliation(s)
| | - Jonathan Nowak
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew J Hamilton
- Department of Gastroenterology, Brigham and Women's Hospital, Boston, MA, USA
| | - John R Goldblum
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Paige Parrack
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert Odze
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Deepa T Patil
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
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15
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Lee JK, Koripella PC, Jensen CD, Merchant SA, Fox JM, Chang SX, Dang CH, Velayos FS, Boparai ES, Evans NS, Leung LJ, Badalov JM, Quesenberry CP, Corley DA, Levin TR. Randomized Trial of Patient Outreach Approaches to De-implement Outdated Colonoscopy Surveillance Intervals. Clin Gastroenterol Hepatol 2024; 22:1315-1322.e7. [PMID: 38191014 DOI: 10.1016/j.cgh.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND AND AIMS Guidelines now recommend patients with low-risk adenomas receive colonoscopy surveillance in 7-10 years and those with the previously recommended 5-year interval be re-evaluated. We tested 3 outreach approaches for transitioning patients to the 10-year interval recommendation. METHODS This was a 3-arm pragmatic randomized trial comparing telephone, secure messaging, and mailed letter outreach. The setting was Kaiser Permanente Northern California, a large integrated healthcare system. Participants were patients 54-70 years of age with 1-2 small (<10 mm) tubular adenomas at baseline colonoscopy, due for 5-year surveillance in 2022, without high-risk conditions, and with access to all 3 outreach modalities. Patients were randomly assigned to the outreach arm (telephone [n = 200], secure message [n = 203], and mailed letter [n = 201]) stratified by age, sex, and race/ethnicity. Outreach in each arm was performed by trained medical assistants (unblinded) communicating in English with 1 reminder attempt at 2-4 weeks. Participants could change their assigned interval to 10 years or continue their planned 5-year interval. RESULTS Sixty-day response rates were higher for telephone (64.5%) and secure messaging outreach (51.7%) vs mailed letter (31.3%). Also, more patients adopted the 10-year surveillance interval in the telephone (37.0%) and secure messaging arms (32.0%) compared with mailed letter (18.9%) and rate differences were significant for telephone (18.1%; 97.5% confidence interval: 8.3%-27.9%) and secure message outreach (13.1%; 97.5% confidence interval: 3.5%-22.7%) vs mailed letter outreach. CONCLUSIONS Telephone and secure messaging were more effective than mailed letter outreach for de-implementing outdated colonoscopy surveillance recommendations among individuals with a history of low-risk adenomas in an integrated healthcare setting. (ClinicalTrials.gov, Number: NCT05389397).
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Affiliation(s)
- Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California.
| | - Pradeep C Koripella
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Christopher D Jensen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sophie A Merchant
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jeffrey M Fox
- Department of Gastroenterology, Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | - Suyi X Chang
- Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
| | - Christian H Dang
- Department of Gastroenterology, Kaiser Permanente San Leandro Medical Center, San Leandro, California
| | - Fernando S Velayos
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Eshandeep S Boparai
- Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
| | - Nicole S Evans
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Lawrence J Leung
- Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Jessica M Badalov
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Theodore R Levin
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Gastroenterology, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California
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16
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Yoshida N, Maeda-Minami A, Ishikawa H, Mutoh M, Tomita Y, Kobayashi R, Hashimoto H, Inoue K, Hirose R, Dohi O, Itoh Y, Mano Y. Prevalence of colonoscopy in Japan using a large-scale health claims data compared to esophagogastroduodenoscopy. J Gastroenterol 2024; 59:457-467. [PMID: 38466371 DOI: 10.1007/s00535-024-02087-x] [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: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Prevalence of colonoscopy (CS) is an important countermeasure against colorectal cancer (CRC). In this study, we used large-scale data for a comparison of CS with esophagogastroduodenoscopy (EGD) in Japan. METHODS This was a retrospective descriptive study. Commercially anonymized patient data were collected from various health insurance societies (JMDC, Inc. Tokyo, Japan) generated from the insurance registry, receipts (inpatient, outpatient, and prescription), and health checkup data. The data also included healthy subjects who had never been examined in a hospital. The data of 2,760,048 persons who were 50-75 years old during January 2012-December 2019 were extracted from the original data source. The annual rate, the prevalence rate (frequency of those undergoing at least one endoscopy during the period), and the percentage of repeaters (undergoing endoscopy at least twice during the period) of CS were calculated and compared to those of EGD. RESULTS The annual rates in 2012/2015/2019 were 3.4%/4.5%/5.3% for CS, respectively, and increased gradually from 2012 to 2019. Those rates were 7.0%/7.9%/7.4% for EGD, respectively, and did not increase. The prevalence rates of CS and EGD were 25.3% and 36.2%, respectively, among the 137,246 participants over 8 years. The prevalence rates of individuals in their 50 s/60 s/70 s were 23.0%/25.9%/31.4% for CS and 33.0%/37.6%/40.7% for EGD, respectively. The proportions of males/females were 27.9%/20.7% for CS, and 36.4%/35.8% for EGD, respectively. The repeat rates of CS and EGD were 40.3% and 44.8%, respectively, over 8 years. CONCLUSIONS Using large-scale data, we determined the status of CS and EGD in Japan.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Ayako Maeda-Minami
- Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michihiro Mutoh
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yasunari Mano
- Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
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17
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Sayed IM, Vo DT, Alcantara J, Inouye KM, Pranadinata RF, Luo L, Boland CR, Goyal NP, Kuo DJ, Huang SC, Sahoo D, Ghosh P, Das S. Molecular Signatures for Microbe-Associated Colorectal Cancers. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.26.595902. [PMID: 38853996 PMCID: PMC11160670 DOI: 10.1101/2024.05.26.595902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Genetic factors and microbial imbalances play crucial roles in colorectal cancers (CRCs), yet the impact of infections on cancer initiation remains poorly understood. While bioinformatic approaches offer valuable insights, the rising incidence of CRCs creates a pressing need to precisely identify early CRC events. We constructed a network model to identify continuum states during CRC initiation spanning normal colonic tissue to pre-cancer lesions (adenomatous polyps) and examined the influence of microbes and host genetics. Methods A Boolean network was built using a publicly available transcriptomic dataset from healthy and adenoma affected patients to identify an invariant Microbe-Associated Colorectal Cancer Signature (MACS). We focused on Fusobacterium nucleatum ( Fn ), a CRC-associated microbe, as a model bacterium. MACS-associated genes and proteins were validated by RT-qPCR, RNA seq, ELISA, IF and IHCs in tissues and colon-derived organoids from genetically predisposed mice ( CPC-APC Min+/- ) and patients (FAP, Lynch Syndrome, PJS, and JPS). Results The MACS that is upregulated in adenomas consists of four core genes/proteins: CLDN2/Claudin-2 (leakiness), LGR5/leucine-rich repeat-containing receptor (stemness), CEMIP/cell migration-inducing and hyaluronan-binding protein (epithelial-mesenchymal transition) and IL8/Interleukin-8 (inflammation). MACS was induced upon Fn infection, but not in response to infection with other enteric bacteria or probiotics. MACS induction upon Fn infection was higher in CPC-APC Min+/- organoids compared to WT controls. The degree of MACS expression in the patient-derived organoids (PDOs) generally corresponded with the known lifetime risk of CRCs. Conclusions Computational prediction followed by validation in the organoid-based disease model identified the early events in CRC initiation. MACS reveals that the CRC-associated microbes induce a greater risk in the genetically predisposed hosts, suggesting its potential use for risk prediction and targeted cancer prevention.
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18
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Zaika V, Prakash MK, Cheng CY, Schlander M, Lang BM, Beerenwinkel N, Sonnenberg A, Krupka N, Misselwitz B, Poleszczuk J. Optimal timing of a colonoscopy screening schedule depends on adenoma detection, adenoma risk, adherence to screening and the screening objective: A microsimulation study. PLoS One 2024; 19:e0304374. [PMID: 38787836 PMCID: PMC11125540 DOI: 10.1371/journal.pone.0304374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/10/2024] [Indexed: 05/26/2024] Open
Abstract
Colonoscopy-based screening provides protection against colorectal cancer (CRC), but the optimal starting age and time intervals of screening colonoscopies are unknown. We aimed to determine an optimal screening schedule for the US population and its dependencies on the objective of screening (life years gained or incidence, mortality, or cost reduction) and the setting in which screening is performed. We used our established open-source microsimulation model CMOST to calculate optimized colonoscopy schedules with one, two, three or four screening colonoscopies between 20 and 90 years of age. A single screening colonoscopy was most effective in reducing life years lost from CRC when performed at 55 years of age. Two, three and four screening colonoscopy schedules saved a maximum number of life years when performed between 49-64 years; 44-69 years; and 40-72 years; respectively. However, for maximum incidence and mortality reduction, screening colonoscopies needed to be scheduled 4-8 years later in life. The optimum was also influenced by adenoma detection efficiency with lower values for these parameters favoring a later starting age of screening. Low adherence to screening consistently favored a later start and an earlier end of screening. In a personalized approach, optimal screening would start earlier for high-risk patients and later for low-risk individuals. In conclusion, our microsimulation-based approach supports colonoscopy screening schedule between 45 and 75 years of age but the precise timing depends on the objective of screening, as well as assumptions regarding individual CRC risk, efficiency of adenoma detection during colonoscopy and adherence to screening.
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Affiliation(s)
- Viktor Zaika
- Faculty of Medicine, Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Meher K. Prakash
- Theoretical Sciences Unit, Jawaharlal Nehru Center for Advanced Scientific Research, Jakkur, Bangalore, India
| | - Chih-Yuan Cheng
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Brian M. Lang
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Niko Beerenwinkel
- Department of Biosystems Science and Engineering, ETH Zurich, Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - Amnon Sonnenberg
- The Portland VA Medical Center, P3-GI, Portland, Oregon, United States of America
| | - Niklas Krupka
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital Bern and Bern University, Bern, Switzerland
| | - Jan Poleszczuk
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
- Department of Computational Oncology, Maria Skłodowska-Curie Institute-Oncology Center, Warsaw, Poland
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19
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Holden JR, Johnson G, Hochman D, Hyun E, Helewa RM. Early Surveillance Endoscopy Should Be Performed Selectively After Transanal Endoscopic Microsurgery for Rectal Lesions. Cureus 2024; 16:e60554. [PMID: 38887330 PMCID: PMC11181246 DOI: 10.7759/cureus.60554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Local recurrence (LR) rates after transanal endoscopic microsurgery (TEM) are unclear, and the utility of early postoperative surveillance for low-risk lesions is unknown. This study aimed to define LR after TEM for benign polyps and invasive adenocarcinoma, describe risk factors for LR, and evaluate the utility of early surveillance endoscopy. Methods This retrospective cohort study was conducted at two hospitals in Winnipeg, Manitoba, Canada. Adult patients who underwent TEM between 2009 and 2020 were evaluated for inclusion. The primary outcome was the rate of LR on surveillance endoscopy. Other outcomes included risk factors for LR and diagnostic yield of surveillance endoscopy. Results Among 357 patients who underwent TEM for benign polyps, LR was 10.5% (95% confidence interval (CI) 5.8-15.2) at three years. Positive margin was correlated with LR on multivariate analysis (hazard ratio (HR) 8.01, 95% CI 2.78-23.08). TEM defect closure was associated with lower LR on multivariate analysis (HR 0.19, 95% CI 0.06-0.59). Among 124 patients who underwent TEM for rectal adenocarcinoma, LR was 15.0% (95% CI 6.0-24.0) at three years. The first surveillance endoscopy had a 1.4% yield for low-risk patients (benign lesion, negative margins, and closed TEM defect) and 6.9% for all others. Conclusions LR at three years after TEM was 10.5% for benign polyps and 15.0% for adenocarcinomas. Early surveillance endoscopy can be considered low yield in some patients after TEM, which can be informative for shared decision-making regarding whether to proceed with early endoscopy in a low-risk subgroup of patients.
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Affiliation(s)
| | | | | | - Eric Hyun
- Surgery, University of Manitoba, Winnipeg, CAN
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20
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Yuan S, Zhang T, Wu Y, Lu Y, Chang F, Zhu Y. Cost-Utility Analysis of Berberine Chemoprevention for Colorectal Cancer After Polypectomy. Cureus 2024; 16:e61030. [PMID: 38915970 PMCID: PMC11194466 DOI: 10.7759/cureus.61030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/26/2024] Open
Abstract
Background Chemoprevention, such as berberine, has been developed as an alternative or complementary strategy to colonoscopy surveillance and has shown promise in reducing the morbidity and mortality of colorectal cancer. This study aims to evaluate the cost-effectiveness of berberine for postpolypectomy patients from the US third-party payer. Methods A Markov microsimulation model was developed to compare the cost and efficacy of berberine to no intervention, colonoscopy, and the combination of berberine and colonoscopy in postpolypectomy patients. Results After simulating 1 million patients, the study found that colonoscopy alone had a mean cost of $16,391 and mean quality-adjusted life-years (QALYs) of 16.03 per patient, whereas adding berberine slightly reduced the mean cost to $15,609 with a mean QALY of 16.05, making it a dominant strategy. Berberine therapy alone was less effective than colonoscopy alone, with a higher mean cost of $37,480 and a mean QALY of 15.32 per patient. However, berberine therapy was found to be a dominant strategy over no intervention. Conclusions Adding berberine to colonoscopy is the most cost-saving and effective approach for postpolypectomy patients. For patients who refuse or have limited access to colonoscopy, berberine alone is likely to be a dominant strategy compared to no intervention.
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Affiliation(s)
- Shuai Yuan
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Tian Zhang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Yingyu Wu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Yun Lu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Feng Chang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
| | - Yumei Zhu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, CHN
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21
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Anderson JC, Butterly LF. Assessing Risk of Index Serrated Polyps. Clin Gastroenterol Hepatol 2024; 22:958-960. [PMID: 37924854 DOI: 10.1016/j.cgh.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Joseph C Anderson
- Section of Gastroenterology, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut; Section of Gastroenterology, Department of Medicine, White River Junction VAMC, White River Junction, Vermont; Section of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Lynn F Butterly
- Section of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Gastroenterology, Department of Medicine, NH Colonoscopy Registry, Lebanon, New Hampshire; Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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22
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Rudolph JE, Calkins KL, Zhang X, Zhou Y, Pirsl F, Xu X, Wentz E, Lau B, Joshu CE. Incidence of Colon Cancer Among Medicaid Beneficiaries With or Without Human Immunodeficiency Virus Under Comparable Colorectal Cancer Screening Patterns. Open Forum Infect Dis 2024; 11:ofae246. [PMID: 38798894 PMCID: PMC11127480 DOI: 10.1093/ofid/ofae246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Background People with human immunodeficiency virus (HIV; PWH) in the United States have a lower incidence of colon cancer than the general population. The lower incidence may be explained by differences in receipt of screening. Thus, we sought to estimate colon cancer incidence under scenarios in which Medicaid beneficiaries, with or without HIV, followed the same screening protocols. Methods We used data from 1.5 million Medicaid beneficiaries who were enrolled in 14 US states in 2001-2015 and aged 50-64 years; 72 747 beneficiaries had HIV. We estimated risks of colon cancer and death by age, censoring beneficiaries when they deviated from 3 screening protocols, which were based on Medicaid's coverage policy for endoscopies during the time period, with endoscopy once every 2, 4, or 10 years. We used inverse probability weights to control for baseline and time-varying confounding and informative loss to follow-up. Analyses were performed overall, by sex, and by race/ethnicity. Results PWH had a lower incidence of colon cancer than beneficiaries without HIV. Compared with beneficiaries without HIV, the risk difference at age 65 years was -1.6% lower (95% confidence interval, -2.3% to -.7%) among PWH with the 2-year protocol and -0.8% lower (-1.3% to -.3%) with the 10-year protocol. Results were consistent across subgroup and sensitivity analyses. Conclusions Our findings suggest that the lower risk of colon cancer that has been observed among PWH aged 50-64 years compared with those without HIV is not due to differences in receipt of lower endoscopy. Keywords: colon cancer, colorectal cancer screening, endoscopy, Medicaid, human immunodeficiency virus.
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Affiliation(s)
- Jacqueline E Rudolph
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Keri L Calkins
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Mathematica, Ann Arbor, Michigan, USA
| | - Xueer Zhang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yiyi Zhou
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Filip Pirsl
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiaoqiang Xu
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Eryka Wentz
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Bryan Lau
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Corinne E Joshu
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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23
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Lam R, Hwang WT, Chennareddy S, Boursi B, Yang YX. Exogenous Insulin Therapy Is Associated with the Risk of Advanced Colorectal Adenoma in Patients with Diabetes Mellitus. Dig Dis Sci 2024; 69:1834-1843. [PMID: 38517561 DOI: 10.1007/s10620-024-08350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND/AIMS Exogenous insulin therapy increases systemic exposure to insulin which may promote the development of colorectal neoplasia. We sought to evaluate the association between exogenous insulin therapy and the incidence of advanced adenoma in type 2 diabetes mellitus. METHODS A retrospective cohort study was conducted from January 1, 2007, to January 1, 2018, in a regional health system serving the United States Philadelphia metropolitan area, Central New Jersey, and South Central Pennsylvania. Study patients consisted of a random sample of patients with type 2 diabetes mellitus aged 40-80 years who had undergone two rounds of colonoscopy examinations. The exposure was cumulative duration of insulin therapy (i.e., no use, 1-365 days and > 365 days). The outcome was time to incident advanced adenoma. RESULTS Of the 975 eligible patients, 184 patients accumulated > 365 days of insulin therapy before the follow-up colonoscopy. The mean (standard deviation) duration between the two rounds of colonoscopy examination was 5.1 (2.9) years among the insulin users and 5.3 (3.9) years among non-users. Compared to no insulin exposure, receiving > 365 days of insulin therapy was associated with an increased incidence of advanced adenoma (adjusted hazard ratio [aHR] 4.84, 95% confidence interval [CI] 2.82-8.30), right-sided advanced adenoma (aHR 5.48, 95% CI 2.90-10.35), and 3 or more adenomas (aHR 2.61, 95% CI 1.46-4.69) at the follow-up colonoscopy examination. CONCLUSION Insulin therapy is associated with an increased risk of advanced adenoma and may serve as a novel risk-stratification factor to enhance the efficiency of existing colorectal cancer screening and surveillance programs.
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Affiliation(s)
- Robert Lam
- Section of Digestive Diseases, Yale School of Medicine, New Haven, CT, USA
| | - Wei-Ting Hwang
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Ben Boursi
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Tel-Aviv University, Tel-Aviv, Israel
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Yu-Xiao Yang
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, 19104, USA.
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Gastrointestinal Section, Medicine Services, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, USA.
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24
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White M, Israilevich R, Lam S, McCarthy M, Mico V, Chipkin B, Abrams E, Moore K, Kastenberg D. Timely Completion of Direct Access Colonoscopy Is Noninferior to Office Scheduled for Screening and Surveillance. J Clin Gastroenterol 2024:00004836-990000000-00287. [PMID: 38630852 DOI: 10.1097/mcg.0000000000002000] [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: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 04/19/2024]
Abstract
GOALS We aimed to evaluate whether direct access colonoscopy (DAC) is noninferior to office-scheduled colonoscopy (OSC) for achieving successful colonoscopy. BACKGROUND DAC may improve access to colonoscopy. We developed an algorithm assessing eligibility, risk for inadequate preparation, and need for nursing/navigator assistance. STUDY This was a retrospective, single-center study of DAC and OSC patients from June 5, 2018, to July 31, 2019. Patients were 45 to 75 years old with an indication of screening or surveillance. A successful colonoscopy met 3 criteria: complete colonoscopy (cecum, anastomosis, or ileum), adequate preparation (Boston Score ≥2/segment), and performed <90 days from initial patient contact. Unsuccessful colonoscopy did not meet ≥1 criteria. Secondary end points included days to successful colonoscopy, preparation quality, polyp detection, and 10-year recall rate. Noninferiority against risk ratio value of 0.85 was tested using 1-sided alpha of 0.05. RESULTS A total of 1823 DAC and 828 OSC patients were eligible. DAC patients were younger, with a greater proportion of black patients and screening indications. For the outcome of successful colonoscopy, DAC was noninferior to OSC (DAC vs. OSC: 62.7% vs. 57.1%, RR 1.16, 95% LCL 1.09, P=0.001). For DAC, days to colonoscopy were fewer, and likelihood of 10-year recall after negative screening greater. Boston Score and polyp detection were similar for groups. Black patients were less likely to achieve successful colonoscopy; otherwise, groups were similar. For unsuccessful colonoscopies, proportionally more DAC patients canceled or no-showed while more OSC patients scheduled >90 days. DAC remained noninferior to OSC at 180 days. CONCLUSIONS DAC was noninferior to OSC for achieving successful colonoscopy, comparing similarly in quality and efficiency outcomes.
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Affiliation(s)
- Mary White
- Sidney Kimmel Medical College
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT
| | - Rachel Israilevich
- Sidney Kimmel Medical College
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Sophia Lam
- Sidney Kimmel Medical College
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York City, NY
| | - Michael McCarthy
- Sidney Kimmel Medical College
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vasil Mico
- Sidney Kimmel Medical College
- Department of Medicine, Tufts Medical Center, Boston
| | - Benjamin Chipkin
- Sidney Kimmel Medical College
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT
| | - Eric Abrams
- Department of Biology, University of Massachusetts-Amherst, Amherst, MA
| | - Kelly Moore
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA
| | - David Kastenberg
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA
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25
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Yao L, Xiong H, Li Q, Wang W, Wu Z, Tan X, Luo C, You H, Zhang C, Zhang L, Lu Z, Yu H, Chen H. Validation of artificial intelligence-based bowel preparation assessment in screening colonoscopy (with video). Gastrointest Endosc 2024:S0016-5107(24)00235-9. [PMID: 38636818 DOI: 10.1016/j.gie.2024.04.015] [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: 11/02/2023] [Revised: 03/17/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND AND AIMS Accurate bowel preparation assessment is essential for determining colonoscopy screening intervals. Patients with suboptimal bowel preparation are at a high risk of missing >5 mm adenomas and should undergo an early repeat colonoscopy. In this study, we used artificial intelligence (AI) to evaluate bowel preparation and validated the ability of the system to accurately identify patients who are at high risk of having >5 mm adenomas missed due to inadequate bowel preparation. METHODS This prospective, single-center, observational study was conducted at the Eighth Affiliated Hospital, Sun Yat-sen University, from October 8, 2021, to November 9, 2022. Eligible patients who underwent screening colonoscopy were consecutively enrolled. The AI assessed bowel preparation using the e-Boston Bowel Preparation Scale (e-BBPS) while endoscopists made evaluations using BBPS. If both BBPS and e-BBPS deemed preparation adequate, the patient immediately underwent a second colonoscopy; otherwise, the patient underwent bowel re-cleansing before the second colonoscopy. RESULTS Among the 393 patients, 72 adenomas >5 mm in size were detected; 27 adenomas >5 mm in size were missed. In unqualified-AI patients, the >5 mm adenoma miss rate (AMR) was significantly higher than in qualified-AI patients (35.71% vs 13.19% [P = .0056]; odds ratio [OR], .2734 [95% CI, .1139-.6565]), as were the AMR (50.89% vs 20.79% [P < .001]; OR, .2532 [95% CI, .1583-.4052]) and >5 mm polyp miss rate (35.82% vs 19.48% [P = .0152]; OR, .4335 [95% CI, .2288-.8213]). CONCLUSIONS This study confirmed that patients classified as inadequate by AI exhibited an unacceptable >5 mm AMR, providing key evidence for implementing AI in guiding bowel re-cleansing and potentially standardizing future colonoscopy screening. (Clinical trial registration number: NCT05145712.).
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Affiliation(s)
- Liwen Yao
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huizhen Xiong
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qiucheng Li
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wen Wang
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhifeng Wu
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xia Tan
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chaijie Luo
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hang You
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chenxia Zhang
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihui Zhang
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zihua Lu
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Honggang Yu
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China; Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, China; Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Honglei Chen
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.
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Panzuto F, Parodi MC, Esposito G, Massironi S, Fantin A, Cannizzaro R, Milione M, De Angelis CG, Annibale B. Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED). Dig Liver Dis 2024; 56:589-600. [PMID: 38216439 DOI: 10.1016/j.dld.2023.12.015] [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: 11/08/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024]
Abstract
The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm.
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Affiliation(s)
- Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy.
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genova, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Fantin
- Gastroenterology Unit; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Massimo Milione
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Giovanni De Angelis
- Gastroenterology Department, Endoscopy Unit, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
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Lee JK, Roy A, Jensen CD, Chan JT, Zhao WK, Levin TR, Chubak J, Halm EA, Skinner CS, Schottinger JE, Ghai NR, Burnett-Hartman AN, Kamineni A, Udaltsova N, Corley DA. Surveillance Colonoscopy Findings in Older Adults With a History of Colorectal Adenomas. JAMA Netw Open 2024; 7:e244611. [PMID: 38564216 PMCID: PMC10988351 DOI: 10.1001/jamanetworkopen.2024.4611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/05/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Postpolypectomy surveillance is a common colonoscopy indication in older adults; however, guidelines provide little direction on when to stop surveillance in this population. Objective To estimate surveillance colonoscopy yields in older adults. Design, Setting, and Participants This population-based cross-sectional study included individuals 70 to 85 years of age who received surveillance colonoscopy at a large, community-based US health care system between January 1, 2017, and December 31, 2019; had an adenoma detected 12 or more months previously; and had at least 1 year of health plan enrollment before surveillance. Individuals were excluded due to prior colorectal cancer (CRC), hereditary CRC syndrome, inflammatory bowel disease, or prior colectomy or if the surveillance colonoscopy had an inadequate bowel preparation or was incomplete. Data were analyzed from September 1, 2022, to February 22, 2024. Exposures Age (70-74, 75-79, or 80-85 years) at surveillance colonoscopy and prior adenoma finding (ie, advanced adenoma vs nonadvanced adenoma). Main Outcomes and Measures The main outcomes were yields of CRC, advanced adenoma, and advanced neoplasia overall (all ages) by age group and by both age group and prior adenoma finding. Multivariable logistic regression was used to identify factors associated with advanced neoplasia detection at surveillance. Results Of 9740 surveillance colonoscopies among 9601 patients, 5895 (60.5%) were in men, and 5738 (58.9%), 3225 (33.1%), and 777 (8.0%) were performed in those aged 70-74, 75-79, and 80-85 years, respectively. Overall, CRC yields were found in 28 procedures (0.3%), advanced adenoma in 1141 (11.7%), and advanced neoplasia in 1169 (12.0%); yields did not differ significantly across age groups. Overall, CRC yields were higher for colonoscopies among patients with a prior advanced adenoma vs nonadvanced adenoma (12 of 2305 [0.5%] vs 16 of 7435 [0.2%]; P = .02), and the same was observed for advanced neoplasia (380 of 2305 [16.5%] vs 789 of 7435 [10.6%]; P < .001). Factors associated with advanced neoplasia at surveillance were prior advanced adenoma (adjusted odds ratio [AOR], 1.65; 95% CI, 1.44-1.88), body mass index of 30 or greater vs less than 25 (AOR, 1.21; 95% CI, 1.03-1.44), and having ever smoked tobacco (AOR, 1.14; 95% CI, 1.01-1.30). Asian or Pacific Islander race was inversely associated with advanced neoplasia (AOR, 0.81; 95% CI, 0.67-0.99). Conclusions and Relevance In this cross-sectional study of surveillance colonoscopy yield in older adults, CRC detection was rare regardless of prior adenoma finding, whereas the advanced neoplasia yield was 12.0% overall. Yields were higher among those with a prior advanced adenoma than among those with prior nonadvanced adenoma and did not increase significantly with age. These findings can help inform whether to continue surveillance colonoscopy in older adults.
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Affiliation(s)
- Jeffrey K. Lee
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Abhik Roy
- Kaiser Permanente San Leandro Medical Center, San Leandro, California
| | | | - Jennifer T. Chan
- Kaiser Permanente San Leandro Medical Center, San Leandro, California
| | - Wei K. Zhao
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Theodore R. Levin
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Ethan A. Halm
- Rutgers Biological Health Sciences, Rutgers University, New Brunswick, New Jersey
| | - Celette S. Skinner
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas
- Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas
| | - Joanne E. Schottinger
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena
- Department of Quality and Systems of Care, Kaiser Permanente Southern California, Pasadena
| | - Nirupa R. Ghai
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena
- Department of Quality and Systems of Care, Kaiser Permanente Southern California, Pasadena
| | | | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Natalia Udaltsova
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland
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Heisser T, Sergeev D, Hoffmeister M, Brenner H. Contributions of early detection and cancer prevention to colorectal cancer mortality reduction by screening colonoscopy: a validated modeling study. Gastrointest Endosc 2024:S0016-5107(24)00163-9. [PMID: 38462054 DOI: 10.1016/j.gie.2024.03.010] [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: 12/13/2023] [Revised: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Screening colonoscopy, recommended every 10 years, reduces mortality from colorectal cancer (CRC) by early detection of prevalent but undiagnosed CRC, as well as by removal of precursor lesions. The aim of this study was to assess the relative contribution of both components to total CRC mortality reduction over time. METHODS Using a validated multistate Markov model, we simulated hypothetical cohorts of 100,000 individuals aged 55 to 64 years with and without screening at baseline. Main outcomes included proportions of prevented CRC deaths arising from (asymptomatic) CRC already present at baseline and from newly developed CRC during 15 years of follow-up, and mortality rate ratios of screened versus nonscreened groups over time. RESULTS Early detection of prevalent cases accounted for 52%, 30%, and 18% of deaths prevented by screening colonoscopy within 5, 10, and 15 years, respectively. Relative reduction of mortality was estimated to be much larger for mortality from incident cancers than for mortality from cancers that were already present and detected early at screening endoscopy and for total CRC mortality (ie, 88% versus 67% and 79%, respectively, within 10 years from screening). CONCLUSIONS Reduction of CRC mortality mainly arises from early detection of prevalent cancers during the early years after screening colonoscopy, but prevention of incident cases accounts for the majority of prevented deaths in the longer run. Prevention of incident cases leads to sustained strong reduction of CRC mortality, possibly warranting an extension of screening intervals.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Dmitry Sergeev
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
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Shaffer SR, Lambert P, Unruh C, Harland E, Helewa RM, Decker K, Singh H. Optimizing Timing of Follow-Up Colonoscopy: A Pilot Cluster Randomized Trial of a Knowledge Translation Tool. Am J Gastroenterol 2024; 119:547-555. [PMID: 37787644 DOI: 10.14309/ajg.0000000000002542] [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] [Received: 06/10/2023] [Accepted: 09/12/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Endoscopists have low adherence to guideline-recommended colonoscopy surveillance intervals. We performed a cluster-randomized single-blind pilot trial in Winnipeg, Canada, to assess the effectiveness of a newly developed digital application tool that computes guideline-recommended follow-up intervals. METHODS Participant endoscopists were randomized to either receive access to the digital application (intervention group) or not receive access (control group). Pathology reports and final recommendations for colonoscopies performed in the 1-4 months before randomization and 3-7 months postrandomization were extracted. Generalized estimating equation models were used to determine whether the access to the digital application predicted guideline congruence. RESULTS We included 15 endoscopists in the intervention group and 14 in the control group (of 42 eligible endoscopists in the city), with 343 patients undergoing colonoscopy before randomization and 311 postrandomization. Endoscopists who received the application made guideline-congruent recommendations 67.6% of the time before randomization and 76.1% of the time after randomization. Endoscopists in the control group made guideline-congruent recommendations 72.4% and 72.9% of the time before and after randomization, respectively. Endoscopists in the intervention group trended to have an increase in guideline adherence comparing postintervention with preintervention (odds ratio [OR]: 1.50, 95% confidence interval [CI] 0.82-2.74). By contrast, the control group had no change in guideline adherence (OR: 1.07, 95% CI 0.50-2.29). Endoscopists in the intervention group with less than median guideline congruence prerandomization had a significant increase in guideline-congruent recommendations postrandomization. DISCUSSION An application that provides colonoscopy surveillance intervals may help endoscopists with guideline congruence, especially those with a lower preintervention congruence with guideline recommendations ( ClincialTrials.gov number, NCT04889352).
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Affiliation(s)
- Seth R Shaffer
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute Cancer, Care Manitoba, Winnipeg, Manitoba, Canada
| | - Claire Unruh
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Harland
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Department of Surgery, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen Decker
- Paul Albrechtsen Research Institute Cancer, Care Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Paul Albrechtsen Research Institute Cancer, Care Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Yamamoto N, Yamashita K, Takehara Y, Morimoto S, Tanino F, Kamigaichi Y, Tanaka H, Arihiro K, Shimamoto F, Oka S. Characteristics and Prognosis of Sporadic Neoplasias Detected in Patients with Ulcerative Colitis. Digestion 2024; 105:213-223. [PMID: 38417416 DOI: 10.1159/000537756] [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: 10/04/2023] [Accepted: 02/08/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Patients with ulcerative colitis (UC) develop not only UC-associated neoplasias but also sporadic neoplasias (SNs). However, few studies have described the characteristics of SNs in patients with UC. Therefore, this study aimed to evaluate the clinical features and prognosis of SNs in patients with UC. METHODS A total of 141 SNs in 59 patients with UC, detected by surveillance colonoscopy at Hiroshima University Hospital between January 1999 and December 2021, were included. SNs were diagnosed based on their location, endoscopic features, and histopathologic findings along with immunohistochemical staining for Ki67 and p53. RESULTS Of the SNs, 91.5% were diagnosed as adenoma and 8.5% were diagnosed as carcinoma (Tis carcinoma, 3.5%; T1 carcinoma, 5.0%). 61.0% of the SNs were located in the right colon, 31.2% were located in the left colon, and 7.8% were located in the rectum. When classified based on the site of the lesion, 70.9% of SNs occurred outside and 29.1% within the affected area. Of all SNs included, 95.7% were endoscopically resected and 4.3% were surgically resected. Among the 59 patients included, synchronous SNs occurred in 23.7% and metachronous multiple SNs occurred in 40.7% during surveillance. The 5-year cumulative incidence of metachronous multiple SNs was higher in patients with synchronous multiple SNs (54.2%) than in those without synchronous multiple SNs (46.4%). CONCLUSION Patients with UC with synchronous multiple SNs are at a higher risk of developing metachronous multiple SNs and may require a closer follow-up by total colonoscopy than patients without synchronous SNs.
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Affiliation(s)
- Noriko Yamamoto
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yudai Takehara
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shin Morimoto
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumiaki Tanino
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Kamigaichi
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumio Shimamoto
- Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
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Berbecka M, Berbecki M, Gliwa AM, Szewc M, Sitarz R. Managing Colorectal Cancer from Ethology to Interdisciplinary Treatment: The Gains and Challenges of Modern Medicine. Int J Mol Sci 2024; 25:2032. [PMID: 38396715 PMCID: PMC10889298 DOI: 10.3390/ijms25042032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/20/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Colorectal cancer (CRC) is a common malignant tumor of the gastrointestinal tract, which has become a serious threat to human health worldwide. This article exhaustively reviews colorectal cancer's incidence and relevance, carcinogenesis molecular pathways, up-to-date treatment opportunities, prophylaxis, and screening program achievements, with attention paid to its regional variations and changes over time. This paper provides a concise overview of known CRC risk factors, including familial, hereditary, and environmental lifestyle-related risk factors. The authors take a closer look into CRC's molecular genetic pathways and the role of specific enzymes involved in carcinogenesis. Moreover, the role of the general practitioner and multidisciplinary approach in CRC treatment is summarized and highlighted based on recent recommendations and experience. This article gives a clear understanding and review of the gains and challenges of modern medicine towards CRC. The authors believe that understanding the current patterns of CRC and its revolution is imperative to the prospects of reducing its burden through cancer prevention and cancer-adjusted treatment.
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Affiliation(s)
- Monika Berbecka
- Department of Human Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (M.B.); (A.M.G.)
| | - Maciej Berbecki
- General Surgery Ward, Independent Health Center in Kraśnik, 23-200 Kraśnik, Poland;
| | - Anna Maria Gliwa
- Department of Human Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (M.B.); (A.M.G.)
| | - Monika Szewc
- Department of Human Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (M.B.); (A.M.G.)
| | - Robert Sitarz
- Department of Human Anatomy, Medical University of Lublin, 20-950 Lublin, Poland; (M.B.); (A.M.G.)
- I Department of Surgical Oncology, Center of Oncology of the Lublin Region, St. Jana z Dukli, 20-090 Lublin, Poland
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Asayama N, Oka S, Nagata S, Matsuo T, Aoyama T, Kawamura T, Kuroda T, Hiraga Y, Nakadoi K, Kunihiro M, Ohnishi M, Tanaka S. Adherence and Effectiveness of MoviPrep Ⓡ in Bowel Preparation for Colonoscopy: A Multicenter Study from the Hiroshima GI Endoscopy Research Group. J Anus Rectum Colon 2024; 8:9-17. [PMID: 38313749 PMCID: PMC10831980 DOI: 10.23922/jarc.2023-030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/13/2023] [Indexed: 02/06/2024] Open
Abstract
Objectives Bowel preparation is burdensome because of long cleansing times and large dose volumes of conventional polyethylene glycol (PEG) lavage solution NiflecⓇ (Nif). MoviPrep (Mov)Ⓡ is a hyperosmolar preparation of PEG, electrolytes, and ascorbic acid; despite the smaller dose volume of 2 L, it can be challenging for many patients. We examined a more effective and acceptable bowel preparation method without compromising cleanliness and effectiveness, combining low-residue diet and laxative (Modified Brown Method) in Mov administered 1 day pre-colonoscopy. Methods This multicenter, randomized, open-label, parallel-group comparative study, conducted at Hiroshima University Hospital and 7 affiliated hospitals in May 2015-March 2016, evaluated adherence to and effectiveness of Mov in bowel preparation. Participants (n=380) were allocated to receive 1 of 3 pre-colonoscopy regimens: Nif+Modified Brown Method (Group A), Mov+Modified Brown Method (Group B), or Mov+Laxative (Group C). Results Total intake volume showed no significant difference among the groups. Bowel preparation time was significantly shorter in Group B (112.4±44.8 min, n=118) than in Groups A (131.3±59 min, n=105) and C (122.6±48.1 min, n=115). Sleep disturbance (37%) was significantly higher in Group B than Group A; distension (11%) was significantly lower in Group C than in Groups A and B (p<0.05, respectively). No severe adverse events occurred in any group. Conclusions Mov+Modified Brown method provided significantly shorter bowel preparation time, with no significant difference in total intake volume among the regimens. Mov+Laxative yielded significantly less distension than the other groups, with bowel preparation equivalent to that of the Nif+Modified Brown method.
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Affiliation(s)
- Naoki Asayama
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | - Taiji Matsuo
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Taiki Aoyama
- Department of Gastroenterology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan
| | | | - Tsuyoshi Kuroda
- Department of Gastroenterology, Mazda Hospital, Hiroshima, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Koichi Nakadoi
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Mayu Ohnishi
- Department of Gastroenterology, Miyoshi Medical Association Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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Huang BL, Wei LF, Lin YW, Huang LS, Qu QQ, Li XH, Chu LY, Xu YW, Wang WD, Peng YH, Wu FC. Serum IGFBP-1 as a promising diagnostic and prognostic biomarker for colorectal cancer. Sci Rep 2024; 14:1839. [PMID: 38246959 PMCID: PMC10800337 DOI: 10.1038/s41598-024-52220-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Our previous study showed that levels of circulating insulin-like growth factor binding protein-1 (IGFBP-1) has potential diagnostic value for early-stage upper gastrointestinal cancers. This study aimed to assess whether serum IGFBP-1 is a potential diagnostic and prognostic biomarker for CRC patients. IGFBP-1 mRNA expression profile data of peripheral blood in colorectal cancer (CRC) patients were downloaded and analyzed from Gene Expression Omnibus database. We detected serum IGFBP-1 in 138 CRC patients and 190 normal controls using enzyme-linked immunosorbent assay. Blood IGFBP-1 mRNA levels were higher in CRC patients than those in normal controls (P = 0.027). In addition, serum IGFBP-1 protein levels in the CRC group were significantly higher than those in normal control group (P < 0.0001). Serum IGFBP-1 demonstrated better diagnostic accuracy for all CRC and early-stage CRC, respectively, when compared with carcinoembryonic antigen (CEA), carbohydrate antigen19-9 (CA 19-9) or the combination of CEA and CA19-9. Furthermore, Cox multivariate analysis revealed that serum IGFBP-1 was an independent prognostic factor for OS (HR = 2.043, P = 0.045). Our study demonstrated that serum IGFBP-1 might be a potential biomarker for the diagnosis and prognosis of CRC. In addition, the nomogram might be helpful to predict the prognosis of CRC.
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Affiliation(s)
- Bin-Liang Huang
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Lai-Feng Wei
- Department of Clinical Laboratory Medicine, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Yi-Wei Lin
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Li-Sheng Huang
- Department of Radiation Oncology, The Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515041, China
| | - Qi-Qi Qu
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Xin-Hao Li
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Ling-Yu Chu
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
| | - Yi-Wei Xu
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
| | - Wei-Dong Wang
- Department of Bone and Soft Tissue Oncology Surgery, The Cancer Hospital of Shantou University Medical College, Shantou, China.
| | - Yu-Hui Peng
- Department of Clinical Laboratory Medicine, The Cancer Hospital of Shantou University Medical College, Shantou, China.
- Precision Medicine Research Center, Shantou University Medical College, Shantou, China.
- Guangdong Esophageal Cancer Institute, Guangzhou, China.
| | - Fang-Cai Wu
- Department of Radiation Oncology, The Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515041, China.
- Guangdong Esophageal Cancer Institute, Guangzhou, China.
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Idouchi K, Gregoski MJ, Rockey DC. Appropriateness of recommendations for surveillance colonoscopy after polypectomy - a comparison of adherence to the 2012 and 2020 USMSTF guidelines. RESEARCH SQUARE 2024:rs.3.rs-3870490. [PMID: 38313272 PMCID: PMC10836104 DOI: 10.21203/rs.3.rs-3870490/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Background Screening colonoscopy detects precancerous polyps, which when resected, prevents colon cancer. Recommendations for surveillance colonoscopy after polypectomy are based on the U.S. Multi-Society Task Force guidelines (USMSTF). Aim to examine provider recommendations based on 2012 and 2020 USMSTF guidelines. Methods A prospective analysis was performed to examine provider recommendations for index screening and surveillance colonoscopy from March 2022 to January 2023. Procedures with unknown histology or unsatisfactory bowel preparation were excluded. We recorded polyp morphology, histology, and subsequent recommendations made by endoscopists, to compare to the USMSTF guidelines. Results 241 patients were included, with 371 endoscopies reviewed. For index screening colonoscopies, 86%, performed between 2012 and 2020, adhered to 2012 guidelines, while 71%, performed after 2020, adhered to the 2020 guidelines. For surveillance colonoscopies, 62% from 2012 and 2020, and 50% after 2020, adhered to the 2012 and 2020 guidelines, respectively (P < 0.001). For polyp types, recommendations after index colonoscopies showed low-risk adenoma (LRA) had 88% adherence to 2012 guidelines versus 73% adherence to 2020 guidelines. For surveillance colonoscopies, LRA had 73% adherence to 2012 guidelines versus 42% adherence to 2020 guidelines (P < 0.001). Recommendations after index colonoscopy showed high-risk adenoma (HRA) had 79% adherence to 2012 guidelines versus 63% adherence to 2020 guidelines. For surveillance colonoscopies, HRA had 88% adherence to the 2012 guidelines versus 69% adherence to 2020 guidelines (P < 0.001). Conclusions Adherence declined for the introduction of 2020 guidelines and was poorer after 2nd surveillance exams. Increasing the evidence for interval recommendations may increase guideline adherence.
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Si S, Shou L, Gao Q, Qin W, Zhao D. Worldwide productivity and research trend of publications concerning intestinal polyps: A bibliometric study. Medicine (Baltimore) 2024; 103:e36507. [PMID: 38215143 PMCID: PMC10783372 DOI: 10.1097/md.0000000000036507] [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: 07/23/2023] [Accepted: 11/16/2023] [Indexed: 01/14/2024] Open
Abstract
There is a significant relationship between intestinal polyps and colorectal cancer, and in recent years, research on intestinal polyps has been rapidly developing around the world. However, there is still a lack of adequate quantification and analysis of publications in this field. The aim of this study was to perform a comprehensive bibliometric analysis of publications related to intestinal polyps over the past 20 years. To enhance the understanding of current research hotspots and potential trends, and to point out the direction of future research. Publications related to intestinal polyps were retrieved from the Science Citation Index Expanded in Web of Science Core Collection. the Bibliometric online analysis platform (https://bibliometric.com/app), the Bibliometrix Package, and the CiteSpace are used for bibliometric analysis and visualization, including the overall range of annual output and annual citations, country-region analysis, author and institution analysis, core journal analysis, reference and keyword analysis. Prior to 2017, the amount of research on intestinal polyps was slow to grow, but it picked up speed after that year. In 1019 journals, 4280 papers on intestinal polyps were published in English. The journal with the highest productivity was Gastrointestinal Endoscopy (189, 4.42%). United States (1124, 26.26%), which is also the hub of collaboration in this subject, was the most productive nation. Mayo Clinic (n = 70, 1.64%) is the most productive institution. Intestinal microbiota, endoscopic mucosal resection, gut microbiota, deep learning, tea polyphenol, insulin resistance and artificial intelligence were current hot subjects in the field. Studies of intestinal polyps increased significantly after 2017. The United States contributed the largest number of publications. Countries and institutions were actively cooperating with one another. artificial intelligence is currently an emerging topic.
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Affiliation(s)
- Sha Si
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
- School of Marine Science, Ningbo University, Ningbo, China
| | - Letian Shou
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
| | - Qi Gao
- Department of Food Science and Engineering, Ningbo University, Ningbo, China
| | - Wenyan Qin
- Yinzhou No. 2 People’s Hospital, Ningbo, China
| | - Dan Zhao
- School of Marine Science, Ningbo University, Ningbo, China
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Ho YM, Merollini KMD, Gordon LG. Frequency of colorectal surveillance colonoscopies for adenomatous polyps: systematic review and meta-analysis. J Gastroenterol Hepatol 2024; 39:37-46. [PMID: 37967829 DOI: 10.1111/jgh.16397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/14/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND AND AIM The purpose of this study was to assess evidence on the frequency of polyp surveillance colonoscopies performed earlier than the recommended follow-up intervals in clinical practice guidelines. METHODS A systematic review was performed based on electronic searches in PubMed and Embase. Research articles, letters to the editors, and review articles, published before April 2022, were included. Studies that focused on the intervals of polyp surveillance in adult populations were selected. The Risk Of Bias In Non-randomized Studies of Exposure (ROBINS-E) was used to assess the risk of bias. A meta-analysis was performed with Forest plots to illustrate the results. RESULTS In total, 16 studies, comprising 11 172 patients from Australia, Europe, and North America, were included for analysis. The quality of the studies was moderate. Overall, 38% (95% CI: 30-47%) of colonoscopies were undertaken earlier than their respective national clinical guidelines. In risk-stratified surveillance, 10 studies contained data relating to low-risk polyp surveillance intervals and 30% (95% CI: 29-31%) of colonoscopies were performed earlier than recommended. Eight studies contained data relating to intermediate-risk polyp surveillance and 15% (95% CI: 14-17%) of colonoscopies were performed earlier than recommended. One study showed that 6% (95% CI: 4-10%) of colonoscopies performed for high-risk polyp surveillance were performed earlier than recommended. CONCLUSIONS A significant proportion of polyp surveillance was performed earlier than the guidelines suggested. This provides evidence of the potential overuse of healthcare resources and the opportunity to improve hospital efficiency.
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Affiliation(s)
- Yiu Ming Ho
- Department of Surgery, The Prince Charles Hospital, Chermside, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Katharina M D Merollini
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
- Sunshine Coast Health Institute, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Louisa G Gordon
- Department of Health Economics, Department of Population Health, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Public Health, The University of Queensland, St. Lucia, Queensland, Australia
- School of Nursing, The Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Huang Z, Xie F, Qing W, Wang M, Liu M, Sun D. MGF-net: Multi-channel group fusion enhancing boundary attention for polyp segmentation. Med Phys 2024; 51:407-418. [PMID: 37403578 DOI: 10.1002/mp.16584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/11/2023] [Accepted: 06/02/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Colonic polyps are the most prevalent neoplastic lesions detected during colorectal cancer screening, and timely detection and excision of these precursor lesions is crucial for preventing multiple malignancies and reducing mortality rates. PURPOSE The pressing need for intelligent polyp detection has led to the development of a high-precision intelligent polyp segmentation network designed to improve polyp screening rates during colonoscopies. METHODS In this study, we employed ResNet50 as the backbone network and embedded a multi-channel grouping fusion encoding module in the third to fifth stages to extract high-level semantic features of polyps. Receptive field modules were utilized to capture multi-scale features, and grouping fusion modules were employed to capture salient features in different group channels, guiding the decoder to generate an initial global mapping with improved accuracy. To refine the segmentation of the initial global mapping, we introduced an enhanced boundary weight attention module that adaptively thresholds the initial global mapping using learnable parameters. A self-attention mechanism was then utilized to calculate the long-distance dependency relationship of the polyp boundary area, resulting in an output feature map with enhanced boundaries that effectively refines the boundary of the target area. RESULTS We carried out contrast experiments of MGF-Net with mainstream polyp segmentation networks on five public datasets of ColonDB, CVC-ColonDB, CVC-612, Kvasir, and ETIS. The results demonstrate that the segmentation accuracy of MGF-Net is significantly improved on the datasets. Furthermore, a hypothesis test was conducted to assess the statistical significance of the computed results. CONCLUSIONS Our proposed MGF-Net outperforms existing mainstream baseline networks and presents a promising solution to the pressing need for intelligent polyp detection. The proposed model is available at https://github.com/xiefanghhh/MGF-NET.
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Affiliation(s)
- Zhiyong Huang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Fang Xie
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Wencheng Qing
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Mengyao Wang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Man Liu
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, China
| | - Daming Sun
- Chongqing Engineering Research Center of Medical Electronics and Information, Technology, Chongqing University of Posts and Telecommunications, Chongqing, China
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Ishibashi F, Suzuki S, Tanaka R, Kobayashi K, Kawakami T, Nagai M, Mochida K, Morishita T. An algorithm-based active cleansing protocol can reduce the bowel preparation time for screening colonoscopy: A propensity score matching study. Saudi J Gastroenterol 2024; 30:30-36. [PMID: 37470635 PMCID: PMC10852146 DOI: 10.4103/sjg.sjg_176_23] [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: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Methods that minimize the time for on-site bowel preparation before colonoscopy are needed. We prospectively validated that a novel algorithm-based active cleansing (ABAC) protocol could reduce the time for preparation compared with the conventional method. METHODS This was an open-label, multicenter, prospective comparative study from April to October 2021. The study compared the bowel preparation time for colonoscopy between patients instructed with the ABAC protocol and control groups. Patients in the ABAC protocol group as well as the control group were administered 2000 mL of polyethylene glycol (PEG) within 2 hours. After the first two hours, patients in the protocol group voluntarily took 300 ml of the solution without the instruction of nursing staff depending on the number of defecations in the first 2 hours. The intervention and control groups were adjusted for background characteristics by propensity score matching (PSM). RESULTS After adjustment by PSM, 174 patients in each of the two groups were included in the final analysis. In the intention-to-treat analysis, the preparation time was significantly shorter in the intervention group than that in the control group (126.3 ± 32.7 min vs. 144.9 ± 39.9 min, P = 0.018). The proportion of additional PEG intake was significantly higher in the intervention group (16 [9.2%] vs. 6 [3.4%], P = 0.047). The number of defecations was also higher in the intervention group than in the control group (7.8 ± 2.5 vs. 6.3 ± 2.2, P = 0.001). CONCLUSIONS Simple active instruction protocol is effective to reduce on-site bowel preparation time and nursing staff labor for colonoscopy.
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Affiliation(s)
- Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
- Koganei Tsurukame Clinic, Endoscopy Center, Tokyo, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Ryu Tanaka
- Mirraza Shinjuku Tsurukame Clinic, Tokyo, Japan
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan
| | | | | | - Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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Lee S, Do YS, Lee HJ, Kim GU, Park HW, Chang HS, Choe J, Byeon JS, Lee JY. Gastrointestinal: Weight gain increases the risk of metachronous advanced colorectal neoplasm observed in post-polypectomy surveillance colonoscopy. J Gastroenterol Hepatol 2024; 39:47-54. [PMID: 37743847 DOI: 10.1111/jgh.16360] [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: 04/10/2023] [Revised: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND AIM Although obesity is a known risk factor for colorectal neoplasms, the correlation between weight change and colorectal neoplasm is unclear. Thus, we aim to evaluate the association between weight change and advanced colorectal neoplasm (ACRN) recurrence during post-polypectomy surveillance colonoscopy. METHODS This retrospective cohort study included 7473 participants diagnosed with colorectal neoplasms between 2003 and 2010 who subsequently underwent surveillance colonoscopies until 2020. We analyzed the association between the risk of metachronous ACRN and weight change, defining stable weight as a weight change of <3% and weight gain as a weight increase of ≥3% from baseline during the follow-up period. RESULTS During a median 8.5 years of follow-up, 619 participants (8.3%) developed ACRN. Weight gain was reported as an independent risk factor for metachronous ACRN in a time-dependent Cox analysis. A weight gain of 3-6% and ≥6% had adjusted hazard ratios (AHRs) of 1.48 (95% confidence interval [CI]: 1.19-1.84) and 2.14 (95% CI: 1.71-2.69), respectively. Participants aged 30-49 and 50-75 years with weight gain of ≥6% showed AHRs of 2.88 (95% CI: 1.96-4.21) and 1.90 (95% CI: 1.43-2.51), respectively. In men and women, weight gain of ≥3% was significantly correlated with metachronous ACRN. CONCLUSIONS Weight gain is associated with an increased risk of metachronous ACRN. Furthermore, weight gain is associated with the recurrence of ACRN in both men and women regardless of age.
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Affiliation(s)
- Sinwon Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon Suh Do
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyo Jeong Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gwang-Un Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye Won Park
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hye-Sook Chang
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jaewon Choe
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Young Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Wong MCS, Leung EYM, Chun SCC, Deng Y, Lam T, Tang RSY, Huang J. Risk of recurrent advanced colorectal neoplasia in individuals with baseline non-advanced neoplasia followed up at 5 vs 7-10 years. J Gastroenterol Hepatol 2023; 38:2122-2129. [PMID: 37771047 DOI: 10.1111/jgh.16367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/10/2023] [Accepted: 09/13/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND AND AIM Colorectal cancer (CRC) is one of the commonest cancers, especially among the Asian populations. We compared the recurrence rate of advanced colorectal neoplasia (ACN) at 5 year vs 7-10 years among individuals with non-advanced adenoma (NAA) detected and polypectomized at baseline colonoscopy in a large Chinese population. METHODS We extracted data of a large Chinese population with NAA polypectomized who received surveillance colonoscopy after 5 or 7-10 years from a large database (2008-2018). The outcome variable included recurrence of ACN at surveillance colonoscopy. We examined the association between length of surveillance and the outcome variable, whilst controlling for risk factors of colorectal cancer. RESULTS We include 109 768 subjects who have received a baseline colonoscopy from our dataset. They were aged 67.35 (SD 9.84) years, and 60.9% of them were male subjects. The crude 5-year and 10-year recurrence rate of ACN was 1.50% and 2.42%, respectively (crude odds ratio = 1.629, 95% CI 1.362 to 1.949, P < 0.001). From the binary logistic regression model, individuals with surveillance colonoscopy performed at 10 years had a statistically higher recurrence rate of ACN than those followed-up at 5 year (adjusted odds ratio [aOR] = 1.544, 95% CI 1.266 to 1.877, P < 0.001), but the effect size of aOR is small. CONCLUSIONS There is a small difference in recurrence of ACN between individuals who received colonoscopy workup at 5 years vs 7-10 years. These findings support a 7-10 years surveillance period after baseline NAA was polypectomized.
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Affiliation(s)
- Martin C S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- The Chinese Academy of Medical Sciences and The Peking Union Medical College, Hong Kong, China
- The School of Public Health, The Peking University, Hong Kong, China
| | - Eman Yee-Man Leung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Sam C C Chun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Yunyang Deng
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Lam
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
| | - Raymond S Y Tang
- S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Centre for Health Education and Health Promotion, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Saini SD, Lewis CL, Kerr EA, Zikmund-Fisher BJ, Hawley ST, Forman JH, Zauber AG, Lansdorp-Vogelaar I, van Hees F, Saffar D, Myers A, Gauntlett LE, Lipson R, Kim HM, Vijan S. Personalized Multilevel Intervention for Improving Appropriate Use of Colorectal Cancer Screening in Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:1334-1342. [PMID: 37902744 PMCID: PMC10616770 DOI: 10.1001/jamainternmed.2023.5656] [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] [Received: 06/03/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023]
Abstract
Importance Despite guideline recommendations, clinicians do not systematically use prior screening or health history to guide colorectal cancer (CRC) screening decisions in older adults. Objective To evaluate the effect of a personalized multilevel intervention on screening orders in older adults due for average-risk CRC screening. Design, Setting, and Participants Interventional 2-group parallel unmasked cluster randomized clinical trial conducted from November 2015 to February 2019 at 2 US Department of Veterans Affairs (VA) facilities: 1 academic VA medical center and 1 of its connected outpatient clinics. Randomization at the primary care physician/clinician (PCP) level, stratified by study site and clinical full-time equivalency. Participants were 431 average-risk, screen-due US veterans aged 70 to 75 years attending a primary care visit. Data analysis was performed from August 2018 to August 2023. Intervention The intervention group received a multilevel intervention including a decision-aid booklet with detailed information on screening benefits and harms, personalized for each participant based on age, sex, prior screening, and comorbidity. The control group received a multilevel intervention including a screening informational booklet. All participants received PCP education and system-level modifications to support personalized screening. Main Outcomes and Measures The primary outcome was whether screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit and screening utilization within 6 months. Results A total of 436 patients were consented, and 431 were analyzed across 67 PCPs. Patients had a mean (SD) age of 71.5 (1.7) years; 424 were male (98.4%); 374 were White (86.8%); 89 were college graduates (21.5%); and 351 (81.4%) had undergone prior screening. A total of 258 (59.9%) were randomized to intervention, and 173 (40.1%) to control. Screening orders were placed for 162 of 258 intervention patients (62.8%) vs 114 of 173 control patients (65.9%) (adjusted difference, -4.0 percentage points [pp]; 95% CI, -15.4 to 7.4 pp). In a prespecified interaction analysis, the proportion receiving orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% vs 71.1%). In contrast, the proportion receiving orders was higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% vs 52.2%) (interaction P = .049). Fewer intervention patients (106 of 256 [41.4%]) utilized screening overall at 6 months than controls (96 of 173 [55.9%]) (adjusted difference, -13.4 pp; 95% CI, -25.3 to -1.6 pp). Conclusions and Relevance In this cluster randomized clinical trial, patients who were presented with personalized information about screening benefits and harms in the context of a multilevel intervention were more likely to receive screening orders concordant with benefit and were less likely to utilize screening. Trial Registration ClinicalTrials.gov Identifier: NCT02027545.
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Affiliation(s)
- Sameer D. Saini
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Eve A. Kerr
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Brian J. Zikmund-Fisher
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Sarah T. Hawley
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jane H. Forman
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Darcy Saffar
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Aimee Myers
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Lauren E. Gauntlett
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Rachel Lipson
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - H. Myra Kim
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor
| | - Sandeep Vijan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Zhang Y, Karahalios A, Aung YK, Win AK, Boussioutas A, Jenkins MA. Risk factors for metachronous colorectal cancer and advanced neoplasia following primary colorectal cancer: a systematic review and meta-analysis. BMC Gastroenterol 2023; 23:421. [PMID: 38036994 PMCID: PMC10688466 DOI: 10.1186/s12876-023-03053-2] [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: 06/09/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Identifying risk factors for metachronous colorectal cancer (CRC) and metachronous advanced neoplasia could be useful for guiding surveillance. We conducted a systematic review and meta-analysis to investigate risk factors for metachronous CRC and advanced neoplasia. METHODS Searches were conducted in MEDLINE, Embase, Web of Science and Cochrane Central Registry of Controlled Trials for articles (searching period: 1945 to Feburary, 2021) that reported the results of an association between any factor and metachronous advanced neoplasia or metachronous CRC. There were no restrictions on the publication date or language. Random effects models were fitted to estimate the combined association between the risk factors and metachronous CRC or advanced neoplasia. The Risk of Bias In Non-Randomised Studies of Interventions tool (ROBINS-I) was used to assess the risk of bias of included studies. RESULTS In total, 22 observational studies with 625,208 participants were included in the systematic review and meta-analysis. Of these, 13 studies investigated risk factors for metachronous CRC and 9 for advanced neoplasia. The risks of metachronous CRC or advanced neoplasia were higher if the first CRC was diagnosed in the presence of a synchronous advanced lesion (pooled risk ratio (RR) from 3 studies: 3.61, 95% confidence interval (CI): 1.44-9.05; and pooled RR from 8 studies: 2.77, 95% CI: 2.23-3.43, respectively). The risk of metachronous CRC was lower, but the risk of metachronous advanced neoplasia was higher if the first CRC was distal (compared with proximal) (pooled RR from 3 studies: 0.48, 95% CI: 0.23-0.98; and pooled RR from 2 studies: 2.99, 95% CI: 1.60-5.58 respectively). The risk of metachronous advanced neoplasia increased with age (pooled RR from 3 studies: 1.07 per year of age, 95% CI: 1.03-1.11). There was no evidence that any lifestyle risk factors studied were associated with the risk of metachronous CRC or advanced neoplasia. CONCLUSIONS The identified risk factors for metachronous CRC and advanced neoplasia might be useful to tailor the existing surveillance guidelines after the first CRC. There were potential limitations due to possible misclassification of the outcome, confounding and risk of bias, and the findings cannot be generalised to high-risk genetic syndrome cases.
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Affiliation(s)
- Ye Zhang
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Amalia Karahalios
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Ye Kyaw Aung
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Aung Ko Win
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, 3010, Australia
- Genetic Medicine, Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
| | - Alex Boussioutas
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, 3050, Australia
- Department of Gastroenterology, The Alfred, Monash University, Melbourne, Victoria, 3800, Australia
- Department of Medicine, Central Clinical School, Monash University, Clayton, Australia
| | - Mark A Jenkins
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, 3010, Australia.
- University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, University of Melbourne, Parkville, Victoria, 3010, Australia.
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Cheng Y, Di YM, Zhang AL, Hu P, Mo J, Zhang H, Xue CC, Zhang B. Does Chinese herbal medicine (CHM) reduce colorectal adenoma (CRA) recurrence: protocol of a registry-based, cohort study and a qualitative interview. BMJ Open 2023; 13:e073969. [PMID: 37984951 PMCID: PMC10660202 DOI: 10.1136/bmjopen-2023-073969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Colorectal adenoma (CRA) is a precancerous lesion for colorectal cancer. Endoscopic resection is the first-line treatment for CRA. However, CRA recurrence rate is high. This proposed study aims to determine if Chinese herbal medicine (CHM) reduces CRA recurrence. METHODS AND ANALYSIS This project encompasses an observational, registry-based, cohort study and a nested qualitative study. The cohort study aims to include 364 postpolypectomy CRA participants at Guangdong Provincial Hospital of Chinese Medicine (GPHCM), China, with a follow-up phase of up to 1 year. In addition to routine care, these participants will receive a CHM treatment prescribed by experienced Chinese medicine (CM) clinicians. The CHM treatment encompasses CHM products and CHM formulae according to CM syndromes. The primary outcome is CRA recurrence rate at 1 year after enrolment. Secondary outcomes include characteristics of recurrent CRA, incidence of colorectal polyp (except for CRA), incidence of advanced CRA, incidence of colorectal cancer, improvement of gastrointestinal symptoms commonly seen in CRA patients, faecal occult blood test result, lipid level, fasting plasma glucose level, uric acid level, carcinoembryonic antigen, carbohydrate antigen 19-9, quality of life and safety evaluations. Logistic regression analysis will be used to explore the correlation between exposure and outcome. Qualitative interviews will be conducted among approximate 30 CRA patients from the cohort study and 10 CM practitioners in Department of Gastroenterology at GPHCM. Thematic analysis will be used to analyse qualitative data. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Human Research Ethics Committee (HREC) of GPHCM (YF2022-320-02) and registered at Royal Melbourne Institute of Technology (RMIT) HREC. The results will be disseminated in peer-reviewed journals and international academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2200065713.
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Affiliation(s)
- Yi Cheng
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Yuan Ming Di
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
| | - Peixin Hu
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jiahao Mo
- The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haiyan Zhang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Beiping Zhang
- Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Jodal HC, Akwiwu EU, Lemmens M, Delis-van Diemen PM, Klotz D, Leon LG, Lakbir S, de Wit M, Fijneman RJ, van Leerdam ME, Dekker E, Spaander MC, Meijer GA, Løberg M, Coupé VM, Kalager M, Carvalho B. Risk Prediction of Metachronous Colorectal Cancer from Molecular Features of Adenomas: A Nested Case-Control Study. CANCER RESEARCH COMMUNICATIONS 2023; 3:2292-2301. [PMID: 37921412 PMCID: PMC10642372 DOI: 10.1158/2767-9764.crc-23-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/22/2023] [Accepted: 10/31/2023] [Indexed: 11/04/2023]
Abstract
Current morphologic features defining advanced adenomas (size ≥10 mm, high-grade dysplasia or ≥25% villous component) cannot optimally distinguish individuals at high risk or low risk of metachronous colorectal cancer (me-CRC), which may result in suboptimal surveillance. Certain DNA copy-number alterations (CNAs) are associated with adenoma-to-carcinoma progression. We aimed to evaluate whether these molecular features can better predict an individual's risk of me-CRC than the morphologic advanced adenoma features.In this nested case-control study, 529 individuals with a single adenoma at first colonoscopy were selected from a Norwegian adenoma cohort. DNA copy-number profiles were determined, by low-coverage whole-genome sequencing. Prevalence of CNAs in advanced and non-advanced adenomas and its association (OR) with me-CRC was assessed. For the latter, cases (with me-CRC) were matched to controls (without me-CRC) on follow-up, age and sex.CNAs associated with adenoma-to-carcinoma progression were observed in 85/267 (32%) of advanced adenomas and in 27/262 (10%) of non-advanced adenomas. me-CRC was statistically significantly associated, also after adjustment for other variables, with age at baseline [OR, 1.14; 95% confidence interval CI), 1.03-1.26; P = 0.012], advanced adenomas (OR, 2.46; 95% CI, 1.50-4.01; P < 0.001) and with the presence of ≥3 DNA copy-number losses (OR, 1.90; 95% CI. 1.02-3.54; P = 0.043).Molecularly-defined high-risk adenomas were associated with me-CRC, but the association of advanced adenoma with me-CRC was stronger. SIGNIFICANCE Identifying new biomarkers may improve prediction of me-CRC for individuals with adenomas and optimize surveillance intervals to reduce risk of colorectal cancer and reduce oversurveillance of patients with low risk of colorectal cancer. Use of DNA CNAs alone does not improve prediction of me-CRC. Further research to improve risk classification is required.
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Affiliation(s)
- Henriette C. Jodal
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Eddymurphy U. Akwiwu
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Group, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, the Netherlands
| | - Margriet Lemmens
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Dagmar Klotz
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Leticia G. Leon
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Soufyan Lakbir
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
- Bioinformatics Group, Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Meike de Wit
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Remond J.A. Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Monique E. van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Manon C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Gerrit A. Meijer
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Veerle M.H. Coupé
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Group, Amsterdam University Medical Centers, Location VU Medical Center, Amsterdam, the Netherlands
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Beatriz Carvalho
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Aziz Z, Wagner S, Agyekum A, Pumpalova YS, Prest M, Lim F, Rustgi S, Kastrinos F, Grady WM, Hur C. Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened. JAMA Netw Open 2023; 6:e2343392. [PMID: 37971743 PMCID: PMC10654798 DOI: 10.1001/jamanetworkopen.2023.43392] [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] [Received: 05/19/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Despite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening. Objective To estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US. Design, Setting, and Participants In this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy-liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy. Exposures No screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy-liquid biopsy hybrid screening. Main Outcomes and Measures Model outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained. Results This study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy-liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy-liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly. Conclusions and Relevance In this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.
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Affiliation(s)
- Zainab Aziz
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sophie Wagner
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Alice Agyekum
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yoanna S. Pumpalova
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Matthew Prest
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Francesca Lim
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sheila Rustgi
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Fay Kastrinos
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Chin Hur
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Cheng Y, Di YM, Zhang AL, Zhang B, Xue CC. Oral Chinese herbal medicine in reducing the recurrence of colorectal adenoma after polypectomy: A protocol for the systematic review and meta-analysis. PLoS One 2023; 18:e0293244. [PMID: 37862339 PMCID: PMC10588860 DOI: 10.1371/journal.pone.0293244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/09/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Colorectal adenoma (CRA) is a significant precancerous lesion of sporadic colorectal cancer (CRC). CRA is likely to recur after polypectomy, increasing the risk of CRC. Chinese herbal medicine (CHM) has been used to reduce CRA recurrence. This review aims to evaluate the effectiveness and safety of oral CHM in reducing CRA recurrence compared to other treatments (placebo, routine care, no treatment, and conventional medicine). METHODS We will search for randomised controlled trials (RCTs) from nine major biomedical databases in English and Chinese from their inception to July 2023. The RCTs that investigate the effects of oral CHM in reducing CRA recurrence compared to other treatments will be involved. We will exclude trials using CHM extract or external application of CHM, cohort study and cross-section study. The Cochrane Risk of Bias Tool version 2 will be used to assess the quality of included studies. Data will be analysed using Review Manager software 5.4 and STATA. The random effect model will be used. The heterogeneity of intervention effects will be tested by Chi2 (Cochrane Q) and I2 statistics. Funnel plots will assess publication bias if more than ten studies are included. Subgroup and sensitivity analysis will be conducted when possible. DISCUSSION This review will discuss the effectiveness and safety of oral CHM in reducing CRA recurrence. It will show the critical information for clinicians in the decision-making process and countries to develop clinical guidelines on CRA management. Systematic review registration PROSPERO CRD42023324197.
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Affiliation(s)
- Yi Cheng
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong Province, China
| | - Yuan Ming Di
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
| | - Anthony Lin Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
| | - Beiping Zhang
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong Province, China
| | - Charlie Changli Xue
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, STEM College, RMIT University, Melbourne, Victoria, Australia
- Department of Gastroenterology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, Guangdong Province, China
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Jung YS. Summary and comparison of recently updated post-polypectomy surveillance guidelines. Intest Res 2023; 21:443-451. [PMID: 37915180 PMCID: PMC10626009 DOI: 10.5217/ir.2023.00107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 11/03/2023] Open
Abstract
Recently, updated guidelines for post-polypectomy surveillance have been published by the U.S. Multi-Society Task Force (USMSTF), the British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE), the European Society of Gastrointestinal Endoscopy (ESGE), the Japan Gastroenterological Endoscopy Society (JGES), and the Korean Multi-Society Taskforce Committee. This review summarizes and compares the updated recommendations of these 5 guidelines. There are some differences between the guidelines for the recommended post-polypectomy surveillance intervals. In particular, there are prominent differences between the guidelines for 1-4 tubular adenomas < 10 mm with low-grade dysplasia (nonadvanced adenomas [NAAs]) and tubulovillous or villous adenomas. The USMSTF, JGES, and Korean guidelines recommend colonoscopic surveillance for patients with 1-4 NAAs and those with tubulovillous or villous adenomas, whereas the BSG/ACPGBI/PHE and ESGE guidelines do not recommend endoscopic surveillance for such patients. Surveillance recommendations for patients with serrated polyps (SPs) are limited. Although the USMSTF guidelines provide specific recommendations for patients who have undergone SPs removal, these are weak and based on very lowquality evidence. Future studies should examine this topic to better guide the surveillance recommendations for patients with SPs. For countries that do not have separate guidelines, we hope that this review article will help select the most appropriate guidelines as per each country's healthcare environment.
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Affiliation(s)
- Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chen BR, Zhang LH, Shi ZH, Ding XW, Liu Y, Wang AX, Chen ZF, Yao LW, Gong RR, Wang JX, Wu LL, Liu J, Yu HG. Preoperative automatic reminder systems and impact on quality and compliance with colonoscopy preparation: A multicenter randomized controlled trial. J Dig Dis 2023; 24:530-539. [PMID: 37610349 DOI: 10.1111/1751-2980.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Traditional preoperative reminding services have been applied to enhance the quality of bowel preparation for colonoscopy. In this study we aimed to evaluate the effectiveness of an automated electronic reminder system (E-reminder) on improving bowel preparation and the quality of preoperative education before colonoscopy. METHODS From August 2021 to March 2022, 833 outpatients aged 50-75 years who underwent colonoscopy were included and randomly assigned to the E-reminder group and the control group. While the control group received routine preoperative education. The E-reminder group received automatic phone call, text message reminders and web services regarding the details of bowel preparation before the colonoscopic examination. The quality of bowel preparation was evaluated by the Boston Bowel Preparation Scale (BBPS) score and the previously validated objective evaluation scale of automatic BBPS (e-BBPS). RESULTS In manual assessment, the rate of adequate bowel preparation was improved in the E-reminder group of intention-to-treat population using BBPS (60.7% vs 54.5%, P = 0.01). The percentage of objective evaluated adequate bowel preparation using e-BBPS in the E-reminder group of per-protocol population was significantly higher than that in the control group (76.9% vs 69.2%, P = 0.02). CONCLUSIONS E-reminder was an effective tool to improve the quality of bowel preparation and compliance with medical instructions. It may be regarded as an efficient and convenient education tool, improving the quality of medical service.
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Affiliation(s)
- Bo Ru Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Hui Zhang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhao Hong Shi
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, Hubei Province, China
| | - Xiang Wu Ding
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Yi Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, Hubei Province, China
| | - Ai Xiang Wang
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Zu Fang Chen
- Department of Gastroenterology, Wuhan Fourth Hospital, Wuhan, Hubei Province, China
| | - Li Wen Yao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Rong Rong Gong
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun Xiao Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lian Lian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jun Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Hong Gang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Chiu LS, Calderwood AH. Noninvasive Colorectal Cancer Prevention Options in Older Adults. J Clin Gastroenterol 2023; 57:855-862. [PMID: 37436836 DOI: 10.1097/mcg.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of morbidity and mortality worldwide and its incidence increases with age. The proportion of older adults in the United States continues to rise, making CRC prevention a key health priority for our aging population. CRC is a largely preventable disease through screening and polyp surveillance, and noninvasive modalities represent an important option for older adults in whom the burdens and risks of invasive testing are higher compared with younger adults. This review highlights the evidence, risks, and benefits of noninvasive CRC screening and surveillance options in older adults and discusses the challenges of CRC prevention in this cohort.
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Affiliation(s)
- Laura S Chiu
- Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA
| | - Audrey H Calderwood
- Department of Medicine, Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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von Renteln D, Djinbachian R, Benard F, Barkun AN, Bouin M, Bouchard S, Deslandres É, Panzini B, Sidani S, Leduc R, Jobse BC, Pohl H. Incomplete resection of colorectal polyps of 4-20 mm in size when using a cold snare, and its associated factors. Endoscopy 2023; 55:929-937. [PMID: 36377124 DOI: 10.1055/a-1978-3277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND : Cold snare polypectomy (CSP) is increasingly used for polypectomy and is recommended as the first-line modality for small (< 10 mm) polyps. This study aimed to evaluate incomplete resection rates (IRRs) when using CSP for colorectal polyps of 4-20 mm. METHODS : Adults (45-80 years) undergoing screening, surveillance, or diagnostic colonoscopy and CSP by one of nine endoscopists were included. The primary outcome was the IRR for colorectal polyps of 4-20 mm, defined as the presence of polyp tissue in marginal biopsies after resection of serrated polyps or adenomas. Secondary outcomes included the IRR for serrated polyps, ease of resection, and complications. RESULTS: 413 patients were included (mean age 63; 48 % women) and 182 polyps sized 4-20 mm were detected and removed by CSP. CSP required conversion to hot snare resection in < 1 % of polyps of < 10 mm and 44 % of polyps sized 10-20 mm. The IRRs for polyps < 10 mm and ≥ 10 mm were 18 % and 21 %. The IRR was higher for serrated polyps (26 %) compared with adenomas (16 %). The IRR was higher for flat (IIa) polyps (odds ratio [OR] 2.9, 95 %CI 1.1-7.4); and when resection was judged as difficult (OR 4.2, 95 %CI 1.5-12.1), piecemeal resection was performed (OR 6.6, 95 %CI 2.0-22.0), or visible residual polyp was present after the initial resection (OR 5.4, 95 %CI 2.0-14.9). Polyp location, use of a dedicated cold snare, and submucosal injection were not associated with incomplete resection. Intraprocedural bleeding requiring endoscopic intervention occurred in 4.7 %. CONCLUSIONS : CSP for polyps of 4-9 mm is safe and feasible; however, for lesions ≥ 10 mm, CSP failure occurs frequently, and the IRR remains high even after technical success. Incomplete resection was associated with flat polyps, visual residual polyp, piecemeal resection, and difficult polypectomies.
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Affiliation(s)
- Daniel von Renteln
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Roupen Djinbachian
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Florence Benard
- Division of General Surgery, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Mickael Bouin
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Simon Bouchard
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Érik Deslandres
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Benoit Panzini
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Sacha Sidani
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Raymond Leduc
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
- Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Bruce C Jobse
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Heiko Pohl
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
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