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Larsen PT, Jørgensen SF, Hagemann-Madsen R, Rasmussen M, Andersen B, Njor SH. Detection of colorectal cancer and advanced neoplasia during first surveillance interval after detection of adenomas in fecal immunochemical test cancer screening: a nationwide study. Endoscopy 2024. [PMID: 38955210 DOI: 10.1055/a-2343-5700] [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] [Indexed: 07/04/2024]
Abstract
BACKGROUND Adenoma surveillance guidelines are based on non-fecal immunochemical test (FIT)-based screening settings. However, colorectal cancer (CRC) risk may be different in FIT-positive screening populations. We evaluated the CRC and advanced adenoma risk within the recommended surveillance periods in the Danish FIT-based CRC screening program for participants with intermediate or high risk adenomas according to 2010 European guidelines. Furthermore, we estimated CRC risk for those who were not recommended surveillance according to European Society of Gastrointestinal Endoscopy (ESGE) 2020 guidelines. METHODS Using nationwide health registries, we identified 17 936 FIT-screening participants from 2014-2017 with adenomas undergoing surveillance (high risk 1 year, intermediate risk 3 years). Participants with a follow-up examination were included (N = 10 068). Relative risk (RR) of CRC and advance adenoma was compared between intermediate and high risk groups and between intermediates who were recommended surveillance (S) or no surveillance (NS) according to 2020 ESGE guidelines. RESULTS During surveillance, CRC occurred in 0.59% of the high risk group and 1.11% of the intermediate risk group (RR 0.53 [95%CI 0.34-0.84]). The high risk group had a 24% increased risk of advanced adenoma. CRC occurred in 1.69% of the intermediateNS group and 0.87% of the intermediateS group (RR 1.94 [95%CI 1.18-3.21]), and RR for advanced adenoma was 1.19 (95%CI 1.03-1.37). CONCLUSION CRC detection was lower among participants rated at higher risk at initial CRC screening. Findings at first screen-derived colonoscopy might not be as good a predictor of CRC risk in a FIT-positive screening population.
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Affiliation(s)
- Pernille T Larsen
- University Research Clinic for Cancer screening, Randers Regional Hospital, Randers NØ, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark
| | - Susanne F Jørgensen
- Department of Data, Innovation and Research, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Morten Rasmussen
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers NØ, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark
| | - Sisse H Njor
- Department of Data, Innovation and Research, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Medicine, Aarhus University Faculty of Health Sciences, Aarhus, Denmark
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Sullivan BA, Lieberman DA. Colon Polyp Surveillance: Separating the Wheat From the Chaff. Gastroenterology 2024; 166:743-757. [PMID: 38224860 DOI: 10.1053/j.gastro.2023.11.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 01/17/2024]
Abstract
One goal of colorectal cancer (CRC) screening is to prevent CRC incidence by removing precancerous colonic polyps, which are detected in up to 50% of screening examinations. Yet, the lifetime risk of CRC is 3.9%-4.3%, so it is clear that most of these individuals with polyps would not develop CRC in their lifetime. It is, therefore, a challenge to determine which individuals with polyps will benefit from follow-up, and at what intervals. There is some evidence that individuals with advanced polyps, based on size and histology, benefit from intensive surveillance. However, a large proportion of individuals will have small polyps without advanced histologic features (ie, "nonadvanced"), where the benefits of surveillance are uncertain and controversial. Demand for surveillance will further increase as more polyps are detected due to increased screening uptake, recent United States recommendations to expand screening to younger individuals, and emergence of polyp detection technology. We review the current understanding and clinical implications of the natural history, biology, and outcomes associated with various categories of colon polyps based on size, histology, and number. Our aims are to highlight key knowledge gaps, specifically focusing on certain categories of polyps that may not be associated with future CRC risk, and to provide insights to inform research priorities and potential management strategies. Optimization of CRC prevention programs based on updated knowledge about the future risks associated with various colon polyps is essential to ensure cost-effective screening and surveillance, wise use of resources, and inform efforts to personalize recommendations.
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Affiliation(s)
- Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
| | - David A Lieberman
- Portland Veteran Affairs Medical Center, Portland, Oregon; Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, Oregon
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Sullivan BA, Qin X, Redding TS, Weiss D, Upchurch J, Sims KJ, Dominitz JA, Stone A, Ear B, Williams CD, Lieberman DA, Hauser ER. Colorectal Cancer Polygenic Risk Score Is Associated With Screening Colonoscopy Findings but Not Follow-Up Outcomes. GASTRO HEP ADVANCES 2023; 3:151-161. [PMID: 39129957 PMCID: PMC11307447 DOI: 10.1016/j.gastha.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/03/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Colorectal cancer (CRC) polygenic risk scores (PRS) may help personalize CRC prevention strategies. We investigated whether an existing PRS was associated with advanced neoplasia (AN) in a population undergoing screening and follow-up colonoscopy. Methods We evaluated 10-year outcomes in the Cooperative Studies Program #380 screening colonoscopy cohort, which includes a biorepository of selected individuals with baseline AN (defined as CRC or adenoma ≥10 mm or villous histology, or high-grade dysplasia) and matched individuals without AN. A PRS was constructed from 136 prespecified CRC-risk single nucleotide polymorphisms. Multivariate logistic regression was used to evaluate the PRS for associations with AN prevalence at baseline screening colonoscopy or incident AN in participants with at least one follow-up colonoscopy. Results The PRS was associated with AN risk at baseline screening colonoscopy (P = .004). Participants in the lowest PRS quintile had more than a 70% decreased risk of AN at baseline (odds ratio 0.29, 95% confidence interval 0.14-0.58; P < .001) compared to participants with a PRS in the middle quintile. Using a PRS cut-off of more than the first quintile to indicate need for colonoscopy as primary screening, the sensitivity for detecting AN at baseline is 91.8%. We did not observe a relationship between the PRS and incident AN during follow-up (P = .28). Conclusion A PRS could identify individuals at low risk for prevalent AN. Ongoing work will determine whether this PRS can identify a subset of individuals at sufficiently low risk who could safely delay or be reassured about noninvasive screening. Otherwise, more research is needed to augment these genetic tools to predict incident AN during long-term follow-up.
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Affiliation(s)
- Brian A. Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
| | - Thomas S. Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, Maryland
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Jason A. Dominitz
- Division of Gastroenterology, VA Puget Sound Health Care System, Seattle, Washington
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
| | - Anjanette Stone
- Cooperative Studies Program Pharmacogenomics Analysis Laboratory, Central Arkansas Veterans Health System, Little Rock, Arkansas
| | - Belinda Ear
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
| | - David A. Lieberman
- Division of Gastroenterology, VA Portland Health Care System, Portland, Oregon
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina
- Division of Gastroenterology, Duke University, Durham, North Carolina
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Obadina D, Haider H, Micic D, Sakuraba A. Older Age at First Screening Colonoscopy is Associated With an Increased Risk of Colorectal Adenomas and Cancer. J Clin Gastroenterol 2023; 57:804-809. [PMID: 35997687 DOI: 10.1097/mcg.0000000000001751] [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: 04/21/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The goal of colorectal cancer (CRC) screening is to detect precancerous polyps before cancer development or identification of cancer at an early stage. Guidelines have recommended screening colonoscopy to start at age 45. Our aim was to determine the impact of delays in performing the first screening colonoscopy on the risk of adenoma or CRC detection. METHODS We analyzed colonoscopy and histopathology data of average CRC risk patients who had their first screening colonoscopy between 2010 and 2017. Univariate and multivariable logistic regression was performed to determine the association between demographic variables and the risk of adenomas or CRC. RESULTS A total of 1155 average risk patients underwent their initial screening colonoscopy during the study period. Median age was 54 years (range of 45-87) and 58.2% were females. In multivariable analysis, older age at first screening colonoscopy was significantly associated with the detection of adenomatous polyps (odds ratio 1.05, 95% confidence interval 1.04-1.07, P <0.001) and CRC (odds ratio 1.11, 95% confidence interval 1.06-1.16, P <0.001). The association between age and risk of adenomatous polyps (F-test 35.43, P =0.0019) and CRC (F-test 36.94, P =0.0017) fit an exponential growth model. It was estimated that the detection rate doubled every 14.20 years and 4.75 years for adenomas and CRC, respectively. CONCLUSION We found that older age at the initial performance of a screening colonoscopy was associated with increased detection of adenomatous polyps and CRC. This work highlights the need for guideline adherence for the prevention of CRC development.
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Affiliation(s)
- David Obadina
- Pritzker School of Medicine, The University of Chicago
| | - Haider Haider
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Dejan Micic
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
| | - Atsushi Sakuraba
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, The University of Chicago Medicine, Chicago, IL
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López-Jamar JME, Gorjão R, Cotter J, Lorenzo-Zúñiga García V, Pantaleón Sánchez MA, Carral Martínez D, Sábado F, Pérez Arellano E, Gómez Rodríguez BJ, López Cano A, Machlab S, Arieira C, Akriche F, Turbí Disla C, Rodriguez Muñoz S. Bowel cleansing effectiveness and safety of 1L PEG + Asc in the real-world setting: Observational, retrospective, multicenter study of over 13000 patients. Endosc Int Open 2023; 11:E785-E793. [PMID: 37593156 PMCID: PMC10431968 DOI: 10.1055/a-2125-0025] [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: 01/11/2023] [Accepted: 06/23/2023] [Indexed: 08/19/2023] Open
Abstract
Background and study aims Effective bowel cleansing is critical for detecting lesions during colonoscopy, highlighting the importance of bowel preparations. 1L polyethylene glycol (PEG) + ascorbate (Asc) is the only recommended 1L PEG product in Europe and the United States. Its efficacy was demonstrated in large-scale controlled trials and confirmed in smaller-scale real-world studies. However, no large-scale real-world data exist. Patients and methods This observational, retrospective, multicenter study, used outpatient follow-up data from medical records from 10 centers in Spain and two in Portugal. Outpatients aged ≥18 years using 1L PEG + Asc as bowel preparation were included. The main outcome measures were overall adequate colon cleansing (Boston Bowel Preparation Scale [BBPS] score ≥6 with BBPS score ≥2 in each segment) and high-quality cleansing of the right colon (BBPS score=3). Results Data from 13169 eligible patients were included. Overall cleansing success was achieved in 89.3% (95%CI 88.7%-89.8%) and high-quality cleansing in the right colon in 49.3% (95%CI 48.4%-50.2%) of patients. For the overnight split-dose and same-day regimens, overall adequate quality cleansing success rate was 94.7% and 86.7% ( P <0.0001) and high-quality cleansing of the right colon rate was 65.4% and 41.4% ( P <0.0001), respectively. Colonoscopy was completed in 97.3% of patients, with non-completion due to poor preparation in only 0.8%; 2.3% of patients experienced at least one adverse event (AE). Conclusions This large-scale, real-world study demonstrates the effectiveness of 1L PEG + Asc in the total and right colon, with a low percentage of patients with AEs in routine clinical practice.
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Affiliation(s)
| | - Ricardo Gorjão
- Gastroenterology, Hospital CUF Descobertas, Lisboa, Portugal
| | - José Cotter
- Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, Universidade do Minho, Braga/Guimarães, Portugal
- Gastroenterology, ICVS/3B’s—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | | | | | | | - Fernando Sábado
- Gastroenteroloy, Consorcio Hospitalario Provincial de Castelló, Castellón, Spain
| | | | | | | | - Salvador Machlab
- Gastroenterology, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Cátia Arieira
- Gastroenterology, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Fatma Akriche
- Medical Affairs, Norgine, Harefield, United Kingdom of Great Britain and Northern Ireland
| | - Carmen Turbí Disla
- Medical Affairs, Norgine, Harefield, United Kingdom of Great Britain and Northern Ireland
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van Toledo D, IJspeert J, Spaander M, Nagtegaal I, van Leerdam M, Lansdorp-Vogelaar I, Dekker E. Colorectal cancer risk after removal of polyps in fecal immunochemical test based screening. EClinicalMedicine 2023; 61:102066. [PMID: 37528844 PMCID: PMC10388570 DOI: 10.1016/j.eclinm.2023.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 08/03/2023] Open
Abstract
Background Colonoscopy surveillance intervals are based on the predicted risk of metachronous colorectal cancer (CRC) after polyp removal. However, risk estimation per polyp subtype is difficult due to the fact that many patients have multiple polyps. To enable risk estimation per polyp subtypes we examined the metachronous CRC risk of subgroups based on presence or absence of co-occurring findings. Methods Using high-quality screening colonoscopies performed after a positive fecal immunochemical test between 2014 and 2020 within the Dutch CRC screening program, we applied Cox regression analysis to evaluate the association between findings at baseline colonoscopy and metachronous CRCs. For our primary outcome, we appointed each patient to unique subgroups based on removed polyp subtypes that were present or absent at baseline colonoscopy and used the groups without polyps as reference. High-risk subgroups were individuals with high-risk serrated polyps, defined as serrated polyp ≥10 mm, sessile serrated lesions with dysplasia, or traditional serrated adenomas, as well as high-risk adenomas, defined as adenoma ≥10 mm or containing high-grade dysplasia. Findings In total 253,833 colonoscopies were included. Over a median follow-up of 36 months (IQR, 21-57), we identified 504 metachronous CRCs. Hazard ratios for metachronous CRC was 1.70 (95% CI, 1.07-2.69) for individuals with high-risk serrated polyps without high-risk adenomas, 1.22 (0.96-1.55) for individuals with high-risk adenomas without high-risk serrated polyps, and 2.00 (1.19-3.39) for individuals with high-risk serrated polyps and high-risk adenomas, compared to patients without polyps. Interpretation Accounting for co-occurring findings, we observed an increased metachronous CRC risk for individuals that had high-risk serrated polyps with the presence of high-risk adenomas, or individuals with high-risk serrated polyps without high-risk adenomas. These findings could provide more evidence to support post-polypectomy surveillance guidelines. Funding None.
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Affiliation(s)
- D.E.F.W.M. van Toledo
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - J.E.G. IJspeert
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - M.C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - I.D. Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M.E. van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - I. Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - E. Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
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Baile-Maxía S, Mangas-Sanjuán C, Ladabaum U, Hassan C, Rutter MD, Bretthauer M, Medina-Prado L, Sala-Miquel N, Pomares OM, Zapater P, Jover R. Risk Factors for Metachronous Colorectal Cancer or Advanced Adenomas After Endoscopic Resection of High-risk Adenomas. Clin Gastroenterol Hepatol 2023; 21:630-643. [PMID: 36549471 DOI: 10.1016/j.cgh.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/24/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Among the characteristics of high-risk adenomas (HRAs), some may predict a higher risk of metachronous advanced lesions. Our aim was to assess which HRA characteristics are associated with high risk of metachronous colorectal cancer (CRC) or advanced adenomas (AAs). METHODS We systematically searched Pubmed, EMBASE, and Cochrane for cohort studies and clinical trials of CRC or AA incidence at surveillance stratified by baseline lesion size, histology, and multiplicity. We calculated pooled relative risks (RRs) using a random-effects model. Heterogeneity was assessed with the I2 statistic. RESULTS Fifty-five studies were included, with 936,540 patients with mean follow-up 5.4 ± 2.9 years. CRC incidence per 1000 person-years was 2.6 (2.1-3.0) for adenomas ≥20 mm, 2.7 (2.2-3.2) for high-grade dysplasia (HGD), 2.0 (1.8-2.3) for villous component, 0.8 (0.1-1.4) for ≥5 adenomas, 1.0 (0.7-1.2) for ≥3 adenomas. Metachronous CRC risk was higher in adenomas ≥20 mm vs 10 to 19 mm (RR, 2.08; 95% confidence interval [CI], 1.20-3.61), HGD vs low-grade dysplasia (RR, 2.89; 95% CI, 1.88-4.44), villous vs tubular (RR, 1.75; 95% CI, 1.33-2.31). No significant differences in CRC risk were found in ≥3 adenomas vs 1 to 2 (RR, 1.24; 95% CI, 0.84-1.83), nor in ≥5 adenomas vs 3 to 4 (RR, 0.79; 95% CI, 0.30-2.11). Compared with normal colonoscopy, RR for CRC risk was 2.61 (95% CI, 2.06-3.32) for ≥10mm, 6.62 (95% CI, 4.60-9.52) for HGD, 3.58 (95% CI, 2.24-5.73) for villous component, and 2.03 (95% CI, 1.40-2.94) for ≥3 adenomas. Similar trends were seen for metachronous AAs. CONCLUSION Metachronous CRC risk is highest in patients with baseline adenomas with ≥20 mm or HGD. Multiplicity does not seem to be associated with substantially higher CRC risk in the near term.
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Affiliation(s)
- Sandra Baile-Maxía
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Carolina Mangas-Sanjuán
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-On-Tees, Cleveland, Yorkshire, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Lucía Medina-Prado
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Noelia Sala-Miquel
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Oscar Murcia Pomares
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmacology Department, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, CIBERehd, Alicante, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
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Park JH, Hong SW, Hwang SW, Park SH, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS. Clinical outcomes of colonoscopic polypectomy with strategic surveillance colonoscopies in patients with 10 or more polyps. Sci Rep 2023; 13:2604. [PMID: 36788338 PMCID: PMC9929449 DOI: 10.1038/s41598-023-29604-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
The clinical usefulness of repeat colonoscopic polypectomy in patients with numerous polyps has not been sufficiently determined. We aimed to analyze the clinical outcomes of colonoscopic polypectomy with surveillance colonoscopies in patients with ≥ 10 polyps. We reviewed the medical records of 152 patients who underwent polypectomy of ≥ 10 polyps at the baseline colonoscopy. We investigated polyp number, polyp size, polypectomy method, procedure time, and adverse events of the baseline colonoscopy. We also investigated the frequency and interval of surveillance colonoscopies and their findings. The mean number of polyps detected at the baseline colonoscopy was 20.0, of which 16.0 polyps were endoscopically resected. The mean size of the largest polyp was 13.4 mm. The mean procedure time was 54.9 min. Post-polypectomy bleeding occurred in 6 (3.9%) patients, all of whom were treated conservatively. No patients developed perforation. With an increasing number of surveillance colonoscopies, the number of detected polyps and the procedure time decreased. Surveillance colonoscopies identified colorectal cancer only in three patients (2.0%), all of which were mucosal cancers that could be curatively treated by polypectomy. Colonoscopic polypectomy with repeat surveillance colonoscopies is a clinically effective, efficient, and safe management option in patients with ≥ 10 polyps.
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Affiliation(s)
- Jin Hwa Park
- Department of Gastroenterology, University of Hanyang College of Medicine, Seoul, Republic of Korea
| | - Seung Wook Hong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Lieberman D. At What Age Should We Stop Colorectal Cancer Screening? When Is Enough, Enough? Cancer Epidemiol Biomarkers Prev 2023; 32:6-8. [PMID: 36620899 DOI: 10.1158/1055-9965.epi-22-1006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 01/10/2023] Open
Abstract
There is strong evidence that colorectal cancer screening can reduce both colorectal cancer incidence and mortality. Guidelines recommend screening for individuals age 45 to 75 years, but are less certain about the benefits after age 75 years. Dalmat and colleagues provide evidence that individuals with a prior negative colonoscopy 10 years or more prior to reaching age 76 to 85 years, had a low risk of colorectal cancer, and would be less likely to benefit from further screening. It is important to note that this study population did not include individuals with a family history of colon cancer or a personal history of having high-risk adenomas. These data suggest that a negative colonoscopy can be an effective risk-stratification tool when discussing further screening with elderly patients. See related article by Dalmat et al., p. 37.
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Affiliation(s)
- David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University L461, Portland, Oregon
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10
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY. Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition. Intest Res 2023; 21:20-42. [PMID: 36751043 PMCID: PMC9911266 DOI: 10.5217/ir.2022.00096] [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: 07/25/2022] [Accepted: 10/05/2022] [Indexed: 02/09/2023] Open
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea,Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence to Jeong-Sik Byeon, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3905, Fax: +82-2-476-0824, E-mail:
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Moon Sung Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea,Co-Correspondence to Oh Young Lee, Department of Internal Medicine, Hanyang University School of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea. Tel: +82-2-2290-8343, Fax: +82-2-2298-8314, E-mail:
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11
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY. Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition. Clin Endosc 2022; 55:703-725. [PMID: 36156035 PMCID: PMC9726446 DOI: 10.5946/ce.2022.136] [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: 04/26/2022] [Accepted: 06/22/2022] [Indexed: 12/15/2022] Open
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea,Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Correspondence: Jeong-Sik Byeon Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea E-mail:
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
| | - Moon Sung Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea,Correspondence: Oh Young Lee Department of Internal Medicine, Hanyang University School of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea E-mail:
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12
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Zhang Y, Wang X, Zhang W, Zhou X, Ren M, Chen H, Pan H. Incidence of colorectal cancer at different screening intervals after index colonoscopy and post-polypectomy: a meta-analysis of 811,181 participants. Expert Rev Gastroenterol Hepatol 2022; 16:1101-1114. [PMID: 36408602 DOI: 10.1080/17474124.2022.2147925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the evidence on the incidence of colorectal cancers (CRCs) at a follow-up screening colonoscopy (after index colonoscopy and post-polypectomy) in individuals with no adenoma, low-risk adenomas, and high-risk adenomas. METHODS We included studies reporting the incidence of CRCs at different screening intervals after index colonoscopy and post-polypectomy. The main outcome was pooled cumulative incidence rate of CRCs stratified by intervals of 3, 5, 10, and >10 years. RESULTS Fourteen studies with 811,181 participants were analyzed, including 10 multicenter studies and 3 national CRC screening programs. The cumulative incidence of CRCs was 0.63% (95% confidence interval [CI]: 0.30, 0.97) in the high-risk-adenoma group at 3 years, 0.37% (95% CI: 0.13, 0.61) and 0.67% (95% CI: 0.36, 0.99) in the low-risk-adenoma group at 5 and 10 years, respectively, and 0.32% (95% CI: 0.20, 0.45) and 0.50% (95% CI: 0.30, 0.69) in the no-adenoma-group at 10 and >10 years, respectively. CONCLUSION This meta-analysis summarizes the results of colonoscopy surveillance programs with detailed data support for different screening intervals. The data on date suggest that reasonable surveillance intervals are within 3 years for the high-risk-adenoma group, 5-10 years for the low-risk-adenoma group, and ≥10 years for the no-adenoma group.
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Affiliation(s)
- Yu Zhang
- Cancer Center, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xueli Wang
- College of Pharmaceutical Science, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of General Surgery, the Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinxin Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Mengting Ren
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Huiyan Chen
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Hanghai Pan
- Cancer Center, Department of Gastroenterology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
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13
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Gupta S, Earles A, Bustamante R, Patterson OV, Gawron AJ, Kaltenbach TR, Yassin H, Lamm M, Shah SC, Saini SD, Fisher DA, Martinez ME, Messer K, Demb J, Liu L. Adenoma Detection Rate and Clinical Characteristics Influence Advanced Neoplasia Risk After Colorectal Polypectomy. Clin Gastroenterol Hepatol 2022:S1542-3565(22)00960-0. [PMID: 36270618 DOI: 10.1016/j.cgh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/17/2022] [Accepted: 10/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Postpolypectomy risk stratification for subsequent metachronous advanced neoplasia (MAN) is imprecise and does not account for colonoscopist adenoma detection rate (ADR). Our aim was to assess association of ADR with MAN and create a prediction model for postpolypectomy risk stratification incorporating ADR and other factors. METHODS We conducted a retrospective cohort study of individuals with baseline polypectomy and subsequent surveillance colonoscopy from 2004 to 2016 within the U.S. Department of Veterans Affairs (VA). Clinical factors, polyp findings, and baseline colonoscopist ADR were considered for the model. Model performance (sensitivity, specificity, and area under the curve) for identifying individuals with MAN was compared with 2020 U.S. Multi-Society Task Force on Colorectal Cancer (USMSTF) surveillance recommendations. RESULTS A total of 30,897 individuals were randomly assigned 2:1 into independent model training and validation sets. Increasing age, male sex, diabetes, current smoking, adenoma number, polyp location, adenoma ≥10 mm or with tubulovillous/villous features, and decreasing colonoscopist ADR were independently associated with MAN. A range of 1.48- to 1.66-fold increased risk for MAN was observed for ADR in the lowest 3 quintiles (ADR <19.7%-39.3%) vs the highest quintile (ADR >47.0%). When the final model selected based on the training set was applied to the validation set, improved sensitivity and specificity over 2020 USMSTF risk stratification were achieved (P = .001), with an area under the curve of 0.62 (95% confidence interval, 0.60-0.64). CONCLUSIONS Colonoscopist ADR is associated with MAN. Combining clinical factors and ADR for risk stratification has potential to improve postpolypectomy risk stratification. Improving ADR is likely to improve postpolypectomy outcomes.
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Affiliation(s)
- Samir Gupta
- Jennifer Moreno VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California; Division of Preventative Medicine, Department of Family Medicine and Public Health, UC San Diego Moores Cancer Center, La Jolla, California.
| | - Ashley Earles
- Veterans Medical Research Foundation, San Diego, California
| | | | - Olga V Patterson
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Andrew J Gawron
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Tonya R Kaltenbach
- San Francisco VA Healthcare System, San Francisco, California; Division of Gastroenterology, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Hanin Yassin
- Veterans Medical Research Foundation, San Diego, California
| | - Mark Lamm
- Veterans Medical Research Foundation, San Diego, California
| | - Shailja C Shah
- Jennifer Moreno VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California
| | - Sameer Dev Saini
- VA HSR&D Center for Clinical Management Research, Ann Arbor, Michigan; Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Deborah A Fisher
- Department of Gastroenterology, Eli Lilly and Company, Indianapolis, Indiana
| | - Maria Elena Martinez
- Division of Preventative Medicine, Department of Family Medicine and Public Health, UC San Diego Moores Cancer Center, La Jolla, California; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Karen Messer
- Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California San Diego, La Jolla, California
| | - Lin Liu
- Jennifer Moreno VA San Diego Healthcare System, San Diego, California; Division of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California.
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14
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Shi Y, Li J, Tang M, Liu J, Zhong Y, Huang W. CircHADHA-augmented autophagy suppresses tumor growth of colon cancer by regulating autophagy-related gene via miR-361. Front Oncol 2022; 12:937209. [PMID: 36313671 PMCID: PMC9606334 DOI: 10.3389/fonc.2022.937209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Colon cancer undergoes a traditional pathway from colon polyps to colon cancer. It is of great significance to investigate the key molecules involved in carcinogenesis from polyps to malignancies. Circular RNAs (circRNAs) are stably expressed in human body fluids such as plasma. Here, we demonstrated a differential expression pattern of plasma circRNAs in healthy individuals, colon polyp patients and colon cancer patients using circRNA Arraystar microarray. We explored that circRNA HADHA (circHADHA) was upregulated in plasma from polyp patients, whereas it was downregulated in plasma from colon cancer patients. Overexpression of circHADHA promoted autophagy in colon epithelial cells. Moreover, in colon cancer cells, overexpression of circHADHA promoted autophagy, whereas it inhibited cell proliferation and colony formation. CircHADHA increased the expression of ATG13 via miR-361 in both colon epithelial and cancer cells. ATG13 knockdown reduced autophagy even in the presence of circHADHA in colon cancer cells. Furthermore, the growth of circHADHA-overexpressing colon cancer cell-derived xenograft tumors was significantly decreased compared with control tumors in nude mice. In conclusion, circHADHA was differentially expressed in the plasma of healthy individuals, colon polyp patients and colon cancer patients. CircHADHA promoted autophagy by regulating ATG13 via miR-361 in both colon epithelial and cancer cells. CircHADHA suppressed tumor growth by inducing cell autophagy in colon cancer cells. CircHADHA potentially serves as a biomarker for screening of precursor colon cancer and a therapeutic target for colon cancer treatment.
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Affiliation(s)
- Ying Shi
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Gastroenterology, Hepatology and Infectious Diseases, Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
| | - Jinying Li
- Endoscopy Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ming Tang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Jingwen Liu
- Endoscopy Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yalu Zhong
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Wei Huang
- Department of Gastroenterology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Endoscopy Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- *Correspondence: Wei Huang,
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15
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY. [Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:115-134. [PMID: 36156035 DOI: 10.4166/kjg.2022.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
| | - Moon Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea, Korea
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16
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Kobe EA, Sullivan BA, Qin X, Redding TS, Hauser ER, Madison AN, Miller C, Efird JT, Gellad ZF, Weiss D, Sims KJ, Williams CD, Lieberman DA, Provenzale D. Longitudinal assessment of colonoscopy adverse events in the prospective Cooperative Studies Program no. 380 colorectal cancer screening and surveillance cohort. Gastrointest Endosc 2022; 96:553-562.e3. [PMID: 35533738 PMCID: PMC9531542 DOI: 10.1016/j.gie.2022.04.1343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/30/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Data are limited regarding colonoscopy risk during long-term, programmatic colorectal cancer screening and follow-up. We aimed to describe adverse events during follow-up in a colonoscopy screening program after the baseline examination and examine factors associated with increased risk. METHODS Cooperative Studies Program no. 380 includes 3121 asymptomatic veterans aged 50 to 75 years who underwent screening colonoscopy between 1994 and 1997. Periprocedure adverse events requiring significant intervention were defined as major events (other events were minor) and were tracked during follow-up for at least 10 years. Multivariable odds ratios (ORs) were calculated for factors associated with risk of follow-up adverse events. RESULTS Of 3727 follow-up examinations in 1983 participants, adverse events occurred in 105 examinations (2.8%) in 93 individuals, including 22 major and 87 minor events (examinations may have had >1 event). Incidence of major events (per 1000 examinations) remained relatively stable over time, with 6.1 events at examination 2, 4.8 at examination 3, and 7.2 at examination 4. Examinations with major events included 1 perforation, 3 GI bleeds requiring intervention, and 17 cardiopulmonary events. History of prior colonoscopic adverse events was associated with increased risk of events (major or minor) during follow-up (OR, 2.7; 95% confidence interval, 1.6-4.6). CONCLUSIONS Long-term programmatic screening and surveillance was safe, as major events were rare during follow-up. However, serious cardiopulmonary events were the most common major events. These results highlight the need for detailed assessments of comorbid conditions during routine clinical practice, which could help inform individual decisions regarding the utility of ongoing colonoscopy follow-up.
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Affiliation(s)
- Elizabeth A Kobe
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; School of Medicine, Duke University, Durham, NC
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Cameron Miller
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jimmy T Efird
- Cooperative Studies Program Coordinating Center, Boston VA Health Care System, Boston, MA
| | - Ziad F Gellad
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Department of Medicine, Duke University Medical Center, Durham, NC
| | - David A Lieberman
- Portland Veteran Affairs Medical Center, Portland, OR; Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland, OR
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC; Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC
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17
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Detection and Yield of Colorectal Cancer Surveillance in Adults with PTEN Hamartoma Tumour Syndrome. Cancers (Basel) 2022; 14:cancers14164005. [PMID: 36010998 PMCID: PMC9406787 DOI: 10.3390/cancers14164005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancer surveillance (CCS) with colonoscopy every five years is advised for PTEN Hamartoma Tumour Syndrome (PHTS) patients aged ≥40 due to an increased colorectal cancer (CRC) risk. However, data to support CCS guidelines are scarce and available CRC risks are low (0-5% at age 50) and likely overestimated. We aimed to assess the detection and yield of CCS for PHTS patients without a CRC history. A retrospective cohort study including PHTS patients aged ≥40 with CCS at a PHTS expertise centre between 2011 and 2022. Adenomas with a ≥10 mm size, (tubulo)villous histology, or high-grade dysplasia were considered advanced. During 67 follow-up years, 37 patients (median age 47 years) underwent 61 colonoscopies. CCS yielded no CRCs. Adenomas were diagnosed in 13/37 (35%) patients during 23/100 colonoscopies (95% CI: 14-36), including one advanced adenoma. Baseline adenoma detection rates were similar to follow-up and higher in patients aged above 50 (50/100, 95% CI: 24-76) vs. age 50 or below (11/100, 95% CI: 3-30; p = 0.021). The low CRC and advanced adenoma yield allow for a more personalised surveillance program. Following our findings combined with literature on CRC risk and progression, we suggest starting CCS at age 40 with variable follow-up intervals between 1 and 10 years depending on previous colonoscopy findings.
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18
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Sullivan BA, Redding TS, Qin X, Gellad ZF, Hauser ER, O'Leary MC, Williams CD, Musselwhite LW, Weiss D, Madison AN, Lieberman D, Provenzale D. Ten or More Cumulative Lifetime Adenomas Are Associated with Increased Risk for Advanced Neoplasia and Colorectal Cancer. Dig Dis Sci 2022; 67:2526-2534. [PMID: 34089135 DOI: 10.1007/s10620-021-07069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/18/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening guidelines recommend frequent colonoscopies and consideration of genetic testing in individuals with ≥10 cumulative adenomas. However, it is unclear how these guidelines apply to routine practice. AIMS We estimated the proportion of participants found to have ≥10 cumulative adenomas in a screening population and described their outcomes of advanced neoplasia (AN), CRC, and extra-colonic malignancy. METHODS We performed a secondary analysis of VA CSP#380, which includes 3121 veterans aged 50-75 who were followed up to 10 years after screening colonoscopy. We calculated the cumulative risk of ≥10 cumulative adenomas by Kaplan-Meier method. We compared baseline risk factors in those with and without ≥10 cumulative adenomas as well as the risk for AN (adenoma ≥1 cm, villous adenoma or high-grade dysplasia, or CRC) and extra-colonic malignancy by multivariate logistic regression. RESULTS The cumulative risk of ≥10 cumulative adenomas over 10.5 years was 6.51% (95% CI 4.38%-9.62%). Age 60-69 or 70-75 at baseline colonoscopy was the only factors associated with the finding of ≥10 cumulative adenomas. Compared to those with 0-9 cumulative adenomas, participants with ≥10 cumulative adenomas were more likely to have had AN (OR 17.03; 95% CI 9.41-30.84), including CRC (OR 7.00; 95% CI 2.84-17.28), but not extra-colonic malignancies. CONCLUSIONS Approximately 6.5% of participants in this screening population were found to have ≥10 cumulative adenomas over 10.5 years, which was uncommon before age 60. These participants were found to have AN and CRC significantly more often compared to those with lower cumulative adenomas.
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Affiliation(s)
- Brian A Sullivan
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Laura W Musselwhite
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, NC, USA
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point Veterans Affairs Medical Center, Perry Point, MD, USA
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - David Lieberman
- Portland Veteran Affairs Medical Center, Portland, OR, USA
- Oregon Health and Science University, Portland, OR, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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19
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Minchenberg SB, Walradt T, Glissen Brown JR. Scoping out the future: The application of artificial intelligence to gastrointestinal endoscopy. World J Gastrointest Oncol 2022; 14:989-1001. [PMID: 35646286 PMCID: PMC9124983 DOI: 10.4251/wjgo.v14.i5.989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/21/2021] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is a quickly expanding field in gastrointestinal endoscopy. Although there are a myriad of applications of AI ranging from identification of bleeding to predicting outcomes in patients with inflammatory bowel disease, a great deal of research has focused on the identification and classification of gastrointestinal malignancies. Several of the initial randomized, prospective trials utilizing AI in clinical medicine have centered on polyp detection during screening colonoscopy. In addition to work focused on colorectal cancer, AI systems have also been applied to gastric, esophageal, pancreatic, and liver cancers. Despite promising results in initial studies, the generalizability of most of these AI systems have not yet been evaluated. In this article we review recent developments in the field of AI applied to gastrointestinal oncology.
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Affiliation(s)
- Scott B Minchenberg
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02130, United States
| | - Trent Walradt
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02130, United States
| | - Jeremy R Glissen Brown
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA 02130, United States
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20
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Zgraggen A, Stoffel ST, Barbier MC, Marbet UA. Colorectal cancer surveillance by colonoscopy in a prospective, population-based long-term Swiss screening study - outcomes, adherence, and costs. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:761-778. [PMID: 35545112 PMCID: PMC9179214 DOI: 10.1055/a-1796-2471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background
The success of colorectal cancer (CRC) screening depends mainly on screening quality, patient adherence to surveillance, and costs. Consequently, it is essential to assess the performance over time.
Methods
In 2000, a closed cohort study on CRC screening in individuals aged 50 to 80 was initiated in Uri, Switzerland. Participants who chose to undergo colonoscopy were followed over 18 years. We investigated the adherence to recommended surveillance and collected baseline characteristics and colonoscopy data. Risk factors at screening for the development of advanced adenomas were analyzed. Costs for screening and follow-up were evaluated retrospectively.
Results
1278 subjects with a screening colonoscopy were included, of which 272 (21.3%; 69.5% men) had adenomas, and 83 (6.5%) had advanced adenomas. Only 59.8% participated in a follow-up colonoscopy, half of them within the recommended time interval. Individuals with advanced adenomas at screening had nearly five times the risk of developing advanced adenomas compared to individuals without adenomas (24.3% vs. 5.0%, OR 4.79 CI 2.30–9.95). Individuals without adenomas developed advanced adenomas in 4.9%, including four cases of CRC; three of them without control colonoscopy. The villous component in adenomas smaller than 10 mm was not an independent risk factor. Costs for screening and follow-up added up to CHF 1’934’521 per 1’000 persons screened, almost half of them for follow-up examinations; 60% of these costs accounted for low-risk individuals.
Conclusion
Our findings suggest that follow-up of screening colonoscopy should be reconsidered in Switzerland; in particular, long-term adherence is critical. Costs for follow-up could be substantially reduced by adopting less expensive long-term screening methods for low-risk individuals.
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Affiliation(s)
- Armin Zgraggen
- Kantonsspital Aarau AG, Division of Rheumatology, Aarau, Switzerland.,Division of Gastroenterology, Kantonsspital Uri, Altdorf, Switzerland
| | - Sandro Tiziano Stoffel
- Institute for Pharmaceutical Medicine, Universität Basel, Basel, Switzerland.,Research Department of Behavioural Sciences and Health, University College London, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Urs Albert Marbet
- Division of Gastroenterology, Kantonsspital Uri, Altdorf, Switzerland
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21
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Risk of Metachronous Colorectal Advanced Neoplasia and Cancer in Patients With 3-4 Nonadvanced Adenomas at Index Colonoscopy: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2022; 117:588-602. [PMID: 35169108 DOI: 10.14309/ajg.0000000000001682] [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: 10/20/2021] [Accepted: 01/21/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This systematic review and meta-analysis evaluated the available evidence on the risk of metachronous advanced neoplasia (AN) and colorectal cancer (CRC) in patients with 3-4 nonadvanced adenomas (NAAs). METHODS We searched MEDLINE, EMBASE, and Cochrane Library databases up to January 2021 for studies evaluating metachronous AN and CRC risk by comparing 3 groups (1-2 vs 3-4 vs ≥5 NAAs) at index colonoscopy. The estimates for risk of metachronous AN and CRC were evaluated using random-effects models. RESULTS Fifteen studies (n = 36,375) were included. The risk of metachronous AN was significantly higher in the 3-4 NAAs group than in the 1-2 NAAs group (relative risk [RR] 1.264, 95% confidence interval [CI] 1.053-1.518, P = 0.012; I2 = 0%); there was no difference between the ≥ 5 NAAs and 3-4 NAAs groups (RR 1.962, 95% CI 0.972-3.958, P = 0.060; I2 = 68%). The risks of metachronous CRC between the 1-2 NAAs and 3-4 NAAs groups (RR 2.663, 95% CI 0.391-18.128, P = 0.317; I2 = 0%) or the 3-4 NAAs and ≥ 5 NAAs groups (RR 1.148, 95% CI 0.142-9.290, P = 0.897; I2 = 0%) were not significantly different. DISCUSSION Although the risk of metachronous AN was greater in the 3-4 NAAs group than in the 1-2 NAAs group, the risk of metachronous AN and CRC between the 3-4 NAAs and ≥ 5 NAAs groups was not different. This suggests that further studies on metachronous AN and CRC risk in the 3-4 NAAs group are warranted to confirm a firm ≥5-year interval surveillance colonoscopy.
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22
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Sullivan BA, Qin X, Miller C, Hauser ER, Redding TS, Gellad ZF, Madison AN, Musselwhite LW, Efird JT, Sims KJ, Williams CD, Weiss D, Lieberman D, Provenzale D. Screening Colonoscopy Findings Are Associated With Noncolorectal Cancer Mortality. Clin Transl Gastroenterol 2022; 13:e00479. [PMID: 35333777 PMCID: PMC9038496 DOI: 10.14309/ctg.0000000000000479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Controversy exists regarding the impact of various risk factors on noncolorectal cancer (CRC) mortality in healthy screening populations. We examined the impact of known CRC risk factors, including baseline colonoscopy findings, on non-CRC mortality in a screening population. METHODS Cooperative Studies Program (CSP) #380 is comprised of 3,121 veterans aged 50-75 years who underwent screening colonoscopy from 1994 to 97 and were then followed for at least 10 years or until death. Hazard ratios (HRs) for risk factors on non-CRC mortality were estimated by multivariate Cox proportional hazards. RESULTS Current smoking (HR 2.12, 95% confidence interval [CI] 1.78-2.52, compared with nonsmokers) and physical activity (HR 0.89, 95% CI 0.84-0.93) were the modifiable factors most associated with non-CRC mortality in CSP#380. In addition, compared with no neoplasia at baseline colonoscopy, non-CRC mortality was higher in participants with ≥3 small adenomas (HR 1.43, 95% CI 1.06-1.94), advanced adenomas (HR 1.32, 95% CI 0.99-1.75), and CRC (HR 2.95, 95% CI 0.98-8.85). Those with 1-2 small adenomas were not at increased risk for non-CRC mortality (HR 1.15, 95% CI 0.94-1.4). DISCUSSION In a CRC screening population, known modifiable risk factors were significantly associated with 10-year non-CRC mortality. Furthermore, those who died from non-CRC causes within 10 years were more likely to have had high-risk findings at baseline colonoscopy. These results suggest that advanced colonoscopy findings may be a risk marker of poor health outcomes. Integrated efforts are needed to motivate healthy lifestyle changes during CRC screening, particularly in those with high-risk colonoscopy findings and unaddressed risk factors.
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Affiliation(s)
- Brian A. Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Cameron Miller
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Elizabeth R. Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Thomas S. Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Ziad F. Gellad
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - Ashton N. Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Laura W. Musselwhite
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Solid Tumor Oncology, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jimmy T. Efird
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kellie J. Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
| | - Christina D. Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
| | - David Weiss
- Perry Point VA Medical Center, Perry Point, Maryland, USA
| | - David Lieberman
- VA Portland Health Care System, Portland, Oregon, USA
- Oregon Health & Science University, Portland, Oregon, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, North Carolina, USA
- Duke University, Durham, North Carolina, USA
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23
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Rebello D, Schroy PC, Leszcynski A, Colletta A, Rebello E, Mills J, Heeren T, Roy H. Prevalence of Metachronous Advanced Colorectal Neoplasia in Black and White Patients at a Safety Net Hospital. GASTRO HEP ADVANCES 2022; 1:14-22. [PMID: 39129928 PMCID: PMC11307537 DOI: 10.1016/j.gastha.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/02/2021] [Indexed: 08/13/2024]
Abstract
Background and Aims Current postpolypectomy surveillance guidelines are based primarily on data from non-Hispanic Whites (NHWs); thus, generalizability to non-Hispanic Blacks (NHBs) remains unknown. Hence, the primary objective of this study was to assess the validity of these guidelines for NHBs by comparing the prevalence of metachronous advanced colorectal neoplasia (ACN) between NHWs and NHBs undergoing surveillance colonoscopy. Methods This was a retrospective cross-sectional study of NHWs (N = 1500) and NHBs (N = 1260) aged 40-75 years who underwent surveillance colonoscopy at an academic safety net hospital between 2007 and 2017. The primary outcome measure was the prevalence of metachronous ACN, defined as an advanced adenoma, advanced sessile polyp, or invasive cancer. Multivariate logistic regression was used to measure associations between race/ethnicity and ACN prevalence after adjustment for potential confounding factors. Results Overall, the prevalence of metachronous ACN was similar for NHBs and NHWs (6.8% vs 7.4%, respectively; P = .60). The prevalence of metachronous cancers (0.2% vs 0.1%; P = .48), advanced adenomas (2.8% vs 3.8%; P = .14), advanced serrated polyps (3.5% vs 3.3%; P = .82), and large hyperplastic polyps ≥10 mm (0.2% vs 0.6%, P = .24) were also similar between the 2 groups. Moreover, race was not a determinant of metachronous ACN after adjustment for age, sex, education, type of insurance, indication (screen/surveillance) for baseline colonoscopy, surveillance interval, and findings at baseline colonoscopy (adjusted odds ratio, 0.96; 95% confidence interval, 0.70-1.30; P = .78). Conclusion Our study finds no significant difference in the prevalence of metachronous ACN between NHWs and NHBs undergoing appropriate postpolypectomy surveillance at an urban safety net hospital, suggesting that current guidelines are appropriate for both NHWs and NHBs.
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Affiliation(s)
- Dionne Rebello
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts
| | - Paul C. Schroy
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts
| | - Anna Leszcynski
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts
| | - Alessandro Colletta
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts
| | - Elliott Rebello
- Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Hemant Roy
- Section of Gastroenterology, Boston University School of Medicine, Boston, Massachusetts
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24
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Jodal HC, Klotz D, Herfindal M, Barua I, Tag P, Helsingen LM, Refsum E, Holme Ø, Adami HO, Bretthauer M, Kalager M, Løberg M. Long-term colorectal cancer incidence and mortality after adenoma removal in women and men. Aliment Pharmacol Ther 2022; 55:412-421. [PMID: 34716941 DOI: 10.1111/apt.16686] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/17/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Women and men with colorectal adenomas are at increased risk of colorectal cancer and colonoscopic surveillance is recommended. However, the long-term cancer risk remains unknown. AIMS To investigate colorectal cancer incidence and mortality after adenoma removal in women and men METHODS: We identified all individuals who had adenomas removed in Norway from 1993 to 2007, with follow-up through 2018. We calculated standardized incidence ratios (SIR) and incidence-based mortality ratios (SMR) with 95% confidence intervals (CI) for colorectal cancer in women and men using the female and male population for comparison. We defined high-risk adenomas as ≥2 adenomas, villous component, or high-grade dysplasia. RESULTS The cohort comprised 40 293 individuals. During median follow-up of 13.0 years, 1079 women (5.5%) and 866 men (4.2%) developed colorectal cancer; 328 women (1.7%) and 275 men (1.3%) died of colorectal cancer. Colorectal cancer incidence was more increased in women (SIR 1.64, 95% CI 1.54-1.74) than in men (SIR 1.12, 95% CI 1.05-1.19). Colorectal cancer mortality was increased in women (SMR 1.13, 95% CI 1.02-1.26) and reduced in men (SMR 0.79, 95% CI 0.71-0.89). Women with high-risk adenomas had an increased risk of colorectal cancer death (SMR 1.37, 95% CI 1.19-1.57); women with low-risk adenomas (SMR 0.90, 95% CI 0.76-1.07) and men with high-risk adenomas had a similar risk (SMR 0.89, 95% CI 0.76-1.04), while men with low-risk adenomas had reduced risk (SMR 0.70, 95% CI 0.59-0.84). CONCLUSIONS After adenoma removal, women had an increased risk of colorectal cancer death, while men had reduced risk, compared to the general female and male populations. Sex-specific surveillance recommendations after adenoma removal should be considered.
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Affiliation(s)
- Henriette C Jodal
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Dagmar Klotz
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Magnhild Herfindal
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Ishita Barua
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Petter Tag
- Department of Medicine, Nordland Hospital Bodø, Bodø, Norway
| | - Lise M Helsingen
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Erle Refsum
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Øyvind Holme
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medicine, Sørlandet Hospital Kristiansand, Kristiansand, Norway
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Magnus Løberg
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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25
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Long-term cumulative incidence of metachronous advanced colorectal neoplasia after colonoscopy and a novel risk factor: a cohort study. Eur J Gastroenterol Hepatol 2021; 33:1341-1347. [PMID: 34402471 DOI: 10.1097/meg.0000000000002259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Long-term cumulative incidence of and risk factors for metachronous advanced colorectal neoplasia, including both advanced colorectal adenoma (≥10 mm, or with villous or high-grade dysplasia) and colorectal cancer, are critical for surveillance strategies. The aim of this study was to determine the cumulative incidence of metachronous advanced colorectal neoplasia and its risk factors. METHODS A retrospective cohort study was conducted on 6720 consecutive individuals who underwent general health check-ups and colonoscopy. Colorectal adenomas at initial colonoscopy were categorized as low-risk (1-2 small [<10 mm] tubular adenomas) or high-risk adenoma (≥3 tubular adenomas of any size; at least one adenoma ≥10 mm; or villous adenoma or adenoma with high-grade dysplasia). Kaplan-Meier estimates and hazard ratio by Cox-proportional hazard regression were calculated. RESULTS The cumulative incidence (95% confidence interval [CI]) of metachronous advanced colorectal neoplasia at 5 and 10 years was 5.7% [4.6-7.1], and 11% [8.9-14] in the low-risk adenoma group, and 10% [8.6-13], and 17% [14-21] in high-risk adenoma group, respectively. Adjusted hazard ratio [95% CI] of low-risk adenoma (vs. no colorectal adenoma), high-risk adenoma (vs. no colorectal adenoma), current smoking and positive fecal immunochemical test were 1.34 [1.04-1.74], 1.94 [1.48-2.55], 1.55 [1.2-2.02] and 1.69 [1.35-2.1], respectively. Adjusted hazard ratio [95% CI] of positive fecal immunochemical test was 1.88 [1.29-2.74] in those with normal colonoscopy. CONCLUSIONS Both low-risk and high-risk adenomas confer substantial risk for metachronous advanced colorectal neoplasia at 10 years. Positive fecal immunochemical test was a significant risk factor for metachronous advanced colorectal neoplasia despite normal colonoscopy.
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26
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Zhu Y, Huang Y, Hu Y, Fang Y, Kong X, Xiao Q, He J, Zhu Y, Li Q, Yang J, Dong Q, Jin M, Wang M, Chen K, Zheng S, Ding K. Long-term risk of colorectal cancer after removal of adenomas during screening colonoscopies in a large community-based population in China. Int J Cancer 2021; 150:594-602. [PMID: 34605013 DOI: 10.1002/ijc.33835] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/30/2021] [Accepted: 09/13/2021] [Indexed: 11/06/2022]
Abstract
Patients with conventional adenoma removal are recommended to undergo colonoscopy surveillance to prevent colorectal cancer (CRC). However, evidence supporting the guidelines of colonoscopy surveillance is limited, especially among the Chinese population. We investigated the association between colonoscopy adenoma findings and CRC risk among individuals aged 40 to 74 years who underwent baseline colonoscopy from 2007 to 2016 in Jiashan and Haining, Zhejiang, China; 34 382 participants were categorized into advanced adenoma, nonadvanced adenoma and no adenoma based on adenoma findings. A multivariable Cox regression model was used to estimate the hazard ratio (HR) of CRC incidence with adjustment for potential confounding factors. After a median follow-up time of 7.7 years, 113 incident cases of CRC were identified (18 occurred in 1632 participants with advanced adenoma, 16 in 3973 participants with nonadvanced adenoma and 79 in 28 777 participants with no adenoma). Compared to no adenoma group, the adjusted HR for CRC in advanced adenoma group was 4.01 (95% CI, 2.37-6.77). For nonadvanced adenomas, individuals with ≥3 adenomas showed an increased risk of CRC (HR, 3.65; 95% CI, 1.43-9.31), but no significantly increased risk of CRC was found for 1 to 2 nonadvanced adenomas, compared to those with no adenoma. Our study suggested that the risk of subsequent CRC increased in individuals with high-risk adenoma (at least one advanced adenoma or ≥3 nonadvanced adenomas), but not in those with 1 to 2 nonadvanced adenomas. These results provide the first evidence from the Chinese population for the current surveillance guidelines.
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Affiliation(s)
- Yingshuang Zhu
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanqin Huang
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yeting Hu
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yimin Fang
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangxing Kong
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Xiao
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinjie He
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunfeng Zhu
- Haining Cancer Prevention and Treatment Research Institute, Chinese Medicine Hospital of Haining, Haining, China
| | - Qilong Li
- Jiashan Institute of Cancer Prevention and Control, Jiashan, China
| | - Jinhuan Yang
- Jiashan Institute of Cancer Prevention and Control, Jiashan, China
| | - Qi Dong
- Cancer Institute, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mingjuan Jin
- Department of Epidemiology and Biostatistics, Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Meilin Wang
- Department of Environmental Genomics, Jiangsu Key Laboratory of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - Kun Chen
- Department of Epidemiology and Biostatistics, Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shu Zheng
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kefeng Ding
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Cancer Center, Zhejiang University, Hangzhou, China
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27
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Karnes WE, Johnson DA, Berzin TM, Gross SA, Vargo JJ, Sharma P, Zachariah R, Samarasena JB, Anderson JC. A Polyp Worth Removing: A Paradigm for Measuring Colonoscopy Quality and Performance of Novel Technologies for Polyp Detection. J Clin Gastroenterol 2021; 55:733-739. [PMID: 34334765 DOI: 10.1097/mcg.0000000000001594] [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: 12/10/2022]
Abstract
Leaving no significant polyp behind while avoiding risks due to unnecessary resections is a commonsense strategy to safely and effectively prevent colorectal cancer (CRC) with colonoscopy. It also alludes to polyps worth removing and, therefore, worth finding. The majority of "worthy" precancerous polyps are adenomas, which for over 2 decades, have received the most attention in performance research and metrics. Consequently, the detection rate of adenomas is currently the only validated, outcome-based measure of colonoscopy demonstrated to correlate with reduced risk of postcolonoscopy CRC. However, a third or more of postcolonoscopy CRCs originate from sessile serrated polyps (SSPs), which are notoriously difficult to find, diagnose and completely resect. Among serrated polyps, the agreement among pathologists differentiating SSPs from non-neoplastic hyperplastic polyps is moderate at best. This lack of ground truth precludes SSPs from consideration in primary metrics of colonoscopy quality or performance of novel polyp detection technologies. By instead leveraging the distinct endoscopic and clinical features of serrated polyps, including those considered important due to proximal location and larger size, clinically significant serrated polyps represent serrated polyps worth removing, enriched with subtle precancerous SSPs. With the explosion of technologies to assist polyp detection, now is the time to broaden benchmarks to include clinically significant serrated polypss alongside adenomas, a measure that is relevant both for assessing the performance of endoscopists, and for assessing new polyp detection technologies.
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Affiliation(s)
- William E Karnes
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA
| | - David A Johnson
- Gastroenterology Division, Eastern VA Medical School, Norfolk, VA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - John J Vargo
- Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, MO
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS
| | - Robin Zachariah
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA
| | - Jason B Samarasena
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA
| | - Joseph C Anderson
- White River Junction VAMC, Geisel School of Medicine at Dartmouth College, University of Connecticut School of Medicine, Farmington, CT
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28
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Hamarneh Z, Cock C, Young GP, Bampton PA, Fraser R, Ang FL, Kholmurodova F, Symonds EL. The influence of the surveillance time interval on the risk of advanced neoplasia after non-advanced adenoma removal. Med J Aust 2021; 215:465-470. [PMID: 34386988 DOI: 10.5694/mja2.51222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To investigate the incidence of advanced neoplasia (colorectal cancer or advanced adenoma) at surveillance colonoscopy following removal of non-advanced adenoma; to determine whether the time interval before surveillance colonoscopy influences the likelihood of advanced neoplasia. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS Patients enrolled in a South Australian surveillance colonoscopy program with findings of non-advanced adenoma during 1999-2016 who subsequently underwent surveillance colonoscopy. MAIN OUTCOME MEASURES Incidence of advanced neoplasia at follow-up surveillance colonoscopy. RESULTS Advanced neoplasia was detected in 169 of 965 eligible surveillance colonoscopies (18%) for 904 unique patients (median age, 62.0 years; interquartile range [IQR], 54.0-69.0 years), of whom 570 were men (59.1%). The median interval between the initial and surveillance procedures was 5.2 years (IQR, 4.4-6.0 years; range, 2.0-14 years). Factors associated with increased risk of advanced neoplasia at follow-up included age (per year: odds ratio [OR], 1.03; 95% CI, 1.01-1.05), prior history of adenoma (OR, 1.48; 95% CI, 1.01-2.15), two non-advanced adenomas identified at baseline procedure (v one: OR, 1.74; 95% CI, 1.18-2.57), and time to surveillance colonoscopy (OR, 1.21; 95% CI, 1.08-1.37). The estimated incidence of advanced neoplasia was 19% five years after non-advanced adenoma removal, and 30% at ten years. CONCLUSIONS Increasing the surveillance colonoscopy interval beyond five years after removal of non-advanced adenoma increases the risk of detection of advanced neoplasia at follow-up colonoscopy.
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Affiliation(s)
| | | | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA
| | | | - Robert Fraser
- Flinders Medical Centre, Adelaide, SA.,Flinders University, Adelaide, SA
| | - Fang Li Ang
- College of Medicine and Public Health, Flinders University, Adelaide, SA
| | - Feruza Kholmurodova
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA
| | - Erin L Symonds
- Flinders Medical Centre, Adelaide, SA.,Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA
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29
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Keswani RN, Crockett SD, Calderwood AH. AGA Clinical Practice Update on Strategies to Improve Quality of Screening and Surveillance Colonoscopy: Expert Review. Gastroenterology 2021; 161:701-711. [PMID: 34334168 DOI: 10.1053/j.gastro.2021.05.041] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 12/23/2022]
Abstract
The purpose of this American Gastroenterological Association Institute Clinical Practice Update was to review the available evidence and provide best practice advice regarding strategies to improve the quality of screening and surveillance colonoscopy. This review is framed around 15 best practice advice statements regarding colonoscopy quality that were agreed upon by the authors, based on a review of the available evidence and published guidelines. This is not a formal systematic review and thus no formal rating of the quality of evidence or strength of recommendation has been carried out.
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Affiliation(s)
- Rajesh N Keswani
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Audrey H Calderwood
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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30
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Duvvuri A, Chandrasekar VT, Srinivasan S, Narimiti A, Dasari C, Nutalapati V, Kennedy KF, Spadaccini M, Antonelli G, Desai M, Vennalaganti P, Kohli D, Kaminski MF, Repici A, Hassan C, Sharma P. Risk of Colorectal Cancer and Cancer Related Mortality After Detection of Low-risk or High-risk Adenomas, Compared With No Adenoma, at Index Colonoscopy: A Systematic Review and Meta-analysis. Gastroenterology 2021; 160:1986-1996.e3. [PMID: 33524401 DOI: 10.1053/j.gastro.2021.01.214] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS The risk of metachronous colorectal cancer (CRC) among patients with no adenomas, low-risk adenomas (LRAs), or high-risk adenomas (HRAs), detected at index colonoscopy, is unclear. We performed a systematic review and meta-analysis to compare incidence rates of metachronous CRC and CRC-related mortality after a baseline colonoscopy for each group. METHODS We searched the PubMed, Embase, Google Scholar, and Cochrane databases for studies that reported the incidence of CRC and adenoma characteristics after colonoscopy. The primary outcome was odds of metachronous CRC and CRC-related mortality per 10,000 person-years of follow-up after baseline colonoscopy for all the groups. RESULTS Our final analysis included 12 studies with 510,019 patients (mean age, 59.2 ± 2.6 years; 55% male; mean duration of follow up, 8.5 ± 3.3 years). The incidence of CRC per 10,000 person-years was marginally higher for patients with LRAs compared to those with no adenomas (4.5 vs 3.4; odds ratio [OR], 1.26; 95% CI, 1.06-1.51; I2=0), but significantly higher for patients with HRAs compared to those with no adenoma ( 13.8 vs 3.4; odds ratio [OR], 2.92; 95% CI, 2.31-3.69; I2=0 ) and patients with HRAs compared to LRAs (13.81 vs 4.5; OR, 2.35; 95% CI, 1.72-3.20; I2=55%). However, the CRC-related mortality per 10,000 person-years did not differ significantly for patients with LRAs compared to no adenomas (OR, 1.15; 95% CI, 0.76-1.74; I2=0) but was significantly higher in persons with HRAs compared with LRAs (OR, 2.48; 95% CI, 1.30-4.75; I2=38%) and no adenomas (OR, 2.69; 95% CI, 1.87-3.87; I2=0). CONCLUSIONS The results of this systematic review and meta-analysis demonstrate that the risk of metachronous CRC and mortality is significantly higher for patients with HRAs, but this risk is very low in patients with LRAs, comparable to patients with no adenomas. Follow-up of patients with LRAs detected at index colonoscopy should be the same as for persons with no adenomas.
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Affiliation(s)
- Abhiram Duvvuri
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas.
| | | | - Sachin Srinivasan
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Anvesh Narimiti
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts
| | - ChandraShekhar Dasari
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Venkat Nutalapati
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas
| | - Kevin F Kennedy
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Marco Spadaccini
- Department of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy
| | - Giulio Antonelli
- Digestive Endoscopy Unit, Sapienza University of Rome, Rome, Italy
| | - Madhav Desai
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri
| | | | - Divyanshoo Kohli
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri
| | | | - Alessandro Repici
- Department of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Prateek Sharma
- Department of Gastroenterology, Veteran Affairs Medical Center, Kansas City, Missouri
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31
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Hong JC, Hauser ER, Redding TS, Sims KJ, Gellad ZF, O'Leary MC, Hyslop T, Madison AN, Qin X, Weiss D, Bullard AJ, Williams CD, Sullivan BA, Lieberman D, Provenzale D. Characterizing chronological accumulation of comorbidities in healthy veterans: a computational approach. Sci Rep 2021; 11:8104. [PMID: 33854078 PMCID: PMC8046765 DOI: 10.1038/s41598-021-85546-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022] Open
Abstract
Understanding patient accumulation of comorbidities can facilitate healthcare strategy and personalized preventative care. We applied a directed network graph to electronic health record (EHR) data and characterized comorbidities in a cohort of healthy veterans undergoing screening colonoscopy. The Veterans Affairs Cooperative Studies Program #380 was a prospective longitudinal study of screening and surveillance colonoscopy. We identified initial instances of three-digit ICD-9 diagnoses for participants with at least 5 years of linked EHR history (October 1999 to December 2015). For diagnoses affecting at least 10% of patients, we calculated pairwise chronological relative risk (RR). iGraph was used to produce directed graphs of comorbidities with RR > 1, as well as summary statistics, key diseases, and communities. A directed graph based on 2210 patients visualized longitudinal development of comorbidities. Top hub (preceding) diseases included ischemic heart disease, inflammatory and toxic neuropathy, and diabetes. Top authority (subsequent) diagnoses were acute kidney failure and hypertensive chronic kidney failure. Four communities of correlated comorbidities were identified. Close analysis of top hub and authority diagnoses demonstrated known relationships, correlated sequelae, and novel hypotheses. Directed network graphs portray chronologic comorbidity relationships. We identified relationships between comorbid diagnoses in this aging veteran cohort. This may direct healthcare prioritization and personalized care.
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Affiliation(s)
- Julian C Hong
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA. .,Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA. .,Bakar Computational Health Sciences Institute, University of California, San Francisco, San Francisco, CA, USA.
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Terry Hyslop
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - David Weiss
- Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, MD, USA
| | - A Jasmine Bullard
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - Brian A Sullivan
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA.,Department of Medicine, Duke University, Durham, NC, USA
| | - David Lieberman
- VA Portland Health Care System, Portland, OR, USA.,Oregon Health and Science University, Portland, OR, USA
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham VA Health Care System, Durham, NC, USA. .,Department of Medicine, Duke University, Durham, NC, USA.
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32
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≥3 Nonadvanced Adenomas are More Common in the Era of Contemporary Colonoscopy and Not Associated With Metachronous Advanced Neoplasia. J Clin Gastroenterol 2021; 55:343-349. [PMID: 32427796 DOI: 10.1097/mcg.0000000000001364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/15/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Data from standard definition colonoscopy era demonstrate patients with an advanced adenoma (≥10 mm, villous features or high-grade dysplasia) or ≥3 nonadvanced adenomas are considered high-risk for metachronous advanced neoplasia (MAN). Low-risk adenoma (LRA) patients are those with 1 to 2, <10 mm tubular adenomas. High definition colonoscopy, split-dose bowel preparation, and attention to adenoma detection enhance diminutive adenoma detection. We compared baseline adenoma characteristics between patients undergoing colonoscopy in a historic cohort (HC) and contemporary cohort (CC) to determine if number of patients with ≥3 nonadvanced adenomas are increased in CC, and if those features are associated with MAN in CC. MATERIALS AND METHODS Patients undergoing their first colonoscopy in HC (<2006) and CC (≥2006) at age 50 and above were identified through natural language processing. Multivariable regression analysis compared baseline adenoma characteristics between HC and CC, and determined the association between baseline characteristics and MAN in CC patients. RESULTS In total, 255,074 colonoscopies were performed between 1990 and 2015. A total of 9773 colonoscopies performed in the HC and 59,531 in the CC were included. At baseline, CC patients were more likely to have ≥3 nonadvanced adenomas [odds ratio (OR): 2.1, 95% confidence interval (CI): 1.7-2.6]. In 3,377 CC patients undergoing follow-up colonoscopy, the risk of MAN did not differ between patients with LRA versus those with ≥3 nonadvanced adenomas (6.3% vs. 4.6%, OR: 1.4, CI: 0.58-3.5) including 3-4 (6.1%, OR: 1.4, CI: 0.52-3.6) and ≥5 (7.7%, OR: 1.8, CI: 0.23-14.6), although few patients had ≥5 nonadvanced adenomas. CONCLUSIONS Colonoscopy in the contemporary era increases detection of patients with ≥3 nonadvanced adenomas, which do not increase the risk of MAN compared with LRA patients. A similar surveillance to LRA patients should be considered for those patients.
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33
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O'Leary MC, Whitley RL, Press A, Provenzale D, Williams CD, Chesnut B, Jones R, Redding TS, Sims KJ. Development of a Multi-Study Repository to Support Research on Veteran Health: The VA Cooperative Studies Program Epidemiology Center-Durham (CSPEC-Durham) Data and Specimen Repository. Front Public Health 2021; 9:612806. [PMID: 33681131 PMCID: PMC7925406 DOI: 10.3389/fpubh.2021.612806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Federal agencies, including the Department of Veterans Affairs (VA), have prioritized improved access to scientific data and results collected through federally funded research. Our VA Cooperative Studies Program Epidemiology Center in Durham, North Carolina (CSPEC-Durham) assembled a repository of data and specimens collected through multiple studies on Veteran health issues to facilitate future research in these areas. We developed a single protocol, request process that includes scientific and ethical review of all applications, and a database architecture using metadata (common variable descriptors) to securely store and share data across diverse studies. In addition, we created a mechanism to allow data and specimens collected through older studies in which re-use was not addressed in the study protocol or consent forms to be shared if the future research is within the scope of the original consent. Our CSPEC-Durham Data and Specimen Repository currently includes research data, genomic data, and study specimens (e.g., DNA, blood) for three content areas: colorectal cancer, amyotrophic lateral sclerosis, and Gulf War research. The linking of the study specimens and research data can support additional genetic analyses and related research to improve Veterans' health.
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Affiliation(s)
- Meghan C O'Leary
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | | | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke University Medical Center, Durham, NC, United States
| | - Blair Chesnut
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC, United States
| | - Rodney Jones
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States.,Duke Molecular Physiology Institute, School of Medicine, Duke University, Durham, NC, United States
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, NC, United States
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34
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Abdelnaby HB, Abuhussein AA, Fouad AM, Alhashash WA, Aldousari AS, Abdelaleem AM, Edelhamre M, Shahin MH, Faisal M. Histopathological and epidemiological findings of colonoscopy screening in a population with an average risk of colorectal cancer in Kuwait. Saudi J Gastroenterol 2021; 27:158-165. [PMID: 33642352 PMCID: PMC8265403 DOI: 10.4103/sjg.sjg_463_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the second most common cancer in women and the third most common in men worldwide, with a significantly rising incidence in the Middle East region over the last few decades. This study investigates the histopathological and epidemiological characteristics of colonoscopic findings in a population with an average risk of CRC in Kuwait. METHODS In this study, 1,005 asymptomatic average-risk Kuwaiti adults aged over 40 years had their first colonoscopy screening during the 2015-2018 period. Data on lifestyle behaviors (cigarette smoking, alcohol consumption, and physical activity), body mass index (BMI), and comorbidities were routinely collected from these individuals. All colorectal polyps or masses were assessed for their site, size, and number and then resected and sent for histopathological examination. RESULTS The mean age of the participants was 54 years, and 52.2% were women. In screened individuals, the polyp detection rate, adenoma detection rate, and carcinoma detection rate were 43.8%, 27.7%, and 1.2%, respectively. Tubular, tubulovillous, and villous types of adenoma constituted 17.3%, 2.8%, and 1.3% of all screened participants. Neoplastic lesions, particularly in the proximal colon, were more common among men aged 40-49 years. Age of 70 years and older (OR: 9.6; 95% CI: 4.7-19.9; P < 0.001), male gender (OR: 1.6; 95% CI: 1.1-2.3; P = 0.011), increased BMI (OR: 1.05; 95% CI: 1.02-1.08; P = 0.001), and smoking (OR: 3.5; 95% CI: 2.3-5.4; P < 0.001) were the most significant independent risk factors for colorectal neoplasia. CONCLUSIONS The high adenoma detection rate (ADR) in Kuwaiti population calls for the establishment of a national programe for CRC screening. The higher ADR in those younger than 50 years calls for assessment of the threshold age at which to start screening.
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Affiliation(s)
- Hassan B. Abdelnaby
- Department of Endemic and Infectious Diseases, Faculty of medicine, Suez Canal University, Ismailia, Egypt,Department of Internal Medicine, Division of gastroenterology, Al Sabah Hospital, Ministry of Health, Kuwait,Address for correspondence: Dr. Hassan B. Abdelnaby, Department of Internal Medicine, Division of Gastroenterology, Al Sabah Hospital, Ministry of Health, P. O. Box (5) – 13001, Safat, Kuwait. E-mail:
| | - Ali A. Abuhussein
- Department of Internal Medicine, Division of gastroenterology, Al Sabah Hospital, Ministry of Health, Kuwait
| | - Ahmed M. Fouad
- Department of Public Health, Occupational and Enivronmental Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Wafaa A. Alhashash
- Department of Internal Medicine, Division of gastroenterology, Al Sabah Hospital, Ministry of Health, Kuwait
| | - Abdulrahman S. Aldousari
- Department of Internal Medicine, Division of gastroenterology, Al Sabah Hospital, Ministry of Health, Kuwait
| | - Ahmed M. Abdelaleem
- Department of Internal Medicine, Division of gastroenterology, Al Sabah Hospital, Ministry of Health, Kuwait,Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marcus Edelhamre
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Maha H. Shahin
- Department of Internal Medicine, Division of gastroenterology, Al Sabah Hospital, Ministry of Health, Kuwait
| | - Mohammed Faisal
- Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden,Department of Surgery, Surgical Oncology Unit, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Lieberman D. Does Colon Surveillance After Polypectomy Prevent Colon Cancer and Save Lives? Clin Gastroenterol Hepatol 2020; 18:2876-2878. [PMID: 32289542 DOI: 10.1016/j.cgh.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Affiliation(s)
- David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
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Pinsky PF, Schoen RE. Contribution of Surveillance Colonoscopy to Colorectal Cancer Prevention. Clin Gastroenterol Hepatol 2020; 18:2937-2944.e1. [PMID: 32017987 PMCID: PMC7549191 DOI: 10.1016/j.cgh.2020.01.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/16/2020] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The contribution of surveillance colonoscopy, as opposed to that of initial colonoscopy examination, to prevention of colorectal cancer (CRC) is uncertain. We estimated the preventive effect of surveillance colonoscopy by applying the recently developed metric of adenoma dwell time avoided needed to prevent 1 CRC case (DTA). METHODS We followed subjects in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial who underwent colonoscopies following positive findings from sigmoidoscopies (colonoscopy cohort, n = 15,935) for CRC incidence for 10 years. The number and timing of adenomas removed during surveillance were measured in a subset (n = 3492) of patients and extrapolated to the entire cohort to estimate the total avoided adenoma dwell time. A previously determined DTA value of 612 dwell years was applied to estimate the number of CRC cases prevented by surveillance. Proportional reduction in CRC was computed as CP/(CO+CP), where CO and CP are observed and estimated prevented cases, respectively. RESULTS In the colonoscopy cohort of the PLCO, 2882 subjects had advanced adenomas (AAs), 572 had 3 or more non-advanced adenomas (NAA3+), 4496 had 1-2 non-advanced adenomas (NAA1-2), and 7985 had no adenoma (NA). The mean number of subsequent colonoscopy examinations over 10 years were 1.80 for subjects with AAs, 1.63 for subjects with NAA3+, and 1.46 for subjects with NAA1-2. Average years of avoided adenoma dwell time per subject were 4.0 for subjects with AAs, 5.5 for subjects with NAA3+, and 2.4 for subjects with NAA1-2. There were 56 cases of CRC in subjects with AAs, 4 cases of CRC in subjects with NAA3+, and 33 cases of CRC in subjects with NAA1-2. Estimated proportional reductions in CRC incidence were 25.0% in subjects with AAs (95% CI, 16%-34%), 34.4% in subjects with NAA1-2 (95% CI, 25%-40%), and 30.4% overall (in subjects with AAs, NAA3+, or NAA1-2; 95% CI, 25%-40%). Absolute CRC incidence reductions were 7.1 per 10,000 PY in subjects with AAs and 4.1 per 10,000 PY in subjects with NAA1-2. CONCLUSIONS Using the recently developed metric of DTA, we estimated that surveillance colonoscopy in the PLCO colonoscopy cohort during 10 years of follow up prevented 30% of CRC cases. Because the methodology for estimation is indirect, the true effect is uncertain.
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Affiliation(s)
- Paul F. Pinsky
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD
| | - Robert E. Schoen
- Division of Gastroenterology, Hepatology and Nutrition, Departments of Medicine and Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Cancino RS, Su Z, Mesa R, Tomlinson GE, Wang J. The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities. JMIR Cancer 2020; 6:e21697. [PMID: 33027039 PMCID: PMC7599065 DOI: 10.2196/21697] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/24/2020] [Accepted: 09/30/2020] [Indexed: 12/15/2022] Open
Abstract
Cancer is a leading cause of death in the United States and across the globe. Cancer screening is an effective preventive measure that can reduce cancer incidence and mortality. While cancer screening is integral to cancer control and prevention, due to the COVID-19 outbreak many screenings have either been canceled or postponed, leaving a vast number of patients without access to recommended health care services. This disruption to cancer screening services may have a significant impact on patients, health care practitioners, and health systems. In this paper, we aim to offer a comprehensive view of the impact of COVID-19 on cancer screening. We present the challenges COVID-19 has exerted on patients, health care practitioners, and health systems as well as potential opportunities that could help address these challenges.
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Affiliation(s)
- Ramon S Cancino
- Department of Family & Community Medicine, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, United States
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Zhaohui Su
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
| | - Ruben Mesa
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
- Department of Medicine, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Gail E Tomlinson
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
- Department of Pediatrics, Joe R & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, United States
| | - Jing Wang
- Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, UT Health San Antonio, San Antonio, TX, United States
- School of Nursing, UT Health San Antonio, San Antonio, TX, United States
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Provenzale D, Ness RM, Llor X, Weiss JM, Abbadessa B, Cooper G, Early DS, Friedman M, Giardiello FM, Glaser K, Gurudu S, Halverson AL, Issaka R, Jain R, Kanth P, Kidambi T, Lazenby AJ, Maguire L, Markowitz AJ, May FP, Mayer RJ, Mehta S, Patel S, Peter S, Stanich PP, Terdiman J, Keller J, Dwyer MA, Ogba N. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 2.2020. J Natl Compr Canc Netw 2020; 18:1312-1320. [PMID: 33022639 DOI: 10.6004/jnccn.2020.0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel's recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.
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Affiliation(s)
| | | | | | | | | | - Gregory Cooper
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Dayna S Early
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Amy L Halverson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | - Rachel Issaka
- Fred Hutchinson Cancer Center/Seattle Cancer Care Alliance
| | | | | | | | | | | | | | | | - Robert J Mayer
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Shivan Mehta
- Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Peter P Stanich
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
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Walradt T, Glissen Brown JR, Alagappan M, Lerner HP, Berzin TM. Regulatory considerations for artificial intelligence technologies in GI endoscopy. Gastrointest Endosc 2020; 92:801-806. [PMID: 32504697 DOI: 10.1016/j.gie.2020.05.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
Artificial intelligence (AI) technologies in clinical medicine have become the subject of intensive investigative efforts and popular attention. In domains ranging from pathology to radiology, AI has demonstrated the potential to improve clinical performance and efficiency. In gastroenterology, AI has been applied on multiple fronts, with particular progress seen in the areas of computer-aided polyp detection (CADe) and computer-aided polyp diagnosis (CADx), to assist gastroenterologists during colonoscopy. As clinical evidence accrues for CADe and CADx, our attention must also turn toward the unique challenges that this new wave of technologies represent for the U.S. Food and Drug Administration and other regulatory agencies, who are tasked with protecting public health by ensuring the safety of medical devices. In this review, we describe the current regulatory pathways for AI tools in gastroenterology and the expected evolution of these pathways.
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Affiliation(s)
- Trent Walradt
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy R Glissen Brown
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Muthu Alagappan
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Herbert P Lerner
- Former GI Deputy Division Director, U.S. Food and Drug Administration
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Sullivan BA, Qin X, Redding TS, Gellad ZF, Stone A, Weiss D, Madison AN, Sims KJ, Williams CD, Lieberman D, Hauser ER, Provenzale D. Genetic Colorectal Cancer and Adenoma Risk Variants Are Associated with Increasing Cumulative Adenoma Counts. Cancer Epidemiol Biomarkers Prev 2020; 29:2269-2276. [PMID: 32928932 DOI: 10.1158/1055-9965.epi-20-0465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/25/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The genetic basis for most individuals with high cumulative lifetime colonic adenomas is unknown. We investigated associations between known colorectal cancer-risk single-nucleotide polymorphisms (SNP) and increasing cumulative adenoma counts. METHODS The Cooperative Studies Program #380 screening colonoscopy cohort includes 612 selected participants age 50 to 75 with genotyped blood samples and 10 years of clinical follow-up. We evaluated 41 published "colorectal cancer-risk SNPs" for associations with individual cumulative adenoma counts or having ≥10 cumulative adenomas. SNPs were analyzed singly or combined in a polygenic risk score (PRS). The PRS was constructed from eight published SNPs associated with multiple adenomas, termed "adenoma-risk SNPs." RESULTS Four colorectal cancer-risk SNPs were associated with increasing cumulative adenoma counts (P < 0.05): rs12241008 (gene: VTI1A), rs2423279 (BMP2/HAO1), rs3184504 (SH2B3), and rs961253 (FERMT1/BMP2), with risk allele risk ratios of 1.31, 1.29, 1.24, and 1.23, respectively. Three colorectal cancer-risk SNPs were associated with ≥10 cumulative adenomas (P < 0.05), with risk allele odds ratios of 2.09 (rs3184504), 2.30 (rs961253), and 1.94 (rs3217901). A weighted PRS comprised of adenoma-risk SNPs was associated with higher cumulative adenomas (weighted rate ratio = 1.57; P = 0.03). CONCLUSIONS In this mostly male veteran colorectal cancer screening cohort, several known colorectal cancer-risk SNPs were associated with increasing cumulative adenoma counts and the finding of ≥10 cumulative adenomas. In addition, an increasing burden of adenoma-risk SNPs, measured by a weighted PRS, was associated with higher cumulative adenomas. IMPACT Future work will seek to validate these findings in different populations and then augment current colorectal cancer risk prediction tools with precancerous, adenoma genetic data.
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Affiliation(s)
- Brian A Sullivan
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
| | - Xuejun Qin
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Ziad F Gellad
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
| | - Anjanette Stone
- Cooperative Studies Program Pharmacogenomics Analysis Laboratory, Central Arkansas Veterans Health System, Little Rock, Arkansas
| | - David Weiss
- Perry Point Cooperative Studies Program Coordinating Center, Perry Point VA Medical Center, Perry Point, Maryland
| | - Ashton N Madison
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Medicine, Duke University, Durham, North Carolina
| | - David Lieberman
- Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health & Science University, Portland, Oregon.,VA Portland Health Care System, Portland, Oregon
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Dawn Provenzale
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, North Carolina. .,Department of Medicine, Duke University, Durham, North Carolina
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High-Risk Adenomas at Screening Colonoscopy Remain Predictive of Future High-Risk Adenomas Despite an Intervening Negative Colonoscopy. Am J Gastroenterol 2020; 115:1275-1282. [PMID: 32483010 DOI: 10.14309/ajg.0000000000000677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Limited data inform the current postpolypectomy surveillance guidelines, which suggest a shortened interval to third colonoscopy after a negative second examination if high-risk adenomas (HRA) were present on the initial screening colonoscopy. Therefore, we examined the risk of HRA at third colonoscopy stratified by findings on 2 previous examinations in a prospective screening colonoscopy cohort of US veterans. METHODS We identified participants who had 3 or more colonoscopies from CSP#380. We examined the risk of HRA on the third examination based on findings from the previous 2 examinations. Multivariate logistic regression was used to adjust for multiple covariates. RESULTS HRA were found at the third examination in 114 (12.8%) of 891 participants. Those with HRA on both previous examinations had the greatest incidence of HRA at third examination (14/56, 25.0%). Compared with those with no adenomas on both previous examinations, participants with HRA on the first examination remained at significantly increased risk for HRA at the third examination at 3 years after a negative second examination (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.28-9.08), 5 years (OR 3.14, 95% CI 1.49-6.61), and 7 years (OR 2.89, 95% CI 1.08-7.74). DISCUSSION In a screening population, HRA on the first examination identified individuals who remained at increased risk for HRA at the third examination, even after a negative second examination. This finding supports current colorectal cancer surveillance guidelines, which suggest a shortened, 5-year time interval to third colonoscopy after a negative second examination if high-risk findings were present on the baseline examination.
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Hassan C, Manning J, Álvarez González MA, Sharma P, Epstein M, Bisschops R. Improved detection of colorectal adenomas by high-quality colon cleansing. Endosc Int Open 2020; 8:E928-E937. [PMID: 32676536 PMCID: PMC7359847 DOI: 10.1055/a-1167-1359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/09/2020] [Indexed: 12/14/2022] Open
Abstract
Background and study aims Reliable adenoma detection requires "adequate" bowel preparation. The adenoma detection rate (ADR) was assessed in patients with high-quality (stool-free) cleansing versus adequate cleansing. Patients and methods This study was a post-hoc combined analysis of three randomized trials individually powered for cleansing quality assessment. Treatment-independent ADR was assessed versus colon cleansing quality by central readers using the Harefield Cleansing Scale (HCS) and the Boston Bowel Preparation Scale (BBPS). The number needed to treat (NNT) to find an additional patient with at least one adenoma was calculated for high-quality versus adequate-quality cleansing. Results A total of 1749 patients were included. ADR increased with high-quality versus adequate-quality cleansing: HCS grade A versus B, 39 % (94/242) versus 27 % (336/1229); NNT = 8.7; P < 0.001. ADR also increased with high-quality versus uniform adequate segmental cleansing scores: HCS grade A versus uniform segmental scores 2, 39 % (94/242) versus 26 % (97/379); NNT = 7.5; P < 0.001. ADR increased with top-quality versus adequate segmental cleansing scores: HCS uniform segmental scores 4 versus 2, 54 % (21/39) versus 26 % (97/379); NNT = 3.6; P < 0.001. ADR increased with BBPS 9 versus 6, 43 % (71/166) versus 26 % (247/950); NNT = 6.0; P < 0.001. Right colon ADR increased with top-quality versus adequate cleansing: HCS 4 versus 2, 20 % (25/122) versus 11 % (121/1117); NNT = 10.4; P < 0.001 and BBPS 3 versus 2, 15 % (42/284) versus 11 % (130/1192); NNT = 25.8; P = 0.033. Conclusions High-quality colon cleansing improves adenoma detection, and it should be a priority for bowel preparations for colonoscopy.
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Affiliation(s)
| | - Jonathan Manning
- Borders General Hospital, NHS Borders, Melrose, Berwickshire, UK
| | | | - Prateek Sharma
- Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas, United States
| | - Michael Epstein
- Investigative Clinical Research, Annapolis, Maryland, United States
| | - Raf Bisschops
- KU Leuven, University Hospitals Leuven, Leuven, Belgium
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Affiliation(s)
- Mohammad Bilal
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy R Glissen Brown
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The goal of colorectal cancer (CRC) screening with colonoscopy is to minimize CRC with minimal risk and cost. In order to continuously improve the quality of colonoscopy, different outcomes must be measured. For this topic, the priority indicators to be measured are (1) frequency of scheduling colonoscopy at appropriate interval based on current guidelines; (2) frequency of identifying adenomas in average-risk individuals undergoing their first screening colonoscopy; and, (3) providing guideline-consistent recommendations for repeat colonoscopy after the procedure.
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Affiliation(s)
- Philip Schoenfeld
- Gastroenterology Section, John D. Dingell VA Medical Center, 4646 John R Street, Detroit, MI 48201, USA.
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45
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Epstein MS, Benamouzig R, Halonen J, Bisschops R. High-quality colon cleansing and multiple neoplasia detection with 1L NER1006 versus mid-volume options: Post hoc analysis of phase 3 clinical trials. Endosc Int Open 2020; 8:E628-E635. [PMID: 32355881 PMCID: PMC7165002 DOI: 10.1055/a-1119-6509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background and study aims Multiple neoplasia increase the risk of colorectal cancer. High-quality cleansing may improve adenoma detection. We assessed whether a new bowel preparation can improve colon cleansing and multiple lesion detection. Patients and methods This post hoc analysis of two randomized clinical trials in Europe and the US assessed the per study and combined cleansing efficacy of overnight split dosing with (preparation + clear fluids) 1 + 1 L polyethylene glycol (PEG) NER1006 versus 2 + 1 L PEG + ascorbate (2LPEG) or 1 + 2 L oral sulfate solution (OSS) combined. Treatment-blinded central readers assessed cleansing quality using the Harefield Cleansing Scale (HCS). Patients with full segmental scoring were included. HCS segmental scores 0-4 (high-quality = HCS 3-4) were analyzed for NER1006 versus 2LPEG/OSS. Mean number of polyps or adenomas per patient (MPP/MAP) was calculated for treatments in patients with at least one polyp or adenoma. Results In 1037 patients, NER1006 attained a greater rate of HCS 3 scores (29 % vs. 20 %; P < 0.001) and HCS 4 scores (20 % vs. 17 %; P = 0.007) versus 2LPEG/OSS. More polyps (678 versus 585) and adenomas (397 versus 331) were detected with NER1006 (N = 517) versus 2LPEG/OSS (N = 520). In all neoplasia-positive patients, with increasing minimal per-patient neoplasia multiplicity from 1 to 10, NER1006 numerically improved MPP (difference ± SE: 0.48 ± 0.24 to 3.89 ± 3.37) and MAP (0.47 ± 0.26 to 7.50 ± 9.00) versus 2LPEG/OSS. Conclusions Low-volume NER1006 enhances high-quality cleansing versus medium-volume 2LPEG or OSS, individually and when combined. NER1006 may consequently facilitate the detection of multiple neoplasia in patients.
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Affiliation(s)
| | | | - Juha Halonen
- Medical Affairs, Norgine Ltd., Harefield, United Kingdom
| | - Raf Bisschops
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, TARGID, KU Leuven, Belgium
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46
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Affiliation(s)
- Linda Rabeneck
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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47
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Burr NE, Derbyshire E, Taylor J, Whalley S, Subramanian V, Finan PJ, Rutter MD, Valori R, Morris EJA. Variation in post-colonoscopy colorectal cancer across colonoscopy providers in English National Health Service: population based cohort study. BMJ 2019; 367:l6090. [PMID: 31722875 PMCID: PMC6849511 DOI: 10.1136/bmj.l6090] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To quantify post-colonoscopy colorectal cancer (PCCRC) rates in England by using recent World Endoscopy Organisation guidelines, compare incidence among colonoscopy providers, and explore associated factors that could benefit from quality improvement initiatives. DESIGN Population based cohort study. SETTING National Health Service in England between 2005 and 2013. POPULATION All people undergoing colonoscopy and subsequently diagnosed as having colorectal cancer up to three years after their investigation (PCCRC-3yr). MAIN OUTCOME MEASURES National trends in incidence of PCCRC (within 6-36 months of colonoscopy), univariable and multivariable analyses to explore factors associated with occurrence, and funnel plots to measure variation among providers. RESULTS The overall unadjusted PCCRC-3yr rate was 7.4% (9317/126 152), which decreased from 9.0% in 2005 to 6.5% in 2013 (P<0.01). Rates were lower for colonoscopies performed under the NHS bowel cancer screening programme (593/16 640, 3.6%), while they were higher for those conducted by non-NHS providers (187/2009, 9.3%). Rates were higher in women, in older age groups, and in people with inflammatory bowel disease or diverticular disease, in those with higher comorbidity scores, and in people with previous cancers. Substantial variation in rates among colonoscopy providers remained after adjustment for case mix. CONCLUSIONS Wide variation exists in PCCRC-3yr rates across NHS colonoscopy providers in England. The lowest incidence was seen in colonoscopies performed under the NHS bowel cancer screening programme. Quality improvement initiatives are needed to address this variation in rates and prevent colorectal cancer by enabling earlier diagnosis, removing premalignant polyps, and therefore improving outcomes.
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Affiliation(s)
- Nicholas E Burr
- Cancer Epidemiology Group, Institute of Cancer and Pathology and Institute of Data Analytics, University of Leeds, Leeds LS2 9JT, UK
- Mid Yorkshire Hospitals NHS Trust, Pinderfields General Hospital, Wakefield, UK
| | - Edmund Derbyshire
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John Taylor
- Cancer Epidemiology Group, Institute of Cancer and Pathology and Institute of Data Analytics, University of Leeds, Leeds LS2 9JT, UK
| | - Simon Whalley
- Cancer Epidemiology Group, Institute of Cancer and Pathology and Institute of Data Analytics, University of Leeds, Leeds LS2 9JT, UK
| | | | - Paul J Finan
- Cancer Epidemiology Group, Institute of Cancer and Pathology and Institute of Data Analytics, University of Leeds, Leeds LS2 9JT, UK
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK
| | - Matthew D Rutter
- University Hospital of North Tees, Hardwick, Stockton on Tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Roland Valori
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Eva J A Morris
- Cancer Epidemiology Group, Institute of Cancer and Pathology and Institute of Data Analytics, University of Leeds, Leeds LS2 9JT, UK
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