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Uebel L, Kromodikoro I, Nyhlin N, van Nieuwenhoven M. Colorectal Cancer Fast Tracks: Cancer Yield and the Predictive Value of Entry Criteria. Cancers (Basel) 2023; 15:4778. [PMID: 37835472 PMCID: PMC10571709 DOI: 10.3390/cancers15194778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/13/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Fast-track pathways for diagnosing colorectal cancer (CRC) have been implemented in several European countries. In Sweden, a substantial number of CRC are diagnosed via the Swedish Standardized Course of Care for colorectal cancer (SCC-CRC). We evaluated the SCC-CRC in terms of CRC yield, and predictive values and odds ratios (OR) for the entry criteria. METHODS We retrospectively analyzed all 2539 patients referred for SCC-CRC colonoscopy between September 2016 and December 2020. Entry criteria and colonoscopy outcomes were analyzed. RESULTS CRC yield was 16.4%. Highest positive predictive values (PPVs) were seen for abnormal radiology (PPV 30.5%, OR 4.7 (95% CI 3.4-6.4) p < 0.001), abnormal rectal examination (PPV 28%, OR 3.6 (95% CI 2.7-4.8) p < 0.001), and anemia (PPV 24.8%, OR 2.2 (95% CI 1.5-3.1) p < 0.001). Some entry criteria showed no significant risk increase, i.e., visible blood in stool/rectal bleeding, change in bowel habits, and the combination of changed bowel habits plus anemia. A positive fecal immunochemical test (FIT), although not part of the SCC-CRC, showed the highest OR: 9.9 (95% CI 4.5-21.7) p < 0.001) and PPV of 18.8%. CONCLUSIONS CRC yield from the SCC-CRC is slightly higher compared to other European fast tracks. A number of entry criteria showed no benefit towards assessing CRC risk. FIT testing should be included in CRC fast tracks to increase diagnostic efficacy.
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Affiliation(s)
- Linnea Uebel
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, SE 70116 Örebro, Sweden; (L.U.)
| | - Indy Kromodikoro
- Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Region Örebro County, SE 70116 Örebro, Sweden; (L.U.)
| | - Nils Nyhlin
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
| | - Michiel van Nieuwenhoven
- Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden
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Aziz S, König S, Umer M, Akhter TS, Iqbal S, Ibrar M, Ur-Rehman T, Ahmad T, Hanafiah A, Zahra R, Rasheed F. Risk factor profiles for gastric cancer prediction with respect to Helicobacter pylori: A study of a tertiary care hospital in Pakistan. Artif Intell Gastroenterol 2023; 4:10-27. [DOI: 10.35712/aig.v4.i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/01/2023] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is the fourth leading cause of cancer-related deaths worldwide. Diagnosis relies on histopathology and the number of endoscopies is increasing. Helicobacter pylori (H. pylori) infection is a major risk factor.
AIM To develop an in-silico GC prediction model to reduce the number of diagnostic surgical procedures. The meta-data of patients with gastroduodenal symptoms, risk factors associated with GC, and H. pylori infection status from Holy Family Hospital Rawalpindi, Pakistan, were used with machine learning.
METHODS A cohort of 341 patients was divided into three groups [normal gastric mucosa (NGM), gastroduodenal diseases (GDD), and GC]. Information associated with socioeconomic and demographic conditions and GC risk factors was collected using a questionnaire. H. pylori infection status was determined based on urea breath test. The association of these factors and histopathological grades was assessed statistically. K-Nearest Neighbors and Random Forest (RF) machine learning models were tested.
RESULTS This study reported an overall frequency of 64.2% (219/341) of H. pylori infection among enrolled subjects. It was higher in GC (74.2%, 23/31) as compared to NGM and GDD and higher in males (54.3%, 119/219) as compared to females. More abdominal pain (72.4%, 247/341) was observed than other clinical symptoms including vomiting, bloating, acid reflux and heartburn. The majority of the GC patients experienced symptoms of vomiting (91%, 20/22) with abdominal pain (100%, 22/22). The multinomial logistic regression model was statistically significant and correctly classified 80% of the GDD/GC cases. Age, income level, vomiting, bloating and medication had significant association with GDD and GC. A dynamic RF GC-predictive model was developed, which achieved > 80% test accuracy.
CONCLUSION GC risk factors were incorporated into a computer model to predict the likelihood of developing GC with high sensitivity and specificity. The model is dynamic and will be further improved and validated by including new data in future research studies. Its use may reduce unnecessary endoscopic procedures. It is freely available.
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Affiliation(s)
- Shahid Aziz
- Patients Diagnostic Lab, Isotope Application Division, Pakistan Institute of Nuclear Science and Technology, Islamabad 44000, Pakistan
- Department of Microbiology, Quaid-i-Azam University, Islamabad 45320, Pakistan
- Interdisciplinary Center for Clinical Research, Core Unit Proteomics, University of Münster, Münster 48149, Germany
| | - Simone König
- Interdisciplinary Center for Clinical Research, Core Unit Proteomics, University of Münster, Münster 48149, Germany
| | - Muhammad Umer
- Management Information System Division, Pakistan Institute of Nuclear Science and Technology, Islamabad 44000, Pakistan
| | - Tayyab Saeed Akhter
- Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi 46300, Pakistan
| | - Shafqat Iqbal
- Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi 46300, Pakistan
| | - Maryum Ibrar
- Pakistan Scientific and Technological Information Centre, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Tofeeq Ur-Rehman
- Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Tanvir Ahmad
- Patients Diagnostic Lab, Isotope Application Division, Pakistan Institute of Nuclear Science and Technology, Islamabad 44000, Pakistan
| | - Alfizah Hanafiah
- Faculty of Medicine, Department of Medical Microbiology and Immunology, Universiti Kebangsan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Rabaab Zahra
- Department of Microbiology, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Faisal Rasheed
- Patients Diagnostic Lab, Isotope Application Division, Pakistan Institute of Nuclear Science and Technology, Islamabad 44000, Pakistan
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Emara MH, Zaghloul M, Abdel-Gawad M, Makhlouf NA, Abdelghani M, Abdeltawab D, Mahros AM, Bekhit A, Behl NS, Mostafa S, Piscoya A, Abd-Elsalam S, Alboraie M. Effect of COVID-19 on gastrointestinal endoscopy practice: a systematic review. Ann Med 2022; 54:2875-2884. [PMID: 36369765 PMCID: PMC9665076 DOI: 10.1080/07853890.2022.2133163] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the emergence of the novel corona virus (SARS-Cov-2) in the late 2019 and not only the endoscopy practice and training but also the health care systems around the globe suffers. This systematic review focused the impact of Corona Virus Disease (COVID-19) on the endoscopy practice. METHODS A web search of different databases combining different search terms describing the endoscopy practice and the COVID-19 pandemic was done. Articles were screened for selection of relevant articles in two steps: title and abstract step and full-text screening step, by two independent reviewers and any debate was solved by a third reviewer. RESULTS Final studies included in qualitative synthesis were 47. The data shown in the relevant articles were evident for marked reduction in the volume of endoscopy, marked affection of colorectal cancer screening, impairments in the workflow, deficiency in personal protective equipment (PPE) and increased likelihood of catching the infection among both the staff and the patients. CONCLUSION The main outcomes from this review are rescheduling of endoscopy procedures to be suitable with the situation of COVID-19 pandemic in each Country. Also, the endorsement of the importance of PPE use for health care workers and screening of COVID-19 infection pre-procedure.Key messagesThe data focussing Gastrointestinal Endoscopy and COVID-19 emerged from different areas around the globe. The data presented on the published studies were heterogeneous. However, there were remarkable reductions in the volume of GI endoscopy worldwideStaff reallocation added a burden to endoscopy practiceThere was a real risk for COVID-19 spread among both the staff and the patients.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Mariam Zaghloul
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Muhammad Abdel-Gawad
- Hepatology, Gastroenterology, and Infectious Diseases Department, Al-Azhar University, Assiut, Egypt
| | - Nahed A Makhlouf
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Abdelghani
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa Abdeltawab
- Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aya M Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Kafrelsheikh University, Kafr El-Sheikh, Egypt
| | - Ahmed Bekhit
- Department of Gastroenterology, Sharqia Health Directorate, Sharqia, Egypt
| | - Nitin S Behl
- Institute of Gastro and liver Diseases, Fortis Hospitals, Ludhiana, India
| | - Sadek Mostafa
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
| | - Alejandro Piscoya
- Department of Gastroenterology, Hospital Guillermo Kaelin De la Fuente - EsSalud, Lima, Peru.,Systematic Reviews and Meta-analysis, Clinical Practice Guidelines and Health Technology Assessments Unit, Universidad San Ignacio Loyola, Lima, Peru
| | - Sherief Abd-Elsalam
- Tropical Medicine and Infectious Diseases Department, Tanta University, Tanta, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo, Egypt
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Calcara C, Ciscato C, Amato A, Sinagra E, Alvisi C, Ardizzone S, Anderloni A, Gambitta P. Impact of the COVID-19 Outbreak on Anesthesiologist Assistance for Endoscopic Procedures. Clin Endosc 2022; 55:49-57. [PMID: 35135178 PMCID: PMC8831403 DOI: 10.5946/ce.2021.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak has modified the activities of endoscopy units worldwide. Herein, we investigated the impact of the COVID-19 outbreak on anesthesiologist assistance for endoscopic procedures in Lombardy, Italy.
Methods: A questionnaire concerning anesthesiologist assistance provided from October 26 to December 6, 2020, in comparison with the same period in 2019, was sent to endoscopic units in Lombardy.
Results: Approximately 54% (34/63) of the units responded. A reduction in the number of all endoscopies (-33.5%; 18792 in 2020 vs. 28264 in 2019) and anesthesiologist-assisted endoscopies (-15.3%; 2652 in 2020 vs. 3132 in 2019) was reported. A greater reduction in anesthesiologist assistance was observed in government community units (-29.5%) than in academic (-14%) and private community units (-4.6%). Among all units, 85% reported a reduction in anesthesiologist assistance; 65% observed a delay/cancellation of procedures; 59%, a restricted patient selection; 17%, the need to transfer some patients to other hospitals; and 32%, a related worsening of procedure quality. Conclusion: The COVID-19 pandemic compromised the anesthesiologist assistance for endoscopic procedures in Lombardy, which worsened the procedure quality mainly in government community units. The COVID-19 “stress test” suggests a more balanced allocation of anesthesiologic resources in the future.
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Affiliation(s)
- Calcedonio Calcara
- Endoscopy Unit, ASST Ovest Milanese, Magenta, Milan, Italy
- Correspondence: Calcedonio Calcara Ospedale Giuseppe Fornaroli, ASST Ovest Milanese Via al Donatore di Sangue, 50, Magenta, Milan 20013, Italy Tel: +39-02-979631, Fax: +39-02-97963437, E-mail:
| | - Camilla Ciscato
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
| | - Arnaldo Amato
- Gastroenterology Division, Valduce Hospital, Como, Italy
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Institute Foundation G. Giglio, Cefalù, Palermo, Italy
| | - Costanza Alvisi
- Endoscopy Unit, Voghera and Vigevano Hospitals-ASST Pavia, Pavia, Italy
| | - Sandro Ardizzone
- Gastroenterology and Endoscopy Unit, Fatebenefratelli-Sacco ASST, Milan, Italy
| | - Andrea Anderloni
- Division of Gastroenterology and Digestive Endoscopy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pietro Gambitta
- Endoscopy Unit, ASST Ovest Milanese, Magenta, Milan, Italy
- Gastroenterology and Digestive Endoscopy Unit, ASST Ovest Milanese, Legnano, Milan, Italy
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Novakova K, Falt P, Navratil V, Halek M, Vetesnik M, Slodicka P, Sauer P, Kolar M, Havlik R, Zapletalova J, Urban O. Routine SARS-CoV-2 RT-PCR testing before digestive endoscopy during the peak of the pandemic - a single tertiary center experience. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 165:380-385. [PMID: 34782795 DOI: 10.5507/bp.2021.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/04/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND AIMS COVID-19 pandemic has impacted on all endoscopy centers in the Czech Republic, that belongs to the most affected countries in the world. The aim of our study was to analyze all procedures following routine RT-PCR testing in our tertiary center during the peak of the pandemic. METHODS We retrospectively analyzed all procedures performed from October 2020 to January 2021 after a new RT-PCR center had been set up. Main outcomes were type of scheduled procedure, indication, rate of therapeutic interventions and rate of new relevant and malignant findings. Comparison to the same period before the pandemic and SARS-CoV-2 infection in endoscopy staff are also reported. RESULTS A total of 1,953 procedures were performed. 624 patients were referred with a negative RT-PCR test and the remaining 1,346 patients were tested in the new center. 1,293 negative tests led to 1,329 procedures. A new relevant finding was reported in 589 (44.3%), including new malignancy in 56 (4.2%). 53 patients tested positive (3.9%). There was a reduction by 9% in the number of all procedures compared to the same period before the pandemic and an increase in the number of screening colonoscopies and ERCP procedures. In the study period, 9 of 54 staff members contracted SARS-CoV-2 infection. CONCLUSIONS Routine RT-PCR testing of patients scheduled for elective endoscopy during the peak of COVID-19 pandemic enabled us to essentially maintain our unit productivity, including activities such as screening colonoscopy, endoscopic resection and pancreatobiliary endoscopy.
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Affiliation(s)
- Karolina Novakova
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
| | - Premysl Falt
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
| | - Vit Navratil
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
| | - Matej Halek
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
| | - Marek Vetesnik
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
| | - Peter Slodicka
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
| | - Pavel Sauer
- Department of Microbiology, University Hospital Olomouc, Czech Republic
| | - Milan Kolar
- Department of Microbiology, University Hospital Olomouc, Czech Republic
| | - Roman Havlik
- Department of Surgery I, University Hospital Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentristy, Palacky University Olomouc, Czech Republic
| | - Ondrej Urban
- Department of Internal Medicine II - Gastroenterology and Hepatology, University Hospital Olomouc, Czech Republic
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Hesary FB, Salehiniya H. The Impact of the COVID-19 Epidemic on Diagnosis, Treatment, Concerns, Problems, and Mental Health in Patients with Gastric Cancer. J Gastrointest Cancer 2021; 53:797-804. [PMID: 34519975 PMCID: PMC8438101 DOI: 10.1007/s12029-021-00692-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION COVID-19 epidemic has had different effects on many diseases, including gastric cancer. Due to COVID-19 epidemic the importance of knowing the effects of the epidemic in patients to deal with it, the present study aimed to investigate the effect of COVID-19 on the diagnosis, treatment, concerns, problems, and mental health of patients with gastric cancer. METHODS The present study was a systematic review by searching the PubMed, Scopus, and Web of Science databases with the keywords of COVID-19 and gastric cancer. The articles that addressed any aspect of COVID-19 epidemic on diagnosis, treatment, problems, and mental health in patients with gastric cancer were included; the data were qualitatively summarized and presented in related tables. RESULTS A total 22 articles were included. The effects of COVID-19 on gastric cancer were divided into four categories of the effects of COVID-19 on the diagnosis, treatment and follow-up, concerns, and problems and mental health of patients with gastric cancer. The COVID-19 epidemic has reduced the number of screenings, altered treatment, and delayed or discontinued treatment, which caused problems and concerns such as sleep disturbances and stress. CONCLUSION Considering the effects of COVID-19 epidemic on gastric cancer and on the other hand, the continuation of the epidemic in the society, it is necessary for the officials and experts of the health system to design and implement necessary interventions to minimize the negative effects of epidemic on patients with gastric cancer.
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Affiliation(s)
- Fatemeh Baghernezhad Hesary
- Department of Public Health, Ghayen School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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Affiliation(s)
- Heiko Pohl
- Section of Gastroenterology, VA Medical Center, White River Junction, Vermont, United States
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