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Nabi Z, Chaithanya M, Inavolu P, Ramchandani M, Reddy PM, Sayyed M, Basha J, Pal P, Sekharan A, Goud R, Reddy P, Jagtap N, Kotla R, Kalpala R, Darisetty S, Lakhtakia S, Rao GV, Tandan M, Gupta R, Devarasetti R, Rebala P, Shetty M, Reddy DN. Outcomes of endoscopic sub-mucosal dissection in laterally spreading colorectal polyps: A tertiary care centre experience from India. Indian J Gastroenterol 2024:10.1007/s12664-024-01635-w. [PMID: 39090330 DOI: 10.1007/s12664-024-01635-w] [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: 03/25/2024] [Accepted: 06/12/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Endoscopic sub-mucosal dissection (ESD) is an established endoscopic modality for the management of colorectal polyps. However, there are no studies regarding the outcomes of ESD from India. In this study, we aimed at evaluating the outcomes of ESD in patients with adenomatous polyps in the colon and rectum. METHODS Data of consecutive patients who underwent ESD for colorectal polyps from 2018 to 2021 were analyzed, retrospectively. The primary outcome of the study was the technical success of ESD. The secondary outcomes included the rate of histologically complete resection (R0), adverse events and recurrence. RESULTS Seventy patients (63.5 years, 60% males) underwent ESD for polyps in colon and rectum. A majority were located in rectum (80%) and sigmoid colon (15.7%). Narrow band classification of the polyps was Japanese Narrow Band Imaging Expert Team (JNET)-2a in 50 (71.4%) and JNET-2b in 13 (18.6%) patients. ESD was technically successful in 64 (91.4%) patients using conventional technique (72.8%) and pocket or tunnelling technique (18.6%). There were no major adverse events. Histologically RO was achieved in 58 (82.8%) patients and deep sub-mucosal invasion was noted in 12 patients. At a median follow-up of 19 (interquartile range [IQR] 15-27) months, recurrence was noticed in four (5.7%) patients all of which could be managed endoscopically. CONCLUSION ESD, performed at a tertiary care centre in India, yields high rates of technical success and histologically R0, with a relatively low incidence of adverse events and recurrences.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India.
| | - Manchu Chaithanya
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Pradev Inavolu
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Mohan Ramchandani
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | | | - Mahiboob Sayyed
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Partha Pal
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Anuradha Sekharan
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Rajesh Goud
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Praveen Reddy
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Nitin Jagtap
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Rama Kotla
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Rakesh Kalpala
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | | | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Guduru Venkat Rao
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Manu Tandan
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Rajesh Gupta
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | | | - Pradeep Rebala
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - Mahesh Shetty
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Asian Institute of Gastroenterology, 6-3-661, Hyderabad, 500 082, India
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Jagtap N, Kalapala R, Rughwani H, Singh AP, Inavolu P, Ramchandani M, Lakhtakia S, Manohar Reddy P, Sekaran A, Tandan M, Nabi Z, Basha J, Gupta R, Memon SF, Venkat Rao G, Sharma P, Nageshwar Reddy D. Application of machine-learning model to optimize colonic adenoma detection in India. Indian J Gastroenterol 2024:10.1007/s12664-024-01530-4. [PMID: 38758433 DOI: 10.1007/s12664-024-01530-4] [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: 09/19/2023] [Accepted: 01/05/2024] [Indexed: 05/18/2024]
Abstract
AIMS There is limited data on the prevalence and risk factors of colonic adenoma from the Indian sub-continent. We aimed at developing a machine-learning model to optimize colonic adenoma detection in a prospective cohort. METHODS All consecutive adult patients undergoing diagnostic colonoscopy were enrolled between October 2020 and November 2022. Patients with a high risk of colonic adenoma were excluded. The predictive model was developed using the gradient-boosting machine (GBM)-learning method. The GBM model was optimized further by adjusting the learning rate and the number of trees and 10-fold cross-validation. RESULTS Total 10,320 patients (mean age 45.18 ± 14.82 years; 69% men) were included in the study. In the overall population, 1152 (11.2%) patients had at least one adenoma. In patients with age > 50 years, hospital-based adenoma prevalence was 19.5% (808/4144). The area under the receiver operating curve (AUC) (SD) of the logistic regression model was 72.55% (4.91), while the AUCs for deep learning, decision tree, random forest and gradient-boosted tree model were 76.25% (4.22%), 65.95% (4.01%), 79.38% (4.91%) and 84.76% (2.86%), respectively. After model optimization and cross-validation, the AUC of the gradient-boosted tree model has increased to 92.2% (1.1%). CONCLUSIONS Machine-learning models may predict colorectal adenoma more accurately than logistic regression. A machine-learning model may help optimize the use of colonoscopy to prevent colorectal cancers. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT04512729).
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Affiliation(s)
- Nitin Jagtap
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India.
| | - Rakesh Kalapala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Hardik Rughwani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Aniruddha Pratap Singh
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Pradev Inavolu
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Mohan Ramchandani
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Sundeep Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - P Manohar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Anuradha Sekaran
- Department of Pathology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Zaheer Nabi
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Jahangeer Basha
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - Sana Fathima Memon
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
| | - G Venkat Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500 082, India
| | - Prateek Sharma
- The University of Kansas Medical Center, Kansas City, KS, USA
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, 500 082, India
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Sundaram S, Giri S, Jearth V, Vizhi N K, Yelsangikar A, Bhat N. Image-enhanced endoscopy and endoscopic resection practices in the colon among endoscopists in India. Endosc Int Open 2022; 10:E1181-E1187. [PMID: 36118641 PMCID: PMC9473856 DOI: 10.1055/a-1914-6197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background and study aims Clinical practice patterns for image-enhanced endoscopy (IEE) and colonic endoscopic resection practices vary among endoscopists. We conducted a survey to understand the differences in IEE and colonoscopic resection practices among endoscopists from India. Methods An online cross-sectional survey comprising 40 questions regarding quality control of colonoscopy, IEE, and colonic endoscopic resection practices was circulated through the registry of the Indian Society of Gastroenterology and Association of Colon and Rectal Surgeons of India. Participation was voluntary and response to all questions was compulsory. Results There were 205 respondents to the survey (93.2 % gastroenterologists, 90.2 % male, 54.6 % aged 30 to 40 years, 36.1 % working in academic institution, 36.1 % working in corporate hospitals). Of the endoscopists, 50.7 % had no training in IEE and 10.7 % performed endoscopy on systems without any IEE modalities. Endoscopists with more experience were more likely to use IEE modalities in practice routinely ( P = 0.007). Twenty percent never used IEE to classify polyps. Sixty percent of respondents did not use dye-chromoendoscopy. Less experienced endoscopists used viscous solutions as submucosal injectate ( P = 0.036) more often. Of the respondents, 44 % never tattooed the site of endoscopic resection. Ablation of edges post-endoscopic mucosal resection was not done by 25.5 % respondents. Most respondents used electronic chromoendoscopy (36.1 %) or random four-quadrant sampling (35.6 %) for surveillance in inflammatory bowel disease. Surveillance post-endoscopic resection was done arbitrarily by 24 % respondents at 6 months to 1 year. Conclusions There are several lacunae in the practice of IEE and colonic endoscopic resection among endoscopists, with need for programs for privileging, credentialing and proctoring these endoscopic skills.
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Affiliation(s)
- Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai
| | - Suprabhat Giri
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Kayal Vizhi N
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
| | - Amit Yelsangikar
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
| | - Naresh Bhat
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
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Jagtap N, Reddy DN, Tandan M. Lower Gastrointestinal Bleeding. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1742694] [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: 10/18/2022] Open
Abstract
AbstractLower gastrointestinal (LGI) bleeding indicates bleeding from colon or anorectum. Typically, patients with LGI bleeding present with bright red blood per rectum or hematochezia, although rarely they can present with melena as well. Alternatively, LGI bleeding is also defined as bleeding from a source within potential reach of a colonoscope, that is, colon and terminal ileum. LGI bleedings have more favorable outcomes than upper GI (UGI) bleeding and less common than UGI bleeding. Any patient presenting with GI bleeding should undergo a detailed history and physical examination for clues that may suggest source and possible etiology. Colonoscopy remains the most widely used and preferred instrument of choice for both diagnosis and therapy. This review will discuss in brief the causes, triaging, and role of colonoscopy in the management of LGI bleeding.
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Affiliation(s)
- Nitin Jagtap
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - D. Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Manu Tandan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
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