Detection of Colon Polyps in India—A Large Retrospective Cohort Study (DoCPIr)

Outcomes of endoscopic sub-mucosal dissection in laterally spreading colorectal polyps: A tertiary care centre experience from India

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.

Application of machine-learning model to optimize colonic adenoma detection in India

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).

Image-enhanced endoscopy and endoscopic resection practices in the colon among endoscopists in India

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.

Lower Gastrointestinal Bleeding

Lower 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.