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Adán Merino L, Mora Soler AM, Ponferrada Díaz Á. [Surveillance recommendations after endoscopic resection of colorectal polyps]. Med Clin (Barc) 2024; 163:143-148. [PMID: 38849270 DOI: 10.1016/j.medcli.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Luisa Adán Merino
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España.
| | - Ana María Mora Soler
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
| | - Ángel Ponferrada Díaz
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
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Meester RG, Lansdorp-Vogelaar I, Winawer SJ, Church TR, Allen JI, Feld AD, Mills G, Jordan PA, Corley DA, Doubeni CA, Hahn AI, Lobaugh SM, Fleisher M, O’Brien MJ, Zauber AG. Projected Colorectal Cancer Incidence and Mortality Based on Observed Adherence to Colonoscopy and Sequential Stool-Based Screening. Am J Gastroenterol 2024; 119:1392-1401. [PMID: 38318949 PMCID: PMC11222052 DOI: 10.14309/ajg.0000000000002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Modeling supporting recommendations for colonoscopy and stool-based colorectal cancer (CRC) screening tests assumes 100% sequential participant adherence. The impact of observed adherence on the long-term effectiveness of screening is unknown. We evaluated the effectiveness of a program of screening colonoscopy every 10 years vs annual high-sensitivity guaiac-based fecal occult blood testing (HSgFOBT) using observed sequential adherence data. METHODS The MIcrosimulation SCreening ANalysis (MISCAN) model used observed sequential screening adherence, HSgFOBT positivity, and diagnostic colonoscopy adherence in HSgFOBT-positive individuals from the National Colonoscopy Study (single-screening colonoscopy vs ≥4 HSgFOBT sequential rounds). We compared CRC incidence and mortality over 15 years with no screening or 10 yearly screening colonoscopy vs annual HSgFOBT with 100% and differential observed adherence from the trial. RESULTS Without screening, simulated incidence and mortality over 15 years were 20.9 (95% probability interval 15.8-26.9) and 6.9 (5.0-9.2) per 1,000 participants, respectively. In the case of 100% adherence, only screening colonoscopy was predicted to result in lower incidence; however, both tests lowered simulated mortality to a similar level (2.1 [1.6-2.9] for screening colonoscopy and 2.5 [1.8-3.4] for HSgFOBT). Observed adherence for screening colonoscopy (83.6%) was higher than observed sequential HSgFOBT adherence (73.1% first round; 49.1% by round 4), resulting in lower simulated incidence and mortality for screening colonoscopy (14.4 [10.8-18.5] and 2.9 [2.1-3.9], respectively) than HSgFOBT (20.8 [15.8-28.1] and 3.9 [2.9-5.4], respectively), despite a 91% adherence to diagnostic colonoscopy with FOBT positivity. The relative risk of CRC mortality for screening colonoscopy vs HSgFOBT was 0.75 (95% probability interval 0.68-0.80). Findings were similar in sensitivity analyses with alternative assumptions for repeat colonoscopy, test performance, risk, age, and projection horizon. DISCUSSION Where sequential adherence to stool-based screening is suboptimal and colonoscopy is accessible and acceptable-as observed in the national colonoscopy study, microsimulation, comparative effectiveness, screening recommendations.
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Affiliation(s)
| | | | - Sidney J. Winawer
- Gastroenterology, Hepatology, and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Timothy R. Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, and Masonic Cancer Center, Minneapolis, MN, United States
| | - John I. Allen
- Gastroenterology and Hepatology, University of Michigan School of Medicine
| | - Andrew D. Feld
- Gastroenterology Clinic, Kaiser Permanente Washington (KPWA), Seattle, WA, United States
| | - Glenn Mills
- Feist-Weiller Cancer Center, Health Department, Louisiana State University, Shreveport, LA, United States
| | - Paul A. Jordan
- Feist-Weiller Cancer Center, Health Department, Louisiana State University, Shreveport, LA, United States
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente, San Francisco, CA, United States
| | | | - Anne I. Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Stephanie M. Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Martin Fleisher
- Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Michael J. O’Brien
- Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Hori H, Ikezawa N, Tanaka S, Ueda C, Fujisawa M, Hoki S, Tanabe H, Ishida R, Okamoto N, Takayama H, Miyazaki H, Sakaguchi H, Kinoshita M, Abe H, Yoshizaki T, Ooi M, Takao M, Morita Y, Toyonaga T, Kodama Y. Efficacy and safety of same-day preparation with sodium picosulfate plus magnesium citrate on the day of colonoscopy for bowel preparation: Multicenter, single-arm, open-label study. J Gastroenterol Hepatol 2024. [PMID: 38899400 DOI: 10.1111/jgh.16660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/30/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND AND AIM Sodium picosulfate plus magnesium citrate (SP + MC) is a well-tolerated bowel preparation agent. However, Japan currently approves only two methods of taking SP + MC: the day-before and split-dose preparation, without approval of same-day preparations. This study aimed to evaluate the efficacy and safety of same-day SP + MC preparations. METHODS This was a multicenter, single-arm, nonrandomized, open-label study. We enrolled 145 Japanese patients between June and December 2023. The patients received two sachets of SP + MC dissolved in 300 ml of water and 1200 mL or more of clear liquid on the day of colonoscopy. Bowel cleansing efficacy, adverse events (AEs), and patient satisfaction were evaluated. RESULTS Of the enrolled patients, 137 underwent colonoscopy according to our protocol. Bowel preparation was adequate in 133 patients (97.1%). The mean total Boston Bowel Preparation Score was 8.3 ± 1.2. Five patients experienced AEs (3.6%): two (1.5%), abdominal pain; one (0.73%), ischemic enteritis; one (0.73%), vomiting or nausea; and one (0.73%), headache. All AEs were treated conservatively. None of the patients exhibited abnormal blood test results or clinical symptoms after receiving SP + MC. Regarding patient satisfaction, all patients were able to take SP + MC as directed; 136 (99.2%) expressed a preference for this bowel preparation for future colonoscopies. CONCLUSION The same-day SP + MC preparation showed high bowel-cleansing efficacy and satisfaction in Japanese patients without serious AEs.
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Affiliation(s)
- Hitomi Hori
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Gastroenterology, International Clinical Cancer Research Center, Kobe University, Kobe, Japan
| | - Nobuaki Ikezawa
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinwa Tanaka
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
- Department of Endoscopy, Tanaka Clinic, Kobe, Japan
| | - Chise Ueda
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mizuho Fujisawa
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hoki
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Tanabe
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Ishida
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Norihiro Okamoto
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Takayama
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Gastroenterology, International Clinical Cancer Research Center, Kobe University, Kobe, Japan
| | - Haruka Miyazaki
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroya Sakaguchi
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Kinoshita
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirofumi Abe
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuya Yoshizaki
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Ooi
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Madoka Takao
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Gastroenterology, International Clinical Cancer Research Center, Kobe University, Kobe, Japan
| | - Yoshinori Morita
- Division of Gastroenterology, International Clinical Cancer Research Center, Kobe University, Kobe, Japan
- Department of Endoscopy, Kobe University Hospital, Kobe, Japan
| | | | - Yuzo Kodama
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
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Jacobsson M, Wagner V, Kanneganti S. Screening for Colorectal Cancer. Surg Clin North Am 2024; 104:595-607. [PMID: 38677823 DOI: 10.1016/j.suc.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Colorectal cancer remains the third leading cause of cancer death in the United States. Colorectal cancer screening allows for prevention and early detection of precancerous and cancerous lesions, and screening has been shown to be effective in preventing colorectal cancer deaths. Screening recommendations vary by patient risk profile. A variety of screening modalities exist.
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Affiliation(s)
- Matthew Jacobsson
- Virginia Mason Franciscan Health, St. Joseph Medical Center General Surgery Residency, 1708 South Yakima Avenue Suite 105 & 112, Tacoma, WA 98408, USA
| | - Vitas Wagner
- Virginia Mason Franciscan Health, St. Joseph Medical Center General Surgery Residency, 1708 South Yakima Avenue Suite 105 & 112, Tacoma, WA 98408, USA
| | - Shalini Kanneganti
- Virginia Mason Franciscan Health, Franciscan Surgical Associates at St. Joseph, 1708 South Yakima Avenue Suite 105 & 112, Tacoma, WA 98405, USA.
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Majumdar D, Bevan R, Essam M, Nickerson C, Hungin P, Bramble M, Rutter MD. Adenoma characteristics in the English Bowel Cancer Screening Programme. Colorectal Dis 2024; 26:643-649. [PMID: 38433121 DOI: 10.1111/codi.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 03/05/2024]
Abstract
AIM The English Bowel Cancer Screening Programme detects colorectal cancers and premalignant polyps in a faecal occult blood test-positive population. The aim of this work is to describe the detection rates and characteristics of adenomas within the programme, identify predictive factors influencing the presence or absence of carcinoma within adenomas and identify the factors predicting the presence of advanced colonic neoplasia in different colon segments. METHOD The Bowel Cancer Screening System was retrospectively searched for polyps detected during colonoscopies between June 2006 and June 2012, at which time a guaiac test was being used. Data on size, location and histological features were collected, and described. Univariate and multivariate analyses were used to determine the significant factors influencing the development of carcinoma within an adenoma. RESULTS A total of 229 419 polyps were identified; after exclusions 136 973 adenomas from 58 334 patients were evaluated. Over half were in the rectum or sigmoid colon. Subcentimetre adenomas accounted for 69.8% of the total. The proportion of adenomas containing advanced histological features increased with increasing adenoma size up to 35 mm, then plateaued. A focus of carcinoma was found in 2282 (1.7%) adenomas, of which 95.6% were located distally. Carcinoma was identified even in diminutive adenomas (0.1%). The proportion of adenomas containing cancer was significantly higher in women than men (2.0% vs. 1.5%, p < 0.001). CONCLUSION This national, prospectively captured dataset adds robust information about histological features of adenomas that convey an increased risk for colorectal cancer, and identifies caecal adenomas, high-grade dysplasia, increasing adenoma size, distal location and female sex as independent risk factors associated with carcinoma.
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Affiliation(s)
| | - Roisin Bevan
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-tees, UK
| | - Mahmoud Essam
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-tees, UK
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Pali Hungin
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Mike Bramble
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-tees, UK
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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Ishibashi F, Suzuki S, Tanaka R, Kobayashi K, Kawakami T, Nagai M, Mochida K, Morishita T. An algorithm-based active cleansing protocol can reduce the bowel preparation time for screening colonoscopy: A propensity score matching study. Saudi J Gastroenterol 2024; 30:30-36. [PMID: 37470635 PMCID: PMC10852146 DOI: 10.4103/sjg.sjg_176_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Methods that minimize the time for on-site bowel preparation before colonoscopy are needed. We prospectively validated that a novel algorithm-based active cleansing (ABAC) protocol could reduce the time for preparation compared with the conventional method. METHODS This was an open-label, multicenter, prospective comparative study from April to October 2021. The study compared the bowel preparation time for colonoscopy between patients instructed with the ABAC protocol and control groups. Patients in the ABAC protocol group as well as the control group were administered 2000 mL of polyethylene glycol (PEG) within 2 hours. After the first two hours, patients in the protocol group voluntarily took 300 ml of the solution without the instruction of nursing staff depending on the number of defecations in the first 2 hours. The intervention and control groups were adjusted for background characteristics by propensity score matching (PSM). RESULTS After adjustment by PSM, 174 patients in each of the two groups were included in the final analysis. In the intention-to-treat analysis, the preparation time was significantly shorter in the intervention group than that in the control group (126.3 ± 32.7 min vs. 144.9 ± 39.9 min, P = 0.018). The proportion of additional PEG intake was significantly higher in the intervention group (16 [9.2%] vs. 6 [3.4%], P = 0.047). The number of defecations was also higher in the intervention group than in the control group (7.8 ± 2.5 vs. 6.3 ± 2.2, P = 0.001). CONCLUSIONS Simple active instruction protocol is effective to reduce on-site bowel preparation time and nursing staff labor for colonoscopy.
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Affiliation(s)
- Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
- Koganei Tsurukame Clinic, Endoscopy Center, Tokyo, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Ryu Tanaka
- Mirraza Shinjuku Tsurukame Clinic, Tokyo, Japan
- Shinjuku Tsurukame Clinic, Digestive Disease Center, Tokyo, Japan
| | | | | | - Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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Wong MCS, Leung EYM, Chun SCC, Deng Y, Lam T, Tang RSY, Huang J. Recurrence rates of advanced colorectal neoplasia (ACN) in subjects with baseline ACN followed up at different surveillance intervals. Dig Liver Dis 2023; 55:1742-1749. [PMID: 37127494 DOI: 10.1016/j.dld.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Current clinical guidelines recommend that a baseline finding of advanced colorectal neoplasia (ACN) should be followed-up within 1-3 years. AIM We compared the recurrence rate of ACN at 1 year vs. 3 years among individuals with ACN detected and polypectomised at baseline colonoscopy. METHODS We extracted data from eligible patients in a Chinese population database from 2008 to 2018. The outcome variables included recurrence of advanced adenoma and advanced neoplasia, respectively, at follow-up colonoscopy. Binary logistic regression modeling was constructed to examine the association between length of surveillance and the outcome variables, controlling for risk factors of colorectal cancer, including age, gender, smoking, alcohol drinking, body mass index and chronic diseases. RESULTS We included 147,270 subjects who have received a baseline colonoscopy from our dataset. They were aged 69.3 years and 59.7% of them were male subjects. The crude 1-year and 3-year recurrence rate of ACN was 7.57% and 7.74%. From a binary logistic regression model, individuals with surveillance colonoscopy performed at 3 years did not have significantly higher recurrence rate of ACN than those followed-up at 1 year. CONCLUSIONS No statistically significantly difference in recurrence of ACN between individuals who received workup at 1vs. 3 years. These findings support a 3-year surveillance period after baseline ACN was polypectomised.
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Affiliation(s)
- Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; The Chinese Academy of Medical Sciences and The Peking Union Medical College, Beijing, China; The School of Public Health, The Peking University, Beijing, China
| | - Eman Yee-Man Leung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sam C C Chun
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yunyang Deng
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Thomas Lam
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR
| | - Raymond S Y Tang
- S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
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Mochida K, Ishibashi F, Suzuki S, Saito D, Kawakami T, Kobayashi K, Nagai M, Morishita T. Dietary restriction after cold snare polypectomy of colorectal polyp for prevention of delayed bleeding. JGH Open 2023; 7:777-782. [PMID: 38034048 PMCID: PMC10684975 DOI: 10.1002/jgh3.12987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 12/02/2023]
Abstract
Background and Aim Cold snare polypectomy (CSP) for small colorectal polyps is a safe technique; however, there is little evidence on whether dietary restriction after CSP is essential. This study aimed to determine whether dietary restriction after CSP is necessary to prevent delayed bleeding. Methods This is a randomized, controlled, non-inferiority trial conducted between November 2021 and March 2022. Patients with non-pedunculated small colorectal polyps (<10 mm) and who did not take anticoagulants were randomly allocated to two groups: (i) the normal diet (ND) group, and (ii) the low-residue diet (LRD) group. The ND group was instructed to eat anything after CSP, whereas the LRD group was advised to take LRD for 3 days after CSP. The primary endpoint was the occurrence of delayed major bleeding that needed endoscopic hemostasis. Results A total of 193 patients (average 57.5 years old, 51.9% male) were enrolled in the study. Subsequently, 97 and 96 patients were allocated to the ND and LRD group, respectively. The occurrence of delayed major bleeding was 1.0% in the ND group and 2.1% in the LRD group (95% confidence interval [CI]: -4.4% to 2.4%; difference: -1.1%), which showed the non-inferiority of the ND group. In addition, there was no difference between the two groups with respect to the occurrence of minor delayed bleeding (3.1% and 4.2%, respectively; difference: -1.1% [95% CI: -6.4% to 4.2%]). Conclusion Dietary restriction after CSP for low-bleeding-risk colorectal polyps is not necessary for the prevention of delayed bleeding (Registration number: UMIN000045669).
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Affiliation(s)
- Kentaro Mochida
- Department of GastroenterologyInternational University of Health and Welfare Ichikawa HospitalChibaJapan
- Endoscopy CenterKoganei Tsurukame ClinicTokyoJapan
| | - Fumiaki Ishibashi
- Department of GastroenterologyInternational University of Health and Welfare Ichikawa HospitalChibaJapan
- Endoscopy CenterKoganei Tsurukame ClinicTokyoJapan
| | - Sho Suzuki
- Department of GastroenterologyInternational University of Health and Welfare Ichikawa HospitalChibaJapan
| | - Daisuke Saito
- Endoscopy CenterKoganei Tsurukame ClinicTokyoJapan
- Department of Gastroenterology and HepatologyKyorin University School of MedicineTokyoJapan
| | | | | | - Mizuki Nagai
- Department of GastroenterologyInternational University of Health and Welfare Ichikawa HospitalChibaJapan
| | - Tetsuo Morishita
- Department of GastroenterologyInternational University of Health and Welfare Ichikawa HospitalChibaJapan
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Baile-Maxía S, Jover R. Surveillance after colorectal polyp resection. Best Pract Res Clin Gastroenterol 2023; 66:101848. [PMID: 37852710 DOI: 10.1016/j.bpg.2023.101848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 07/02/2023] [Indexed: 10/20/2023]
Abstract
Post-polypectomy surveillance has proven to reduce colorectal cancer (CRC) incidence in patients with high-risk polyps, but it implies a major burden on colonoscopy units. Therefore, it should be targeted to individuals with a higher risk. Different societies have published guidelines on surveillance after resection of polyps, with notable discrepancies among them, and many recommendations come from low-quality evidence based on surrogate measures, such as risk of advanced adenoma, and not CRC risk. In this review, we aimed to summarize the evidence supporting post-polypectomy surveillance, compare the recently updated major guidelines, and discuss the existing discrepancies on this topic. Briefly, patients with adenomas ≥10 mm or high-grade dysplasia and patients with serrated polyps ≥10 mm or dysplasia are generally considered to have an increased risk of metachronous CRC and require surveillance, whereas the indication of surveillance is not clearly established in patients without these high-risk features.
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Affiliation(s)
- Sandra Baile-Maxía
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
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10
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Nishimoto S, Kudo T, Horiuchi I, Yabe K, Kurasawa S, Horiuchi A. Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study. Medicine (Baltimore) 2023; 102:e35264. [PMID: 37746993 PMCID: PMC10519449 DOI: 10.1097/md.0000000000035264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
We investigated the effectiveness of cap-assisted colonoscopy conducted with the patient in the left lateral decubitus position at both the colonoscope's insertion and withdrawal timepoints compared to the effectiveness of colonoscopy without a cap conducted in the supine position at withdrawal. This was a case-control study, based on historical comparisons of patients over 2 time periods. The first group of patients underwent colonoscopies with a transparent cap and the patient was in the left lateral decubitus position at both the insertion and withdrawal timepoints from April to June 2019. The subsequent group underwent colonoscopies without a cap and with the patient in the supine position at withdrawal from July to September 2019. The rates of successful intubation, cecal intubation time, and number, size, shape, and location of the detected adenomas and sessile serrated lesions were compared between the 2 groups. Data from 644 colonoscopies (cap-assisted colonoscopy + left lateral decubitus position, n=320; other colonoscopies, n=324) were analyzed. The demographic characteristics and technical performances were similar. The SSL detection rate was significantly higher with cap-assisted colonoscopy and the left lateral decubitus position than with other colonoscopies (3.4% vs 0.93%, P=.029). The adenoma detection rates in the 2 groups were similar (31% and 28%, respectively, P=.43).Cap-assisted colonoscopy in the left lateral decubitus position may increase the detection rate of sessile serrated lesions compared to colonoscopy without a cap and supine position at withdrawal.
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Affiliation(s)
- Satomi Nishimoto
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ichitaro Horiuchi
- Department of Gastroenterology, Shinshu University Hospital, Matsumoto, Japan
| | - Kiyoaki Yabe
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
| | - Shingo Kurasawa
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
- Department of Pediatrics, Shinshu University Hospital, Matsumoto, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
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11
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East JE. Risk Classification After Colonoscopy and Polypectomy: Are We Always Fighting the Last War? Gastroenterology 2023; 165:333-335. [PMID: 37245590 DOI: 10.1053/j.gastro.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/23/2023] [Indexed: 05/30/2023]
Affiliation(s)
- James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, United Kingdom.
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12
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Huynh TM, Le QD, Le NQ, Le HM, Quach DT. Utility of narrow-band imaging with or without dual focus magnification in neoplastic prediction of small colorectal polyps: a Vietnamese experience. Clin Endosc 2023; 56:479-489. [PMID: 37501625 PMCID: PMC10393570 DOI: 10.5946/ce.2022.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/04/2022] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND/AIMS Accurate neoplastic prediction can significantly decrease costs associated with pathology and unnecessary colorectal polypectomies. Narrow band imaging (NBI) and dual-focus (DF) mode are promising emerging optical technologies for recognizing neoplastic features of colorectal polyps digitally. This study aimed to clarify the clinical usefulness of NBI with and without DF assistance in the neoplastic prediction of small colorectal polyps (<10 mm). METHODS This cross-sectional study included 530 small colorectal polyps from 343 consecutive patients who underwent colonoscopy at the University Medical Center from September 2020 to May 2021. Each polyp was endoscopically diagnosed in three successive steps using white-light endoscopy (WLE), NBI, and NBI-DF and retrieved for histopathological assessment. The diagnostic accuracy of each modality was evaluated with reference to histopathology. RESULTS There were 295 neoplastic polyps and 235 non-neoplastic polyps. The overall accuracies of WLE, WLE+NBI, and WLE+NBI+NBI-DF in the neoplastic prediction of colorectal polyps were 70.8%, 87.4%, and 90.8%, respectively (p<0.001). The accuracy of WLE+NBI+NBI-DF was significantly higher than that of WLE+NBI in the polyp size ≤5 mm subgroup (87.3% vs. 90.1%, p<0.001). CONCLUSION NBI improved the real-time neoplastic prediction of small colorectal polyps. The DF mode was especially useful in polyps ≤5 mm in size.
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Affiliation(s)
- Tien Manh Huynh
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center, Ho Chi Minh City, Vietnam
| | - Nhan Quang Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center, Ho Chi Minh City, Vietnam
| | - Huy Minh Le
- Department of Endoscopy, University Medical Center, Ho Chi Minh City, Vietnam
- Department of Surgical Pathology, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
- Department of Endoscopy, University Medical Center, Ho Chi Minh City, Vietnam
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13
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Hayasaka J, Yamashita S, Matsui A, Kawai Y, Ochiai Y, Okamura T, Suzuki Y, Mitsunaga Y, Nomura K, Tanaka M, Fuchinoue K, Odagiri H, Kikuchi D, Takazawa Y, Hoteya S. Safety of Cold Snare Polypectomy during Continuous Use of Antithrombotic Drugs for Delayed Post-Polypectomy Bleeding: A Pilot Study. Dig Dis 2023; 41:729-736. [PMID: 37231888 PMCID: PMC10614267 DOI: 10.1159/000531061] [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: 01/10/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Cold snare polypectomy is a high-risk endoscopic procedure with a low delayed post-polypectomy bleeding rate. However, it is unclear whether delayed post-polypectomy bleeding rates increase during continuous antithrombotic treatment. This study aimed to determine the safety of cold snare polypectomy during continuous antithrombotic treatment. METHODS This single-center, retrospective cohort study enrolled patients who underwent cold snare polypectomy during antithrombotic treatment between January 2015 and December 2021. Patients were divided into continuation and withdrawal groups based on whether they continued with antithrombotic drugs or not. Propensity score matching was performed using age, sex, Charlson comorbidity index, hospitalization, scheduled treatment, type of antithrombotic drugs used, multiple medications used, indication for antithrombotic drugs, and gastrointestinal endoscopist qualifications. The delayed polypectomy bleeding rates were compared between the groups. Delayed polypectomy bleeding was defined as the presence of blood in stools and requiring endoscopic treatment or a decrease in hemoglobin level by 2 g/dL or more. RESULTS The continuation and withdrawal groups included 134 and 294 patients, respectively. Delayed polypectomy bleeding was observed in 2 patients (1.5%) and 1 patient (0.3%) in the continuation and withdrawal groups, respectively (p = 0.23), before propensity score matching, with no significant difference. After propensity score matching, delayed polypectomy bleeding was observed in 1 patient (0.9%) in the continuation group but not in the withdrawal group, with no significant difference. CONCLUSION Cold snare polypectomy during continuous antithrombotic treatment did not significantly increase delayed post-polypectomy bleeding rates. Therefore, this procedure may be safe during continuous antithrombotic treatment.
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Affiliation(s)
| | | | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yusuke Kawai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Takayuki Okamura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yutaka Mitsunaga
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Hiroyuki Odagiri
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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14
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Boregowda U, Umapathy C, Echavarria J, Saligram S. Risk of Metachronous Neoplasia with High-Risk Adenoma and Synchronous Sessile Serrated Adenoma: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13091569. [PMID: 37174960 PMCID: PMC10177994 DOI: 10.3390/diagnostics13091569] [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: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Background: Sessile serrated adenomas are important precursors to colorectal cancers and account for 30% of colorectal cancers. The United States Multi-Society Task Force recommends that patients with sessile serrated adenomas undergo surveillance similar to tubular adenomas. However, the risk of metachronous neoplasia when the high-risk adenoma co-exists with sessile serrated adenomas is poorly defined. Objective: To examine the risk of metachronous neoplasia in the presence of high-risk adenoma and synchronous sessile serrated adenomas compared with isolated high-risk adenoma. Data sources: PubMed, Embase, Scopus, Cochrane Library. Study selection: A literature search for studies evaluating the risk of metachronous neoplasia in patients with high-risk adenoma alone and those with synchronous high-risk adenoma and sessile serrated adenomas during surveillance colonoscopy was conducted on online databases. Main outcome measures: The primary outcome of interest was the presence of metachronous neoplasia. Results: Of the 1164 records reviewed, six (four retrospective and two prospective) studies met inclusion criteria with 2490 patients (1607 males, mean age 59.98 ± 3.23 years). Average follow-up was 47.5 ± 12.5 months. There were 2068 patients with high-risk adenoma on index colonoscopy and 422 patients with high-risk adenoma and synchronous sessile serrated adenomas. Pooled estimates showed a significantly elevated risk for metachronous neoplasia in patients with high-risk adenoma and synchronous sessile serrated adenomas (pooled odds ratio 2.21; 95% confidence intervals 1.65-2.96; p < 0.01). There was low heterogeneity (I2 = 11%) among the studies. Sensitivity analysis of the prospective studies alone also showed elevated risk of metachronous neoplasm (pooled odds ratio 2.56; 95%, confidence intervals 1.05-6.23; p = 0.04). Limitations: Inclusion of a small number of retrospective studies. Conclusions: The presence of high-risk adenomas and synchronous sessile serrated adenomas is associated with an increased risk of metachronous neoplasia. Therefore, shorter surveillance intervals may be considered in patients with high-risk adenoma and synchronous sessile serrated adenomas compared to those with high-risk adenoma alone.
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Affiliation(s)
- Umesha Boregowda
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Chandraprakash Umapathy
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Juan Echavarria
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health San Antonio, San Antonio, TX 78229, USA
| | - Shreyas Saligram
- Division of Gastroenterology, Hepatology, and Nutrition, University of Texas Health San Antonio, San Antonio, TX 78229, USA
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15
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Rudnicki Y, Horesh N, Harbi A, Lubianiker B, Green E, Raveh G, Slavin M, Segev L, Gilshtein H, Khalifa M, Barenboim A, Wasserberg N, Khaikin M, Tulchinsky H, Issa N, Duek D, Avital S, White I. Rectal Cancer following Local Excision of Rectal Adenomas with Low-Grade Dysplasia-A Multicenter Study. J Clin Med 2023; 12:jcm12031032. [PMID: 36769680 PMCID: PMC9917362 DOI: 10.3390/jcm12031032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose: Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to assess the rectal cancer rate following local excision of LGD rectal lesions. Methods: A retrospective multicenter study including all patients that underwent LE for rectal polyps over a period of 11 years was conducted. Demographic, clinical, and surgical data of patients with LGD werecollected and analyzed. Results: Out of 274 patients that underwent LE of rectal lesions, 81 (30%) had a pathology of LGD. The mean patient age was 65 ± 11 years, and 52 (64%) were male. The mean distance from the anal verge was 7.2 ± 4.3 cm, and the average lesion was 3.2 ± 1.8 cm. Full thickness resection was achieved in 68 patients (84%), and four (5%) had involved margins for LGD. Nine patients (11%) had local recurrence and developed rectal cancer in an average time interval of 19.3 ± 14.5 months, with seven of them (78%) diagnosed less than two years after the initial LE. Seven of the nine patients were treated with another local excision, whilst one had a low anterior resection, and one was treated with radiation. The mean follow-up time was 25.3 ± 22.4 months. Conclusions: Locally resected rectal polyps with LGD may carry a significant risk of recurring and developing cancer within two years. This data suggests patients should have a closer surveillance protocol in place.
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Affiliation(s)
- Yaron Rudnicki
- Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
- Correspondence:
| | - Nir Horesh
- Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel
| | - Assaf Harbi
- Rambam Health Care Campus, Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Barak Lubianiker
- Rabin Medical Center-Hasharon Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel
| | - Eraan Green
- Tel Aviv Sourasky Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Guy Raveh
- Rabin Medical Center-Beilinson Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
| | - Moran Slavin
- Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
| | - Lior Segev
- Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel
| | - Haim Gilshtein
- Rambam Health Care Campus, Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Muhammad Khalifa
- Rabin Medical Center-Hasharon Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel
| | - Alexander Barenboim
- Tel Aviv Sourasky Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nir Wasserberg
- Rabin Medical Center-Beilinson Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
| | - Marat Khaikin
- Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel
| | - Hagit Tulchinsky
- Tel Aviv Sourasky Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nidal Issa
- Rabin Medical Center-Hasharon Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel
| | - Daniel Duek
- Rambam Health Care Campus, Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Shmuel Avital
- Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
| | - Ian White
- Rabin Medical Center-Beilinson Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
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16
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Cheng CL, Chen SW, Su IC, Wu CH, Kuo YL, Chien TH, Liu YY, Huang KC, Xie CH, Lee MH, Tang JH, Tsui YN, Lee BP, Liu NJ. Risk of Metachronous Advanced Colorectal Neoplasia After Removal of Diminutive Versus Small Nonadvanced Adenomas: A Multicenter Study. Dig Dis Sci 2023; 68:259-267. [PMID: 35790704 DOI: 10.1007/s10620-022-07608-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/03/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current postpolypectomy guidelines treat 1-9 mm nonadvanced adenomas (NAAs) as carrying the same level of risk for metachronous advanced colorectal neoplasia (ACRN). AIMS To evaluate whether small (6-9 mm) NAAs are associated with a greater risk of metachronous ACRN than diminutive (1-5 mm) NAAs. METHODS We retrospectively evaluated 10,060 index colonoscopies performed from July 2011 to June 2019. A total of 1369 patients aged ≥ 40 years with index NAAs and having follow-up examinations were categorized into 5 groups based on size and number of index findings: Group 1, ≤ 2 diminutive NAAs (n = 655); Group 2, ≤ 2 small NAAs (n = 529); Group 3, 3-4 diminutive NAAs (n = 78); Group 4, 3-4 small NAAs (n = 65); and Group 5, 5-10 NAAs (n = 42). Size was classified based on the largest NAA. ACRN was defined as finding an advanced adenoma or colorectal cancer at follow-up. RESULTS The absolute risk of metachronous ACRN increased from 7.2% in patients with all diminutive NAAs to 12.2% in patients with at least 1 small NAA (P = 0.002). Patients in Group 2 (adjusted odds ratio [AOR] 1.89; 95% confidence interval [CI], 1.21-2.95), Group 3 (AOR 2.40; 95% CI 1.78-4.90), Group 4 (AOR 2.77; 95% CI 1.35-5.66), and Group 5 (AOR 3.71; 95% CI 1.65-8.37) were associated with an increased risk of metachronous ACRN compared with Group 1. CONCLUSIONS Patients with small NAAs have an increased risk of metachronous ACRN. Postpolypectomy guidelines should consider including risk stratification between small and diminutive adenomas.
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Affiliation(s)
- Chi-Liang Cheng
- Division of Gastroenterology, Evergreen General Hospital, 150 Huan-Zhong East Road, Zhongli District, Taoyuan, 320, Taiwan, ROC.
| | - Shuo-Wei Chen
- Division of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, 222 Maijin Road, Keelung, 204, Taiwan, ROC.,School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - I-Chia Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 252 Wuxing Street, Xinyi District, Taipei, 110, Taiwan, ROC
| | - Chi-Huang Wu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, ROC
| | - Yen-Lin Kuo
- Division of Gastroenterology, Evergreen General Hospital, 150 Huan-Zhong East Road, Zhongli District, Taoyuan, 320, Taiwan, ROC
| | - Tsuo-Hsuan Chien
- Division of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, 222 Maijin Road, Keelung, 204, Taiwan, ROC
| | - Yuh-Ying Liu
- Division of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, 222 Maijin Road, Keelung, 204, Taiwan, ROC
| | - Kuang-Chen Huang
- Division of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, 222 Maijin Road, Keelung, 204, Taiwan, ROC
| | - Cheng-Han Xie
- Division of Gastroenterology and Hepatology, Keelung Chang Gung Memorial Hospital, 222 Maijin Road, Keelung, 204, Taiwan, ROC
| | - Mu-Hsien Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, ROC
| | - Jui-Hsiang Tang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, 252 Wuxing Street, Xinyi District, Taipei, 110, Taiwan, ROC
| | - Yi-Ning Tsui
- Division of Gastroenterology, Evergreen General Hospital, 150 Huan-Zhong East Road, Zhongli District, Taoyuan, 320, Taiwan, ROC
| | - Bai-Ping Lee
- Division of Gastroenterology, Evergreen General Hospital, 150 Huan-Zhong East Road, Zhongli District, Taoyuan, 320, Taiwan, ROC
| | - Nai-Jen Liu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC.,Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, ROC
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17
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Gashi Z, Sherifi F, Komoni F. Ball Valve Syndrome is caused by Colon Polyp. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.11043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND: Intestinal obstruction caused by ball valve syndrome, is a potentially lethal pathology. This case report will show ball valve syndrome in the large intestine (mechanical obstruction) and endoscopic treatment.
CASE PRESENTATION: Our patient presented with abdominal pain and with intestinal obstruction-ileus. After colonoscopic examination was noticed, a large precancerous pedunculated polyp obstructed of large intestine due to ball valve effect. Mechanical obstruction was removed with endoscopic polypectomy.
CONCLUSION: Endoscopic polypectomy must first be performed and if does not succeed, then indicated surgical interventions.
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18
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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19
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Kapinos KA, Halm EA, Murphy CC, Santini NO, Loewen AC, Skinner CS, Singal AG. Cost Effectiveness of Mailed Outreach Programs for Colorectal Cancer Screening: Analysis of a Pragmatic, Randomized Trial. Clin Gastroenterol Hepatol 2022; 20:2383-2392.e4. [PMID: 35144024 PMCID: PMC9357235 DOI: 10.1016/j.cgh.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Clinical guidelines for colorectal cancer (CRC) screening suggest use of either stool-based tests or colonoscopy - modalities that differ in recommended screening intervals, adherence, and costs. We know little about the long-term cost differences in population-health outreach strategies to promote these strategies. METHODS We conducted a cost-effectiveness analysis to compare 2 mailed outreach strategies to increase CRC screening from a pragmatic, randomized clinical trial: mailed fecal immunochemical test (FIT) kits vs invitations to complete a screening colonoscopy. We built a 10-year Markov chain Monte Carlo microsimulation model to account for differences in screening intervals, adherence, and costs. RESULTS Mailed FIT kits had a lower 10-year average per-person cost of screening relative to colonoscopy invitations ($1139 vs $1725) but with 10.89 fewer months of compliance and 60 fewer advanced neoplasia detected (37 advanced adenomas and 23 CRC). Incremental cost effectiveness ratios for colonoscopy invitations compared with mailed FIT kits were $55.23, $15.84, and $25.48 per additional covered month, advanced adenoma, and CRC, respectively. Although FIT was the preferred strategy at low willingness-to-pay thresholds, the 2 strategies were equal at a willingness-to-pay threshold of $41.31 per covered month gained. CONCLUSION Mailed FIT or colonoscopy invitations are both options to improve CRC screening completion and advanced neoplasia detection, and the choice of outreach strategy may differ by a health system's willingness-to-pay threshold. Mailed FIT kits are less expensive than colonoscopy invitations but result in fewer months of screening compliance and advanced neoplasia detected.
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Affiliation(s)
- Kandice A Kapinos
- The Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas; RAND Corporation, Arlington, Virginia.
| | - Ethan A Halm
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Caitlin C Murphy
- The Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; School of Public Health, University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | | | - Adam C Loewen
- The Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Celette Sugg Skinner
- The Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Amit G Singal
- The Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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20
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Tani Y, Kanesaka T, Takeuchi Y, Okubo Y, Kawakami Y, Sakurai H, Nakamura T, Matsueda K, Miyake M, Shichijo S, Maekawa A, Yamamoto S, Higashino K, Uedo N, Michida T, Ishihara R. Indication of emergency colonoscopy after colorectal endoscopic submucosal dissection: A proposal of hematochezia scale. J Gastroenterol Hepatol 2022; 37:1998-2003. [PMID: 35735159 DOI: 10.1111/jgh.15925] [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: 03/30/2022] [Revised: 06/04/2022] [Accepted: 06/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Hematochezia is a major adverse event associated with colorectal endoscopic submucosal dissection (ESD). This study aimed to distinguish between hematochezia that required endoscopic hemostasis and hematochezia that required no hemostasis. METHODS This retrospective study included consecutive patients who underwent ESD for colorectal tumors at the Osaka International Cancer Institute between September 2017 and August 2020. The exclusion criteria were as follows: patients with coexisting advanced colorectal cancers or inflammatory bowel diseases, patients who received incomplete ESD or emergency surgery, or patients who underwent ESD for multiple lesions. We evaluated whether the patients had hematochezia and underwent emergency colonoscopy and hemostasis during hospitalization. The degree of hematochezia in the saved photographs was assessed using the hematochezia scale and classified as mild, moderate, or severe. Blood pressure, heart rate, time from ESD to first hematochezia, and total number of hematochezia episodes were also evaluated. RESULTS Among the 437 patients who underwent ESD, 44 were excluded, and 393 patients were evaluated. Hematochezia was observed in 100 patients (25%). Emergency colonoscopy was performed in 12 patients (3%), and hemostasis was required in six patients (2%). For patients with hematochezia, only mild hematochezia and hematochezia that developed ≤ 48 h after ESD were significantly associated with no intervention for hemostasis. The positive predictive value for no intervention for hemostasis was 100% (93-100%) for mild hematochezia and 98% (93-100%) for hematochezia ≤ 48 h. CONCLUSIONS Mild hematochezia and hematochezia ≤ 48 h were negative predictors of hemostasis, in which emergency colonoscopy may be avoided.
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Affiliation(s)
- Yasuhiro Tani
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuki Okubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yushi Kawakami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hirohisa Sakurai
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiko Nakamura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Muneaki Miyake
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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21
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Modi S, Picado O, Fiser C, Lubarsky M, Giri B, Hui V, Force L, Marchetti F, Sands LR, Paluvoi NV. Comparison of procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons. Surg Endosc 2022; 36:6543-6550. [PMID: 35024931 DOI: 10.1007/s00464-022-09022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Colonoscopy is a common procedure performed by colorectal surgeons for screening, diagnosis, and surveillance of various colorectal diseases. Existing literature has conflicting data on quality outcomes of colonoscopies performed in the afternoon and the morning schedules and only includes colonoscopies performed by gastroenterologists. We sought to analyze procedural outcomes between morning and afternoon colonoscopies performed by colorectal surgeons. DATA SOURCES AND MAIN OUTCOME MEASURES A retrospective chart review of colonoscopies performed by colorectal surgeons at a tertiary care center from October 2018 through July 2020 was performed. Complete colonoscopies with documented times were included. Patients with colonic resection and incomplete colonoscopy were excluded. Main outcome measures adenoma and polyp detection rates and colonoscopy time variables were compared between morning and afternoon colonoscopies. RESULTS A total of 781 patients were analyzed. Colonoscopies were evenly distributed during shifts (49% morning and 51% afternoon). The overall polyp and adenoma detection rates were 46% and 29%, respectively. There were no significant differences in adenoma and polyp detection rates and colonoscopy duration between morning and afternoon colonoscopies. Multivariate analysis demonstrated that history of prior polypectomy was an independent predictor of adenoma detection rate (OR: 2.17, 95% CI 1.33-3.54, p = 0.002) and was associated with significantly increased colonoscopy times in afternoon shift. CONCLUSION There were no differences in quality outcomes of adenoma and polyp detection rates between morning and afternoon colonoscopies performed by colorectal surgeons. In addition to known predictors, cecal intubation time and history of polypectomy were also independent predictors of adenoma detection rate. Patients with prior polypectomy had increased colonoscopy times in afternoon shift. Since colorectal surgeons perform higher proportion of diagnostic and surveillance colonoscopies, these patients may be better suited for colonoscopies in morning shift.
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Affiliation(s)
- Shrey Modi
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA.
| | - Omar Picado
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Caroline Fiser
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Maya Lubarsky
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Bhuwan Giri
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Vanessa Hui
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Luanne Force
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Floriano Marchetti
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Laurence R Sands
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
| | - Nivedh V Paluvoi
- Division of Colon and Rectum Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, 1611 NW 12th avenue, Miami, FL, 33136, USA
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22
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Inagaki Y, Yoshida N, Fukumoto K, Kassai K, Inoue K, Hirose R, Dohi O, Okuda T, Hasegawa D, Okuda K, Ogiso K, Motoyoshi T, Yoriki H, Murakami T, Itoh Y. Risk Factors of Delayed Bleeding After Cold Snare Polypectomy for Colorectal Polyps: A Multicenter Study. Dig Dis Sci 2022; 67:3177-3184. [PMID: 34184204 DOI: 10.1007/s10620-021-07119-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed bleeding (DB) rarely occurs after cold snare polypectomy (CSP) for colorectal polyps, but no large-scale studies have investigated this. The present study evaluated the rate, characteristics, and risk factors of DB of CSP. METHODS We conducted a multicenter retrospective study at 10 Japanese institutions. A total of 18,007 patients underwent CSP for colorectal polyps ≤ 10 mm in size from March 2015 to September 2019, and cases of DB (DB group) were analyzed for the rate, antithrombotic drugs, polyp size, morphology, location, and risk factors. As a control, 269 non-bleeding cases (non-DB group) with 606 polyps who underwent CSP at the same 10 facilities in the 2-week study period were extracted. RESULTS We analyzed 26 DB cases with 28 lesions, and the total DB rate was 0.14% (26/18,007). The DB group had significantly higher rates of using antiplatelets (42.3% vs. 13.0%, p < 0.001) and anticoagulants (19.2% vs. 2.6%, p = 0.002), and significantly higher rates of polyp size ≥ 5 mm (67.9% vs. 45.2%, p = 0.015), rectal lesion (25.0% vs. 6.6%, p = 0.003), and polypoid lesion (89.3% vs. 55.3%, p < 0.001) than the non-DB group. A multivariate analysis (odds ratio; 95% confidence interval) for patient characteristics showed antiplatelet use (4.521; 1.817-11.249, p = 0.001) and anticoagulant use (7.866; 20.63-29.988, p = 0.003) as independent risk factors for DB. Polyp size ≥ 5 mm (3.251; 1.417-7.463, p = 0.005), rectal lesion (3.674; 1.426-9.465, p = 0.007), and polypoid lesion (7.087; 20.81-24.132, p = 0.002) were also risk factors for lesion characteristics. CONCLUSIONS The rate of DB was 0.14% and antithrombotic drug use, polyp size, location, and morphology were related to it.
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Affiliation(s)
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kohei Fukumoto
- Department of Gastroenterology, Nara City Hospital, Nara, Japan
| | - Kyoichi Kassai
- Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takashi Okuda
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Saiseikai Suita Hospital, Osaka, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | | | - Hiroyuki Yoriki
- Department of Gastroenterology, Otsu City Hospital, Shiga, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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23
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Akwiwu EU, Klausch T, Jodal HC, Carvalho B, Løberg M, Kalager M, Berkhof J, H. Coupé VM. A progressive three-state model to estimate time to cancer: a likelihood-based approach. BMC Med Res Methodol 2022; 22:179. [PMID: 35761181 PMCID: PMC9235269 DOI: 10.1186/s12874-022-01645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/30/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To optimize colorectal cancer (CRC) screening and surveillance, information regarding the time-dependent risk of advanced adenomas (AA) to develop into CRC is crucial. However, since AA are removed after diagnosis, the time from AA to CRC cannot be observed in an ethically acceptable manner. We propose a statistical method to indirectly infer this time in a progressive three-state disease model using surveillance data. METHODS Sixteen models were specified, with and without covariates. Parameters of the parametric time-to-event distributions from the adenoma-free state (AF) to AA and from AA to CRC were estimated simultaneously, by maximizing the likelihood function. Model performance was assessed via simulation. The methodology was applied to a random sample of 878 individuals from a Norwegian adenoma cohort. RESULTS Estimates of the parameters of the time distributions are consistent and the 95% confidence intervals (CIs) have good coverage. For the Norwegian sample (AF: 78%, AA: 20%, CRC: 2%), a Weibull model for both transition times was selected as the final model based on information criteria. The mean time among those who have made the transition to CRC since AA onset within 50 years was estimated to be 4.80 years (95% CI: 0; 7.61). The 5-year and 10-year cumulative incidence of CRC from AA was 13.8% (95% CI: 7.8%;23.8%) and 15.4% (95% CI: 8.2%;34.0%), respectively. CONCLUSIONS The time-dependent risk from AA to CRC is crucial to explain differences in the outcomes of microsimulation models used for the optimization of CRC prevention. Our method allows for improving models by the inclusion of data-driven time distributions.
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Affiliation(s)
- Eddymurphy U. Akwiwu
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Thomas Klausch
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Henriette C. Jodal
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Beatriz Carvalho
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Johannes Berkhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Veerle M. H. Coupé
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health, Amsterdam, The Netherlands
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24
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Green Tea Extract to Prevent Colorectal Adenomas, Results of a Randomized, Placebo-Controlled Clinical Trial. Am J Gastroenterol 2022; 117:884-894. [PMID: 35213393 DOI: 10.14309/ajg.0000000000001706] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Preclinical, epidemiological, and small clinical studies suggest that green tea extract (GTE) and its major active component epigallocatechingallate (EGCG) exhibit antineoplastic effects in the colorectum. METHODS A randomized, double-blind trial of GTE standardized to 150 mg of EGCG b.i.d. vs placebo over 3 years was conducted to prevent colorectal adenomas (n = 1,001 with colon adenomas enrolled, 40 German centers). Randomization (1:1, n = 879) was performed after a 4-week run-in with GTE for safety assessment. The primary end point was the presence of adenoma/colorectal cancer at the follow-up colonoscopy 3 years after randomization. RESULTS The safety profile of GTE was favorable with no major differences in adverse events between the 2 well-balanced groups. Adenoma rate in the modified intention-to-treat set (all randomized participants [intention-to-treat population] and a follow-up colonoscopy 26-44 months after randomization; n = 632) was 55.7% in the placebo and 51.1% in the GTE groups. This 4.6% difference was not statistically significant (adjusted relative risk 0.905; P = 0.1613). The respective figures for the per-protocol population were 54.3% (151/278) in the placebo group and 48.3% (129/267) in the GTE group, indicating a slightly lower adenoma rate in the GTE group, which was not significant (adjusted relative risk 0.883; P = 0.1169). DISCUSSION GTE was well tolerated, but there was no statistically significant difference in the adenoma rate between the GTE and the placebo groups in the whole study population.
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25
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Cross AJ, Robbins EC, Pack K, Stenson I, Kirby PL, Patel B, Rutter MD, Veitch AM, Saunders BP, Little M, Gray A, Duffy SW, Wooldrage K. Colonoscopy surveillance following adenoma removal to reduce the risk of colorectal cancer: a retrospective cohort study. Health Technol Assess 2022; 26:1-156. [PMID: 35635015 DOI: 10.3310/olue3796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Colonoscopy surveillance is recommended for some patients post polypectomy. The 2002 UK surveillance guidelines classify post-polypectomy patients into low, intermediate and high risk, and recommend different strategies for each classification. Limited evidence supports these guidelines. OBJECTIVES To examine, for each risk group, long-term colorectal cancer incidence by baseline characteristics and the number of surveillance visits; the effects of interval length on detection rates of advanced adenomas and colorectal cancer at first surveillance; and the cost-effectiveness of surveillance compared with no surveillance. DESIGN A retrospective cohort study and economic evaluation. SETTING Seventeen NHS hospitals. PARTICIPANTS Patients with a colonoscopy and at least one adenoma at baseline. MAIN OUTCOME MEASURES Long-term colorectal cancer incidence after baseline and detection rates of advanced adenomas and colorectal cancer at first surveillance. DATA SOURCES Hospital databases, NHS Digital, the Office for National Statistics, National Services Scotland and Public Health England. METHODS Cox regression was used to compare colorectal cancer incidence in the presence and absence of surveillance and to identify colorectal cancer risk factors. Risk factors were used to stratify risk groups into higher- and lower-risk subgroups. We examined detection rates of advanced adenomas and colorectal cancer at first surveillance by interval length. Cost-effectiveness of surveillance compared with no surveillance was evaluated in terms of incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained. RESULTS Our study included 28,972 patients, of whom 14,401 (50%), 11,852 (41%) and 2719 (9%) were classed as low, intermediate and high risk, respectively. The median follow-up time was 9.3 years. Colorectal cancer incidence was 140, 221 and 366 per 100,000 person-years among low-, intermediate- and high-risk patients, respectively. Attendance at one surveillance visit was associated with reduced colorectal cancer incidence among low-, intermediate- and high-risk patients [hazard ratios were 0.56 (95% confidence interval 0.39 to 0.80), 0.59 (95% confidence interval 0.43 to 0.81) and 0.49 (95% confidence interval 0.29 to 0.82), respectively]. Compared with the general population, colorectal cancer incidence without surveillance was similar among low-risk patients and higher among high-risk patients [standardised incidence ratios were 0.86 (95% confidence interval 0.73 to 1.02) and 1.91 (95% confidence interval 1.39 to 2.56), respectively]. For intermediate-risk patients, standardised incidence ratios differed for the lower- (0.70, 95% confidence interval 0.48 to 0.99) and higher-risk (1.46, 95% confidence interval 1.19 to 1.78) subgroups. In each risk group, incremental costs per colorectal cancer prevented and per quality-adjusted life-year gained with surveillance were lower for the higher-risk subgroup than for the lower-risk subgroup. Incremental costs per quality-adjusted life-year gained were lowest for the higher-risk subgroup of high-risk patients at £7821. LIMITATIONS The observational design means that we cannot assume that surveillance caused the reductions in cancer incidence. The fact that some cancer staging data were missing places uncertainty on our cost-effectiveness estimates. CONCLUSIONS Surveillance was associated with reduced colorectal cancer incidence in all risk groups. However, in low-risk patients and the lower-risk subgroup of intermediate-risk patients, colorectal cancer incidence was no higher than in the general population without surveillance, indicating that surveillance might not be necessary. Surveillance was most cost-effective for the higher-risk subgroup of high-risk patients. FUTURE WORK Studies should examine the clinical effectiveness and cost-effectiveness of post-polypectomy surveillance without prior classification of patients into risk groups. TRIAL REGISTRATION This trial is registered as ISRCTN15213649. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 26. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Amanda J Cross
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Emma C Robbins
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kevin Pack
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Iain Stenson
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paula L Kirby
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bhavita Patel
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, UK.,Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | | | - Matthew Little
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group, Department of Surgery and Cancer, Imperial College London, London, UK
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26
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Koh M, Kim MC, Jang JS. Difference in the prevalence of advanced colon adenoma between patients with gastric neoplasm and healthy people: A STROBE-compliant study. Medicine (Baltimore) 2022; 101:e29308. [PMID: 35623070 PMCID: PMC9276267 DOI: 10.1097/md.0000000000029308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/27/2022] [Indexed: 01/04/2023] Open
Abstract
We compared the prevalence of adenoma and cancerous colon polyps in patients undergoing endoscopic removal or gastric surgery for gastric adenoma or gastric cancer and in healthy individuals.The medical records of 707 patients with gastric neoplasm and 798 age- and sex-matched healthy subjects were retrospectively analyzed between January 2010 and July 2018. The clinicopathological characteristics, prevalence of colorectal neoplasm diagnosed by colonoscopy, and risk factors for colorectal polyps were also investigated.When comparing the two groups, the prevalence of overall colorectal polyps and its distribution was not different between the two groups (54.0% vs.49.5%, P = .079), whereas, the number of colon polyps (1.20 ± 1.71 vs 0.99 ± 1.54, P = .015) and the maximal size (3.53 ± 6.14 vs 2.08 ± 2.88, P < .001) were significantly larger in the gastric neoplasm group. The prevalence of advanced colon adenoma was significantly higher in the gastric neoplasm group (10.7% vs 3.8%, P < .001). Risk factors such as elevated glucose levels and the presence of gastric neoplasm were related to the prevalence of all colon polyps. The presence of gastric neoplasm is an important risk factor for advanced colon polyps.Patients with gastric neoplasms had a significantly higher prevalence of advanced colon adenoma. Advanced colon adenoma is associated with the chain from benign adenomas through malignant altered adenomas to advanced colon cancer. Thus, patients with gastric neoplasm are regarded as a high-risk group for colorectal cancer and are recommended for screening colonoscopy at the time of diagnosis.
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Affiliation(s)
- Myeongseok Koh
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Min-Chan Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
| | - Jin Seok Jang
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, South Korea
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27
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Isik Z, Leblebici A, Demir Karaman E, Karaca C, Ellidokuz H, Koc A, Ellidokuz EB, Basbinar Y. In silico identification of novel biomarkers for key players in transition from normal colon tissue to adenomatous polyps. PLoS One 2022; 17:e0267973. [PMID: 35486660 PMCID: PMC9053805 DOI: 10.1371/journal.pone.0267973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Adenomatous polyps of the colon are the most common neoplastic polyps. Although most of adenomatous polyps do not show malign transformation, majority of colorectal carcinomas originate from neoplastic polyps. Therefore, understanding of this transformation process would help in both preventive therapies and evaluation of malignancy risks. This study uncovers alterations in gene expressions as potential biomarkers that are revealed by integration of several network-based approaches. In silico analysis performed on a unified microarray cohort, which is covering 150 normal colon and adenomatous polyp samples. Significant gene modules were obtained by a weighted gene co-expression network analysis. Gene modules with similar profiles were mapped to a colon tissue specific functional interaction network. Several clustering algorithms run on the colon-specific network and the most significant sub-modules between the clusters were identified. The biomarkers were selected by filtering differentially expressed genes which also involve in significant biological processes and pathways. Biomarkers were also validated on two independent datasets based on their differential gene expressions. To the best of our knowledge, such a cascaded network analysis pipeline was implemented for the first time on a large collection of normal colon and polyp samples. We identified significant increases in TLR4 and MSX1 expressions as well as decrease in chemokine profiles with mostly pro-tumoral activities. These biomarkers might appear as both preventive targets and biomarkers for risk evaluation. As a result, this research proposes novel molecular markers that might be alternative to endoscopic approaches for diagnosis of adenomatous polyps.
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Affiliation(s)
- Zerrin Isik
- Faculty of Engineering, Department of Computer Engineering, Dokuz Eylul University, Izmir, Turkey
| | - Asım Leblebici
- Department of Translational Oncology, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Ezgi Demir Karaman
- Department of Computer Engineering, Institute of Natural and Applied Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Caner Karaca
- Department of Translational Oncology, Institute of Health Sciences, Dokuz Eylul University, Izmir, Turkey
| | - Hulya Ellidokuz
- Department of Preventive Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
| | - Altug Koc
- Gentan Genetic Medical Genetics Diagnosis Center, Izmir, Turkey
| | - Ender Berat Ellidokuz
- Faculty of Medicine, Department of Gastroenterology, Dokuz Eylul University, Izmir, Turkey
| | - Yasemin Basbinar
- Department of Translational Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey
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Cross AJ, Robbins EC, Pack K, Stenson I, Rutter MD, Veitch AM, Saunders BP, Duffy SW, Wooldrage K. Post-polypectomy surveillance interval and advanced neoplasia detection rates: a multicenter, retrospective cohort study. Endoscopy 2022; 54:948-958. [PMID: 35405762 PMCID: PMC9500009 DOI: 10.1055/a-1795-4673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Longer post-polypectomy surveillance intervals are associated with increased colorectal neoplasia detection at surveillance in some studies. We investigated this association to inform optimal surveillance intervals. METHODS Patients who underwent colonoscopy and post-polypectomy surveillance at 17 UK hospitals were classified as low/high risk by baseline findings. We compared detection rates of advanced adenomas (≥ 10 mm, tubulovillous/villous, high grade dysplasia), high risk findings (HRFs: ≥ 2 serrated polyps/[adenomas] of which ≥ 1 is ≥ 10 mm or has [high grade] dysplasia; ≥ 5 serrated polyps/adenomas; or ≥ 1 nonpedunculated polyp ≥ 20 mm), or colorectal cancer (CRC) at surveillance colonoscopy by surveillance interval (< 18 months, 2, 3, 4, 5, 6 years). Risk ratios (RRs) were estimated using multivariable regression. RESULTS Of 11 214 patients, 7216 (64 %) were low risk and 3998 (36 %) were high risk. Among low risk patients, advanced adenoma, HRF, and CRC detection rates at first surveillance were 7.8 %, 3.7 %, and 1.1 %, respectively. Advanced adenoma detection increased with increasing surveillance interval, reaching 9.8 % with a 6-year interval (P trend < 0.001). Among high risk patients, advanced adenoma, HRF, and CRC detection rates at first surveillance were 15.3 %, 10.0 %, and 1.5 %, respectively. Advanced adenoma and CRC detection rates (P trends < 0.001) increased with increasing surveillance interval; RRs (95 % confidence intervals) for CRC were 1.54 (0.68-3.48), 4.44 (1.95-10.08), and 5.80 (2.51-13.40) with 3-, 4-, and 5-year intervals, respectively, versus an interval of < 18 months. CONCLUSIONS Metachronous neoplasia was uncommon among low risk patients, even with long surveillance intervals, supporting recommendations for no surveillance in these patients. For high risk patients, a 3-year surveillance interval would ensure timely CRC detection.
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Affiliation(s)
- Amanda J. Cross
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Emma C. Robbins
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Kevin Pack
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Iain Stenson
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Matthew D. Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom,Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Andrew M. Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, United Kingdom
| | - Brian P. Saunders
- Wolfson Unit for Endoscopy, St Mark’s Hospital, London, United Kingdom
| | - Stephen W. Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Early-Onset Colorectal Cancer Is Associated with a Lower Risk of Metachronous Advanced Neoplasia than Traditional-Onset Colorectal Cancer. Dig Dis Sci 2022; 67:1045-1053. [PMID: 33721159 DOI: 10.1007/s10620-021-06902-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 02/09/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) incidence in the USA has increased in adults under age 50. Current CRC surveillance guidelines do not consider age at diagnosis, and there are limited data available on outcomes from surveillance colonoscopies in early-onset CRC (EO-CRC) to guide recommendations on surveillance intervals. AIMS To compare surveillance outcomes between EO-CRC and traditional-onset colorectal cancer (TO-CRC). METHODS In a retrospective cohort study in a large tertiary care academic medical center, we collected data on patients with a diagnosis of CRC between 2000 and 2014 who received surgery with curative intent. We used log-rank test and inverse probability of treatment weighted Cox regression analysis to compare the development of metachronous advanced neoplasia (MAN) in patients with EO-CRC (diagnosed ages 18-49) and TO-CRC (diagnosed ages 50-75). RESULTS Patients with EO-CRC (n = 107) were more likely to present with advanced-stage disease (62% versus 35%, p < 0.0001), rectal tumors (45% versus 27%, p < 0.01), and a family history of CRC (30% versus 16%, p = 0.02) compared to those with TO-CRC (n = 139). Patients with EO-CRC had lower risk of MAN (adjusted HR 0.44, 95% CI 0.22-0.88) than TO-CRC patients. The 5-year event rate for MAN was lower for patients with EO-CRC compared to patients with TO-CRC (5.8% vs. 16.1%, p = 0.07). The presence of synchronous neoplasia or history of diabetes was also predictive of MAN. CONCLUSIONS EO-CRC was independently associated with a lower risk of developing MAN compared to TO-CRC. Shorter surveillance intervals may not be warranted in EO-CRC; however, large prospective studies are needed.
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An Evidence-Based Guideline for Surveillance of Patients after Curative Treatment for Colon and Rectal Cancer. Curr Oncol 2022; 29:724-740. [PMID: 35200561 PMCID: PMC8870404 DOI: 10.3390/curroncol29020062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To provide recommendations for a surveillance regimen that leads to the largest overall survival benefit for patients after curative treatment for Stage I–IV colon and rectal cancer. Methods: Consistent with the Program in Evidence-Based Care’s standard approach, guideline databases, i.e., MEDLINE, EMBASE, PubMed, Cochrane Library, and PROSPERO, were systematically searched. Then, we drafted recommendations and methodology experts performed an internal review of the resulting draft recommendations, which was followed by an external review by targeted experts and intended users. Results: Four systematic reviews and two randomized controlled trials were identified that provided evidence for recommendations. Conclusions: For patients with stage I–III colon cancer, a medical history and physical examination should be performed every six months for three years; computed tomography (CT) of the chest-abdomen-pelvis (CT CAP) should be performed at one and three years, or one CT CAP could be performed at 18 months; the use of carcinoembryonic antigen (CEA) is optional if CT imaging is being performed; and surveillance colonoscopy should be performed one year after the initial surgery. The frequency of subsequent surveillance colonoscopy should be dictated by previous findings, but generally, colonoscopies should be performed every five years if the findings are normal. There was insufficient evidence to support these recommendations for patients with rectal cancer, Stage IV colon cancer, and patients over the age of 75 years. Patients should be informed of current recommendations and the treating physician should discuss the specific risks and benefits of each recommendation with their patients.
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Spadaccini M, Bourke MJ, Maselli R, Pioche M, Bhandari P, Jacques J, Haji A, Yang D, Albéniz E, Kaminski MF, Messmann H, Herreros de Tejada A, Sferrazza S, Pekarek B, Rivory J, Geyl S, Gulati S, Draganov P, Shahidi N, Hossain E, Fleischmann C, Vespa E, Iannone A, Alkandari A, Hassan C, Repici A. Clinical outcome of non-curative endoscopic submucosal dissection for early colorectal cancer. Gut 2022; 71:gutjnl-2020-323897. [PMID: 35058275 DOI: 10.1136/gutjnl-2020-323897] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/08/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) in a curative intent for submucosa-invasive early (T1) colorectal cancers (T1-CRCs) often leads to subsequent surgical resection in case of histologic parameters indicating higher risk of nodal involvement. In some cases, however, the expected benefit may be offset by the surgical risks, suggesting a more conservative approach. DESIGN Retrospective analysis of consecutive patients with T1-CRC who underwent ESD at 13 centres ending inclusion in 2019 (n=3373). Cases with high risk of nodal involvement (non-curative ESD: G3, submucosal invasion>1000 µm, lymphovascular involvement, budding or incomplete resection/R1) were analysed if follow-up data (endoscopy/imaging) were available, regardless of the postendoscopic management (follow-up vs surgery) selected by the multidisciplinary teams in these institutions. Comorbidities were classified according to Charlson Comorbidity Index (CCI). Outcomes were disease recurrence, death and disease-related death rates in the two groups. Rate of residual disease (RD) at both the previous resection site and regional lymph nodes was assessed in the surgical cases as well as from follow-up in the follow-up group. RESULTS Of 604 patients treated by colorectal ESD for submucosally invasive cancer, 207 non-curative resections (34.3%) were included (138 male; mean age 67.6±10.9 years); in 65.2% of cases, no complete resection was achieved (R1). Of the 207 cases, 60.9% (n=126; median CCI: 3; IQR: 2-4) underwent surgical treatment with RD in 19.8% (25/126), while 39.1% (n=81, median CCI: 5; IQR: 4-6) were followed up by endoscopy in all cases. Patients in the follow-up group had a higher overall mortality (HR=3.95) due to non-CRC causes (n=9, mean survival after ESD 23.7±13.7 months). During this follow-up time, tumour recurrence and disease-specific survival rates were not different between the groups (median follow-up 30 months; range: 6-105). CONCLUSION Following ESD for a lesion at high risk of RD, follow-up only may be a reasonable choice in patients at high risk for surgery. Also, endoscopic resection quality should be improved. TRIAL REGISTRATION NUMBER NCT03987828.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Marhieu Pioche
- Endoscopy unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | | | | | - Amyn Haji
- Endoscopy unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Dennis Yang
- Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain
| | - Michal Filip Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Centre fo Postgraduate Education, Warsaw, Poland
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, Warsaw, Poland
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | | | - Sandro Sferrazza
- Endoscopy unit, Ospedale di Trento, Trento, Trentino-Alto Adige, Italy
| | - Boris Pekarek
- University Hospital Bratislava, Bratislava, Slovakia
| | - Jerome Rivory
- Endoscopy unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Sophie Geyl
- Gastroenterology, Hospital Dupuytren, Limoges, France
| | - Shraddha Gulati
- Endoscopy unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Peter Draganov
- Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Neal Shahidi
- Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ejaz Hossain
- Endoscopy unit, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Carola Fleischmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Edoardo Vespa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Andrea Iannone
- U.O. Gastroenterologia Universitaria, Policlinico di Bari, Bari, Italy
| | - Asma Alkandari
- Gastroenterology, Amiri Hospital, Kuwait City, Kuwait
- Gastroenterology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center -IRCCS-, Rozzano, Italy
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Post-polypectomy colonoscopy surveillance: Can we improve the diagnostic yield? GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:474-487. [PMID: 34848307 DOI: 10.1016/j.gastrohep.2021.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022]
Abstract
Although adenomas and serrated polyps are the preneoplastic lesions of colorectal cancer, only few of them will eventually progress to cancer. This review provides a comprehensive overview of the present and future of post-polypectomy colonoscopy surveillance. Post-polypectomy surveillance guidelines have recently been updated and all share the aim towards more selective and less frequent surveillance. We have examined these current guidelines and compared the recommendations of each of them. To improve the diagnostic yield of post-polypectomy surveillance it is important to find predictors of metachronous polyps that better identify high-risk individuals of developing advanced neoplasia. For this reason, we have also conducted a literature review of the molecular biomarkers of metachronous advanced colorectal polyps. Finally, we have discussed future directions of post-polypectomy surveillance and identified possible strategies to improve the use of endoscopic resources with the COVID-19 pandemic.
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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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Kolb JM, Hu J, DeSanto K, Gao D, Singh S, Imperiale T, Lieberman DA, Boland CR, Patel SG. Early-Age Onset Colorectal Neoplasia in Average-Risk Individuals Undergoing Screening Colonoscopy: A Systematic Review and Meta-Analysis. Gastroenterology 2021; 161:1145-1155.e12. [PMID: 34119517 PMCID: PMC8463452 DOI: 10.1053/j.gastro.2021.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/18/2021] [Accepted: 06/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Incidence and mortality associated with early-age onset colorectal cancer (EAO-CRC) is increasing, prompting professional society recommendations to lower the screening age in average-risk individuals. The yield of screening individuals younger than 50 years is not known. METHODS A systematic review of 3 databases from inception through July 2020 was performed in all languages that reported colonoscopy findings in average-risk individuals younger than 50 years. The primary outcomes were EAO colorectal neoplasia (CRN) and advanced colorectal neoplasia (aCRN) prevalence. Subgroup analyses were performed based on sex, geographic location, time period, and age, including comparison with those aged 50-59 years. Generalized linear mixed model with random intercept logistic regression and fixed subgroup effects were performed. RESULTS Of 10,123 unique articles, 17 studies published between 2002 and 2020, including 51,811 average-risk individuals from 4 continents, were included. The pooled rate of EAO-CRN was 13.7% (95% confidence interval [CI], 0.112%-0.168%) and EAO-aCRN was 2.2% (95% CI, 0.016%-0.031%). Prevalence of CRC was 0.05% (95% CI, 0.00029%-0.0008%). Rates of EAO-CRN were higher in men compared with women (relative risk, 1.71%; 95% CI, 1.49%-1.98%), and highest in the United States (15.6%; 95% CI, 12.2%-19.7%) compared with Europe (14.9%; 95% CI, 6.9%-29.3%), East Asia (13.4%; 95% CI, 10.3%-17.2%), and the Middle East (9.8%; 95% CI, 7.8%-12.2%) (P = .04) The rate of EAO-CRN in age groups 45-49 years and 50-59 years was 17.8% (95% CI, 14.5%-21.6%) and 24.8% (95% CI, 19.5%-30.8%), respectively (P = .04). The rate of EAO-aCRN in age group 45-49 years was 3.6% (95% CI, 1.9%-6.7%) and 4.2% (95% CI, 3.2%-5.7%), respectively (P = .69). CONCLUSIONS The rate of aCRN in individuals aged 45-49 years was similar to the rate observed in individual aged 50-59 years, suggesting that expanding screening to this population could yield a similar impact on colorectal cancer risk reduction.
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Affiliation(s)
- Jennifer M. Kolb
- H.H. Chao Comprehensive Digestive Disease Center, University of California Irvine, Orange, California
| | - Junxiao Hu
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen DeSanto
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Dexiang Gao
- Department of Pediatrics, Cancer Center Biostatistics Core, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Siddharth Singh
- University of California San Diego School of Medicine, La Jolla, California
| | - Thomas Imperiale
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - C. Richard Boland
- University of California San Diego School of Medicine, La Jolla, California
| | - Swati G. Patel
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Rocky Mountain Regional Veterans Affairs Hospital, Aurora, Colorado
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Yokota M, Muto J, Hashida K, Nagahisa Y, Okabe M, Kitagawa H, Kawamoto K. The necessity of intensive surveillance colonoscopy for patients with a remaining right colon after resection of colorectal cancer: a retrospective cohort study. Surg Today 2021; 52:502-509. [PMID: 34499260 DOI: 10.1007/s00595-021-02372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To clarify how often postoperative surveillance colonoscopy should be undertaken based on the risk factors for the development of metachronous cancer (MC) and advanced adenoma (AA) after surgery for colorectal cancer. METHODS We collected data of consecutive patients who underwent curative resection for primary colorectal cancer between 2005 and 2012, with preoperative colonoscopy and surveillance colonoscopy at 1 year after surgery (406 patients, mean age: 69 years, 59% male). The detection rates of AA (with villous features, > 10 mm or high-grade dysplasia) and MC by surveillance colonoscopy were the primary outcomes. RESULTS At 5 years, colonoscopy was performed as postoperative surveillance an average of 3.2 times. AA and MC were detected in 57 (14.0%) and 18 patients (4.4%), respectively. Both lesions were more common in the right colon (n = 43) than in the left colon (n = 28). The detection rate did not differ to a statistically significant extent according to the number of colonoscopies performed for surveillance (p = 0.21). However, after left-sided colectomy, both types of lesions were more commonly detected in those who received ≥ 3 colonoscopies than in those with one or two colonoscopies (p = 0.04). CONCLUSION A remaining right colon after left-sided colectomy was associated with a higher risk of developing AA and MC. Physicians should consider performing surveillance colonoscopy more frequently if the right colon remains after surgery.
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Affiliation(s)
- Mitsuru Yokota
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan.
| | - Jun Muto
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuki Hashida
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Yoshio Nagahisa
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Michio Okabe
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Hirohisa Kitagawa
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Kazuyuki Kawamoto
- Department of General Surgery, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama, 710-8602, Japan
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Li XP, Chen HM, Lei XH, Dou GS, Chen YC, Chen LP, Zhang Y, Zhao GM, Zhong W. Cost-effectiveness analysis of a community-based colorectal cancer screening program in Shanghai, China. J Dig Dis 2021; 22:452-462. [PMID: 34086400 DOI: 10.1111/1751-2980.13027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study investigated the cost-effectiveness of a community-based colorectal cancer-screening program (C-CRCSP) in Shanghai, China, among the residents in the urban, suburban and rural areas. METHODS A Markov model was constructed to evaluate the cost-effectiveness of a 25-year annual C-CRCSP including 100 000 populations. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER); referring to either life-years gained, or quality-adjusted life-years (QALYs) gained. The threshold was gross domestic product per capita. Univariate and multivariate sensitivity analyses were performed to investigate the influence of compliance, prevalence, technological performance, medical cost and annual cost discount rate (3.5%) on ICER. A probabilistic sensitivity analysis evaluated the probability of the cost-effectiveness of C-CRCSP at different maximum acceptable ceiling ratios. RESULTS Compared with no screening, the C-CRCSP resulted in total gains of 7840 QALYs and 2210 life-years (LY), at a total cost of CNY 58.54 million; that is, the ICER were CNY 7460/QALYs and CNY 26650/LY. Stratifying by residency, the cumulative gains in QALYs and LY were estimated to be the lowest in the urban populations compared with the rural and suburban populations. The cost for the urban population was 3-fold and 6-fold that of the suburban and rural populations. The ICER for QALYs ranged from 2180 (rural) to 16 840 (urban). CONCLUSION The cost-effectiveness of a C-CRCSP in Shanghai was most favorable for the rural population, while the urban population benefits less in terms of QALYs. ICER could be enhanced by measures that increase compliance.
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Affiliation(s)
- Xiao Pan Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Office of Scientific Research and Information Management, Pudong Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Hui Min Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Hong Lei
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guan Shen Dou
- Department of Health Economics, Key Laboratory For Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Yi Chen Chen
- Office of Scientific Research and Information Management, Pudong Center for Disease Control and Prevention, Fudan University Pudong Institute of Preventive Medicine, Shanghai, China
| | - Li Ping Chen
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yao Zhang
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Gen Ming Zhao
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Wei Zhong
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, State Key Laboratory for Oncogenes and Related Genes, Shanghai Institute of Digestive Disease, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Park J, Han JS, Jo HJ, Kim HY, Yoon H, Shin CM, Park YS, Kim N, Lee DH. Resting heart rate is associated with colorectal advanced adenoma. PLoS One 2021; 16:e0254505. [PMID: 34242355 PMCID: PMC8270146 DOI: 10.1371/journal.pone.0254505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Resting heart rate is an independent predictor of colorectal cancer (CRC) development and CRC-related mortality. However, little is known about the relationship between resting heart rate and colorectal adenoma development. We aimed to investigate this association in a population who underwent screening colonoscopy. Methods Among 39,021 patients who underwent both electrocardiogram and screening colonoscopy during routine health examinations at the Seoul National University Bundang Hospital, Health Promotion Center, Korea from January 2014 to July 2019, 1,344 patients had advanced adenoma. We performed 1:1 propensity score (PS) matching to establish a control group that mitigated the confounding effects of age and sex. We performed multivariate logistic regression analyses to identify the independent risk factors of advanced adenoma development. Results Resting heart rate was significantly higher in the advanced adenoma group than in the control group. The prevalence of advanced polyp increased across the quartiles of resting heart rate. Patients with higher resting heart rates were more likely to be older, smokers, and have increased blood pressure and DM and less likely to engage in active exercises than those with lower resting heart rates. Patients with higher resting heart rates had higher serum glucose, triglyceride, hemoglobin A1C, and insulin levels and lower high-density lipoprotein cholesterol levels. Patients with resting heart rate in the highest quartile (≥71 bpm) still showed significantly increased odds ratio (OR) of advanced adenoma development (OR: 1.379, 95% confidence interval: 1.099–1.731, p = 0.006). Conclusions High resting heart rate was a meaningful independent risk factor of advanced adenoma development.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Soo Han
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jin Jo
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Young Kim
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Tepeš B, Mlakar DN, Stefanovič M, Štabuc B, Grazio SF, Zakotnik JM. The impact of 6 years of the National Colorectal Cancer Screening Program on colorectal cancer incidence and 5-year survival. Eur J Cancer Prev 2021; 30:304-310. [PMID: 33369945 DOI: 10.1097/cej.0000000000000628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We aimed to assess the impact of the first three rounds of the National Colorectal Cancer Screening Program (NCCSP) on CRC incidence and mortality in Slovenia. In NCCSP, we use two fecal immune tests (FITs) and if test is positive patient is referred to colonoscopy. From 2009, we invite Slovenian residents aged 50-69 years, one screening round takes 2 years. The response rate was from 56.9 to 59.9%. FIT was positive in 6.0-6.2% (more in older patients and in men; P < 0.05). The adenoma detection rate was >51.3% (more in men; P < 0.01). In NCCSP, 70.3% of all cancers diagnosed were in stages I and II, while 20.7% of all CRC were found in polyps resected during colonoscopies. Patients with positive first FIT have odds ratio 2.19 [95% confidence interval (CI), 2.06-2.32] for advanced neoplasia and cancer compared to patients with two negative FITs. The incidence rate for CRC has dropped significantly after 6 years in population and in men (P < 0.01) but not in women. Five-year CRC survival was 31.3% higher if cancer was diagnosed in NCCSP (P < 0.05). After 6 years of NCCSP, the incidence rate for CRC has dropped significantly (P < 0.01). Hazard ratio for death from CRC was 3.84 higher (95% CI, 3.36-4.40; P < 0.001) in patients with cancer detected outside the program.
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Affiliation(s)
- Bojan Tepeš
- AM DC Rogaška, Department of Gastroenterology, Rogaška Slatina
| | | | | | - Borut Štabuc
- University Clinical Center, Clinical department of Gastroenterology, Ljubljana, Slovenia
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Ishibashi F, Tanaka R, Sugihara K, Konda K, Sato A, Kawakami T, Kobayashi K, Baba S. Pre-administration of super-low volume polyethylene glycol is as effective as senna laxative as bowel preparation for colonoscopy: a randomized controlled phase 2 trial. Surg Endosc 2021; 36:3141-3151. [PMID: 34159460 DOI: 10.1007/s00464-021-08617-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Senna laxatives are commonly used for bowel preparation before colonoscopies in Japan. However, this laxative frequently causes complications such as abdominal pain. This study aimed to establish a novel method of bowel preparation, which involved the pre-administration of super-low volume polyethylene glycol (PEG) for three days followed by the same-day administration of low volume PEG. METHODS This study was a prospective, multicenter, investigator-blinded, phase 2, randomized control trial. The intake of 13.9 g (120 mL) of PEG or 1 g of a senna laxative for 3 days before the examination was indicated for each group, and 2 L of PEG solution was used for preparation on the examination day. The primary endpoint was the efficacy of bowel cleansing, as assessed by the Boston bowel preparation scale. The secondary endpoints were the adenoma detection rate and occurrence of complications. RESULTS A total of 250 patients were initially enrolled. A total of 122 patients from each group were included in the intention-to-treat analysis. In the intention-to-treat analysis, the responder rates were the same for the two groups (56.6% vs 50.8%). Additionally, the adenoma detection rate did not differ between the two groups (34.9% vs 41.8%, P = 0.3795). In contrast, adherence was higher in the PEG group (93.4% vs 82.8%, P = 0.0101), and the occurrence of complications was lower in the PEG group (1.7% vs 16.4%, P = 0.0001). CONCLUSION The novel super-low volume PEG method for bowel preparation was as effective as the conventional method with senna laxatives.
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Affiliation(s)
- Fumiaki Ishibashi
- Endoscopy Center, Koganei Tsurukame Clinic, 6-14-28-3F, Honcho, Koganei-shi, Tokyo, 184-0004, Japan.
- Digestive Disease Center, Shinjuku Tsurukame Clinic, 2-11-15, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan.
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Ryu Tanaka
- Digestive Disease Center, Shinjuku Tsurukame Clinic, 2-11-15, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Kazuaki Sugihara
- Digestive Disease Center, Shinjuku Tsurukame Clinic, 2-11-15, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
| | - Kenichi Konda
- Digestive Disease Center, Shinjuku Tsurukame Clinic, 2-11-15, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
- Department of Gastroenterology, Showa University Hospital, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Ayako Sato
- Digestive Disease Center, Shinjuku Tsurukame Clinic, 2-11-15, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Tomohiro Kawakami
- Endoscopy Center, Koganei Tsurukame Clinic, 6-14-28-3F, Honcho, Koganei-shi, Tokyo, 184-0004, Japan
| | - Konomi Kobayashi
- Endoscopy Center, Koganei Tsurukame Clinic, 6-14-28-3F, Honcho, Koganei-shi, Tokyo, 184-0004, Japan
| | - Satoshi Baba
- Digestive Disease Center, Shinjuku Tsurukame Clinic, 2-11-15, Yoyogi, Shibuya-ku, Tokyo, 151-0053, Japan
- Endoscopy Center, Yotsuya Medical Cube, 7-7, Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan
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Saito Y, Oka S, Kawamura T, Shimoda R, Sekiguchi M, Tamai N, Hotta K, Matsuda T, Misawa M, Tanaka S, Iriguchi Y, Nozaki R, Yamamoto H, Yoshida M, Fujimoto K, Inoue H. Colonoscopy screening and surveillance guidelines. Dig Endosc 2021; 33:486-519. [PMID: 33713493 DOI: 10.1111/den.13972] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/21/2021] [Accepted: 03/09/2021] [Indexed: 12/15/2022]
Abstract
The Colonoscopy Screening and Surveillance Guidelines were developed by the Japan Gastroenterological Endoscopy Society as basic guidelines based on the scientific methods. The importance of endoscopic screening and surveillance for both detection and post-treatment follow-up of colorectal cancer has been recognized as essential to reduce disease mortality. There is limited high-level evidence in this field; therefore, we had to focus on the consensus of experts. These clinical practice guidelines consist of 20 clinical questions and eight background knowledge topics that have been determined as the current guiding principles.
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Affiliation(s)
- Yutaka Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shiro Oka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ryo Shimoda
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Naoto Tamai
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kinichi Hotta
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Masashi Misawa
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | - Ryoichi Nozaki
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | | | - Haruhiro Inoue
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Wang X, Zhang JY, Zheng ZQ, Wang T, Piao MY, Liu H, Liu J, Liu WT. Value of combined detection of IFOBT, tumor markers, and inflammatory markers in predicting occurrence of advanced colorectal adenoma. Shijie Huaren Xiaohua Zazhi 2021; 29:347-355. [DOI: 10.11569/wcjd.v29.i7.347] [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: 02/06/2023] Open
Abstract
BACKGROUND At present, there is a lack of effective, non-invasive screening tests for colorectal precancerous lesions. Identification of high-risk groups and multi-biomarker detection have become the trend of cancer and precancerous lesion screening. Inflammatory markers have been widely used in the diagnosis and prognosis of various tumors, but there are few studies on their diagnostic value in precancerous lesions.
AIM To explore the predictive value of the general characteristics, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), CEA, CA199, and immunochemical fecal occult blood testing (IFOBT) in the occurrence of advanced colorectal adenoma.
METHODS Two hundred and ninety-five cases of advanced colorectal adenomas confirmed by pathology and electronic colonoscopy at our hospital from 2014 to 2018 were retrospectively analyzed, and 448 cases of non-advanced adenomas in the same period were selected as a control group. The general clinical data of the patients, including basic characteristics (gender and age), living habits (smoking and drinking), and past history of disease (hypertension, coronary heart disease, diabetes), history of surgery (history of cholecystectomy or appendectomy), and laboratory examinations (NLR, PLR, CEA, CA199, and IFOBT) were collected. Measurement data were compared using t-test or Mann-Whitney U test, and count data were compared using χ2 test. Statistically significant variables were included in binary logistic regression analysis. ROC curve was drawn to evaluate the predictive value of related indexes in the occurrence of advanced colorectal adenoma.
RESULTS Multivariate logistic regression analysis demonstrated that age (odds ratio [OR] = 1.047, 95% confidence interval [CI]: 1.028-1.066, P = 0.000), smoking (OR = 1.880, 95%CI: 1.250-2.826, P = 0.002), diabetes (OR = 2.073, 95CI%: 1.216-3.535, P=0.007), previous cholecystectomy (OR = 9.206, 95CI%: 2.904-29.181, P = 0.000), IFOBT (OR = 7.681, 95%CI: 4.585-12.869, P = 0.000), CA199 (OR = 1.039, 95%CI: 1.018-1.059, P = 0.000), and NLR (OR = 1.706, 95%CI: 1.388-2.097, P = 0.000) were independent factors for advanced colorectal adenoma. ROC analysis showed that the areas under the ROC curves (AUCs) of IFOBT, CA199, and NLR in predicting advanced colorectal adenoma were 0.644 (95%CI: 0.602-0.686), 0.639 (95%CI: 0.598-0.679), and 0.645 (95%CI: 0.605-0.685), respectively. The optimal cutoff values for NLR and CA199 were 2.04 and 7.87 U/mL, respectively. The sensitivity and specificity of IFOBT, CA199, and NLR in predicting advanced colorectal adenoma were 34.6% and 94.2%, 53.9% and 66.1%, and 50.2% and 71.8%, respectively. The AUC of combination of the three biomarkers for the diagnosis of advanced adenoma was 0.752 (95%CI: 0.716-0.788), with a sensitivity of 52.9%and specificity of 82.8%. In the subgroup analysis, there were significant differences between the IFOBT(+) subgroup and IFOBT(-) subgroups with regard to tumor location (P = 0.048), diameter (P = 0.000), and differentiation(P = 0.000). There were also significant differences between the low NLR (< 2.04) subgroup and high NLR (≥ 2.04) subgroup with regard to gender (P = 0.004), tumor diameter (P = 0.028), and tumor differentiation (P = 0.000).
CONCLUSION Advanced colorectal adenoma is associated with advanced age, smoking, diabetes, and previous cholecystectomy, and more attention should be paid to populations with these risk factors. IFOBT, NLR, and CA199 have appreciated diagnostic value for advanced colorectal adenoma, with the combination of all three having the highest diagnostic value.
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Affiliation(s)
- Xu Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jing-Yu Zhang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Zhong-Qing Zheng
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Mei-Yu Piao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Heng Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jing Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen-Tian Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Tanaka S, Saitoh Y, Matsuda T, Igarashi M, Matsumoto T, Iwao Y, Suzuki Y, Nozaki R, Sugai T, Oka S, Itabashi M, Sugihara KI, Tsuruta O, Hirata I, Nishida H, Miwa H, Enomoto N, Shimosegawa T, Koike K. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol 2021; 56:323-335. [PMID: 33710392 PMCID: PMC8005396 DOI: 10.1007/s00535-021-01776-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The Japanese Society of Gastroenterology (JSGE) published ''Daicho Polyp Shinryo Guideline 2014'' in Japanese and a part of this guideline was published in English as "Evidence-based clinical practice guidelines for management of colorectal polyps" in the Journal of Gastroenterology in 2015. A revised version of the Japanese-language guideline was published in 2020, and here we introduce a part of the contents of revised version. METHODS The guideline committee discussed and drew up a series of clinical questions (CQs). Recommendation statements for the CQs were limited to items with multiple therapeutic options. Items with established conclusions that had 100% agreement with previous guidelines (background questions) and items with no (or old) evidence that are topics for future research (future research questions: FRQs) were given descriptions only. To address the CQs and FRQs, PubMed, ICHUSHI, and other sources were searched for relevant articles published in English from 1983 to October 2018 and articles published in Japanese from 1983 to November 2018. The Japan Medical Library Association was also commissioned to search for relevant materials. Manual searches were performed for questions with insufficient online references. RESULTS The professional committee created 18 CQs and statements concerning the current concept and diagnosis/treatment of various colorectal polyps, including their epidemiology, screening, pathophysiology, definition and classification, diagnosis, management, practical treatment, complications, and surveillance after treatment, and other colorectal lesions (submucosal tumors, nonneoplastic polyps, polyposis, hereditary tumors, ulcerative colitis-associated tumors/carcinomas). CONCLUSIONS After evaluation by the moderators, evidence-based clinical practice guidelines for management of colorectal polyps were proposed for 2020. This report addresses the therapeutic related CQs introduced when formulating these guidelines.
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Affiliation(s)
- Shinji Tanaka
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
- Department of Endoscopy, Hiroshima University Hospital, 1-2-3 Minami-ku, KasumiHiroshima, 734-8551, Japan.
| | - Yusuke Saitoh
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takahisa Matsuda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Masahiro Igarashi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takayuki Matsumoto
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yasushi Iwao
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yasumoto Suzuki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ryoichi Nozaki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Tamotsu Sugai
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Shiro Oka
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Michio Itabashi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ken-Ichi Sugihara
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Osamu Tsuruta
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Ichiro Hirata
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroshi Nishida
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroto Miwa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Nobuyuki Enomoto
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Tooru Shimosegawa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Management of Colorectal Polyps", the Japanese Society of Gastroenterology (JSGE), 6F Shimbashi i-MARK Bldg., 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
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Robbins EC, Wooldrage K, Stenson I, Pack K, Duffy S, Weller D, Levin T, Conell C, Wright S, Nickerson C, Martin J, Cross AJ. Heterogeneity in colorectal cancer incidence among people recommended 3-yearly surveillance post-polypectomy: a validation study. Endoscopy 2021; 53:402-410. [PMID: 32814350 PMCID: PMC8007389 DOI: 10.1055/a-1217-0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/12/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Colonoscopy surveillance is recommended for patients at increased risk of colorectal cancer (CRC) following adenoma removal. Low-, intermediate-, and high-risk groups are defined by baseline adenoma characteristics. We previously examined intermediate-risk patients from hospital data and identified a higher-risk subgroup who benefited from surveillance and a lower-risk subgroup who may not require surveillance. This study explored whether these findings apply in individuals undergoing CRC screening. METHODS This retrospective study used data from the UK Flexible Sigmoidoscopy Screening Trial (UKFSST), English CRC screening pilot (ECP), and US Kaiser Permanente CRC prevention program (KPCP). Screening participants (50 - 74 years) classified as intermediate-risk at baseline colonoscopy were included. CRC data were available through 2006 (KPCP) or 2014 (UKFSST, ECP). Lower- and higher-risk subgroups were defined using our previously identified baseline risk factors: higher-risk participants had incomplete colonoscopies, poor bowel preparation, adenomas ≥ 20 mm or with high-grade dysplasia, or proximal polyps. We compared CRC incidence in these subgroups and in the presence vs. absence of surveillance using Cox regression. RESULTS Of 2291 intermediate-risk participants, 45 % were classified as higher risk. Median follow-up was 11.8 years. CRC incidence was higher in the higher-risk than lower-risk subgroup (hazard ratio [HR] 2.08, 95 % confidence interval [CI] 1.07 - 4.06). Surveillance reduced CRC incidence in higher-risk participants (HR 0.35, 95 %CI 0.14 - 0.86) but not statistically significantly so in lower-risk participants (HR 0.41, 95 %CI 0.12 - 1.38). CONCLUSION As previously demonstrated for hospital patients, screening participants classified as intermediate risk comprised two risk subgroups. Surveillance clearly benefited the higher-risk subgroup.
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Affiliation(s)
- Emma C. Robbins
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Kate Wooldrage
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Iain Stenson
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Kevin Pack
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Stephen Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University, London, United Kingdom
| | - David Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Theodore Levin
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States
| | - Carol Conell
- Division of Research, Kaiser Permanente Northern California, Oakland, California, United States
| | - Suzanne Wright
- Public Health England (PHE) Screening, Sheffield, United Kingdom
| | - Claire Nickerson
- Public Health England (PHE) Screening, Sheffield, United Kingdom
| | - Jessica Martin
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Amanda J. Cross
- Cancer Screening and Prevention Research Group (CSPRG), Department of Surgery and Cancer, Imperial College London, United Kingdom
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Tiankanon K, Aniwan S, Rerknimitr R. Current Status of Colorectal Cancer and Its Public Health Burden in Thailand. Clin Endosc 2021; 54:499-504. [PMID: 33721484 PMCID: PMC8357574 DOI: 10.5946/ce.2020.245-iden] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/13/2020] [Indexed: 12/19/2022] Open
Abstract
Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program.
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Affiliation(s)
- Kasenee Tiankanon
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand.,Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Satimai Aniwan
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand.,Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Chulalongkorn University, Bangkok, Thailand.,Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
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45
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Yuen SWJ, Tay TY, Gao N, Tho NQ, Tan NC. Development of a decision aid to support colorectal cancer screening: perspectives of Asians in an endemic urban community-a qualitative research study. BMC Med Inform Decis Mak 2021; 21:86. [PMID: 33676504 PMCID: PMC7936439 DOI: 10.1186/s12911-021-01404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/20/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a common malignancy worldwide. Despite being the most common cancer in Singapore, CRC screening rate remains low due to knowledge deficits, social reasons such as inconvenience and a lack of reminder or recommendation. A decision aid (DA) may facilitate an individual's decision-making to undertake CRC screening by addressing misconceptions and barriers. We postulate that a more person-centred and culturally adapted DA will better serve the local population. The views of the target users are thus needed to develop such a DA. A CRC screening DA prototype has been adapted from an American DA to cater to the Asian users. This study aimed to explore user perspectives on an adapted CRC screening DA-prototype in terms of the design, content and perceived utility. METHODS The study used in-depth interviews (IDIs) and focus group discussions (FGDs) to gather qualitative data from English-literate multi-ethnic Asian adults aged 50 years old and above. They had yet to screen for CRC before they were recruited from a public primary care clinic in Singapore. The interviews were audio-recorded, transcribed and analysed to identify emergent themes via thematic analysis. RESULTS This study included 27 participants involved in 5 IDI and 5 FGDs. Participants found the DA easily comprehensible and of appropriate length. They appreciated information about the options and proposed having multi-lingual DAs. The design, in terms of the layout, size and font, was well-accepted but there were suggestions to digitalize the DA. Participants felt that the visuals were useful but there were concerns about modesty due to the realism of the illustration. They would use the DA for information-sharing with their family and for discussion with their doctor for decision making. They preferred the doctor's recommendation for CRC screening and initiating the use of the DA. CONCLUSIONS Participants generally had favourable perceptions of the DA-prototype. A revised DA will be developed based on their feedback. Further input from doctors on the revised DA will be obtained before assessing its effectiveness to increase CRC screening rate in a randomized controlled trial.
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Affiliation(s)
- Sok Wei Julia Yuen
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore.
| | - Tsang Yew Tay
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
| | - Ning Gao
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
| | - Nian Qin Tho
- Ministry of Health Holdings, Singapore, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
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46
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Musselwhite LW, May FP, Salem ME, Mitchell EP. Colorectal Cancer: In the Pursuit of Health Equity. Am Soc Clin Oncol Educ Book 2021; 41:108-117. [PMID: 34010044 DOI: 10.1200/edbk_321071] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Colorectal cancer mortality has decreased considerably following the adoption of national screening programs, yet, within at-risk subgroups, there continue to be measurable differences in clinical outcomes from variations in screening, receipt of chemotherapy, radiation or surgery, access to clinical trials, research participation, and survivorship. These disparities are well-described and some have worsened over time. Disparities identified have included race and ethnicity, age (specifically young adults), socioeconomic status, insurance access, geography, and environmental exposures. In the context of the COVID-19 pandemic, colorectal cancer care has necessarily shifted dramatically, with broad, immediate uptake of telemedicine, transition to oral medications when feasible, and considerations for sequence of treatment. However, it has additionally marginalized patients with colorectal cancer with historically disparate cancer-specific outcomes; among them, uninsured, low-income, immigrant, and ethnic-minority patients-all of whom are more likely to become infected, be hospitalized, and die of either COVID-19 or colorectal cancer. Herein, we outline measurable disparities, review implemented solutions, and define strategies toward ensuring that all have a fair and just opportunity to be as healthy as possible.
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Affiliation(s)
- Laura W Musselwhite
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Folasade P May
- Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA-Kaiser Permanente Center for Health Equity, and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, CA
- Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Mohamed E Salem
- Department of Solid Tumor Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Edith P Mitchell
- Center to Eliminate Cancer Disparities, Sidney Kimmel Cancer Center at Jefferson, Philadelphia, PA
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Winawer SJ, Zauber AG, O’Brien MJ, Geenen J, Waye JD. The National Polyp Study at 40: challenges then and now. Gastrointest Endosc 2021; 93:720-726. [PMID: 33010298 PMCID: PMC7887080 DOI: 10.1016/j.gie.2020.09.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/25/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Sidney J. Winawer
- Gastroenterology, Hepatology and Nutrition Service,
Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial
Sloan Kettering Cancer
| | - Michael J. O’Brien
- Department of Laboratory Pathology, Boston University
School of Medicine
| | - Joseph Geenen
- Department of Medicine, Medical College of Wisconsin
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Inoue T, Ishihara R, Nishida T, Akasaka T, Hayashi Y, Nakamatsu D, Ogiyama H, Yamaguchi S, Yamamoto K, Mukai A, Kinoshita K, Yakushijin T, Iijima H, Takehara T. Prophylactic clipping not effective in preventing post-polypectomy bleeding for < 20-mm colon polyps: A multicenter, open-label, randomized controlled trial. J Gastroenterol Hepatol 2021; 36:383-390. [PMID: 32511792 DOI: 10.1111/jgh.15134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Prophylactic clipping (PC) after polypectomy has the potential to prevent post-polypectomy bleeding (PPB). We aimed to evaluate the effectiveness of PC in preventing PPB for < 20-mm polyps. METHODS This multicenter, open-label, randomized controlled trial conducted from December 2013 to June 2017 at 10 institutions randomly assigned 1080 patients with < 20-mm colon polyps to the non-PC and PC groups. Allocation factors were institution, antiplatelet drug use, and polyp number. The primary endpoint was differences in PPB rates between the groups. The severity of PPB and post-procedural abdominal symptoms were also investigated. These endpoints in intention-to-treat and per-protocol (PP) analyses were evaluated. RESULTS We investigated 1039 patients with 2960 lesions. There was no significant difference between the groups in characteristics including age, sex, hypertension, diabetes, hyperlipidemia, antiplatelet drug use, and lesion characteristics such as type and size. Excluding the clip used in the non-PC group, intraoperative bleeding, and deviation of protocol, 903 patients were investigated in PP analysis. There was no significant difference in the PPB rate between the non-PC and PC groups (2.7% vs 2.3%, P = 0.6973 [intention-to-treat analysis]; 3.0 vs 2.4%, P = 0.7353 [PP analysis]). Severe PPB (≥ grade 3) was similar between the groups. Total procedure time was significantly shorter in the non-PC group than in the PC group (31 vs 36 min, P = 0.0002). Post-procedural abdominal fullness was less common in the non-PC group than in the PC group (20.8% vs 25.6%, P = 0.0833). CONCLUSION Prophylactic clipping is not effective in preventing PBB for < 20-mm colon polyps (UMIN000012163).
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Affiliation(s)
- Takuya Inoue
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Center, Osaka, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Tomofumi Akasaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Center, Osaka, Japan.,Department of Gastroenterology and Hepatology, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan.,Department of Gastroenterology, Kaizuka City Hospital, Kaizuka, Japan
| | - Hideharu Ogiyama
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
| | | | - Katsumi Yamamoto
- Department of Gastroenterology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
| | - Akira Mukai
- Department of Gastroenterology, Sumitomo Hospital, Osaka, Japan
| | - Kazuo Kinoshita
- Department of Gastroenterology, Otemae Hospital, Osaka, Japan
| | - Takayuki Yakushijin
- Department of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan.,Osaka Gut Forum, Osaka, Japan
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Barua I, Mori Y, Bretthauer M. Colorectal polyp characterization with endocytoscopy: Ready for widespread implementation with artificial intelligence? Best Pract Res Clin Gastroenterol 2020; 52-53:101721. [PMID: 34172248 DOI: 10.1016/j.bpg.2020.101721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 01/31/2023]
Abstract
Endocytoscopy provides an in-vivo visualization of nuclei and micro-vessels at the cellular level in real-time, facilitating so-called "optical biopsy" or "virtual histology" of colorectal polyps/neoplasms. This functionality is enabled by 520-fold magnification power with endocytoscopy and recent breakthroughs in artificial intelligence (AI) allowing a great advance in endocytoscopic imaging; interpretation of images is now fully supported by AI tool which outputs predictions of polyp histopathology during colonoscopy. The advantage of the use of AI during optical biopsy can be appreciated especially by non-expert endoscopists who to increase performance. This paper provides an overview of the latest evidence on colorectal polyp characterization with endocytoscopy combined with AI and identify the barriers to its widespread implementation.
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Affiliation(s)
- Ishita Barua
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, and Department of Transplantation Medicine Oslo University Hospital, Oslo, Norway
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, and Department of Transplantation Medicine Oslo University Hospital, Oslo, Norway; Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, and Department of Transplantation Medicine Oslo University Hospital, Oslo, Norway
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Chang JJ, Chien CH, Chen SW, Chen LW, Liu CJ, Yen CL. Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection. BMC Gastroenterol 2020; 20:376. [PMID: 33172387 PMCID: PMC7656717 DOI: 10.1186/s12876-020-01499-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 10/14/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. METHODS 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. RESULTS Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3-12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06-9.04 95% CI), 3.47 (1.67-7.22 95% CI), 2.55 (1.11-5.89 95% CI), 2.46 (1.16-5.22 95% CI), 2.89 (1.44-5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32-7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52-6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. CONCLUSION Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.
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Affiliation(s)
- Jia-Jang Chang
- Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung, 204, Taiwan.,Keelung Division, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Cheng-Hung Chien
- Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung, 204, Taiwan.,Keelung Division, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shuo-Wei Chen
- Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung, 204, Taiwan.,Keelung Division, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Li-Wei Chen
- Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung, 204, Taiwan.,Keelung Division, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ching-Jung Liu
- Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung, 204, Taiwan.,Keelung Division, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Cho-Li Yen
- Division of Hepatogastroenterology, Keelung Chang Gung Memorial Hospital, No. 222, Mai Chin Road, Keelung, 204, Taiwan. .,Keelung Division, Chang Gung Memorial Hospital, Keelung, Taiwan.
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