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Moura DTHD, Baroni LM, Bestetti AM, Funari MP, Rocha RSDP, Santos MELD, Silveira SQ, Moura EGHD. EVALUATION OF QUALITY INDICATORS OF SCREENING COLONOSCOPY PERFORMED IN A PRIVATE QUARTERNARY HOSPITAL IN BRAZIL. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1815. [PMID: 39140571 PMCID: PMC11318960 DOI: 10.1590/0102-6720202400022e1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/03/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Colorectal cancer is the third most common type of cancer in Brazil, despite the availability of screening methods that reduce its risk. Colonoscopy is the only screening method that also allows therapeutic procedures. The proper screening through colonoscopy is linked to the quality of the exam, which can be evaluated according to quality criteria recommended by various institutions. Among the factors, the most used is the Adenoma Detection Rate, which should be at least 25% for general population. AIMS To evaluate the quality of the screening colonoscopies performed in a quarternary private Brazilian hospital. METHODS This is a retrospective study evaluating the quality indicators of colonoscopies performed at a private center since its inauguration. Only asymptomatic patients aged over 45 years who underwent screening colonoscopy were included. The primary outcome was the Adenoma Detection Rate, and secondary outcomes included polyps detection rate and safety profile. Subanalyses evaluated the correlation of endoscopic findings with gender and age and the evolution of detection rates over the years. RESULTS A total of 2,144 patients were include with a mean age of 60.54 years-old. Polyps were diagnosed in 68.6% of the procedures. Adenoma detection rate was 46.8%, with an increasing rate over the years, mainly in males. A low rate of adverse events was reported in 0.23% of the cases, with no need for surgical intervention and no deaths. CONCLUSIONS This study shows that high quality screening colonoscopy is possible when performed by experienced endoscopists and trained nurses, under an adequate infrastructure.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Gastrointestinal Endoscopy Division - São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Luiza Martins Baroni
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Alexandre Moraes Bestetti
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Gastrointestinal Endoscopy Division - São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Mateus Pereira Funari
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Gastrointestinal Endoscopy Division - São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Rodrigo Silva de Padua Rocha
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Gastrointestinal Endoscopy Division - São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Marcos Eduardo Lera Dos Santos
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Gastrointestinal Endoscopy Division - São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Saullo Queiroz Silveira
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Anestesiology Department - São Paulo (SP), Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Instituto D´Or de Pesquisa e Ensino, Hospital Vila Nova Star, Gastrointestinal Endoscopy Division - São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine, Gastrointestinal Endoscopy Unit, Department of Gastroenterology - São Paulo (SP), Brazil
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Liang PS, Bhatt D. Modeling disparities in colorectal cancer outcomes: colonoscopy follow-up and quality are key. J Natl Cancer Inst 2024:djae176. [PMID: 39118191 DOI: 10.1093/jnci/djae176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Affiliation(s)
- Peter S Liang
- Departments of Medicine and Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY, USA
| | - Divya Bhatt
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Internal Medicine, VA North Texas Health Care System, Dallas, TX, USA
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Frank A, Bernstedt SW, Jamizadeh N, Forsberg A, Hedin C, Blom J, Backman AS. Complications of colonoscopy surveillance of patients with Lynch syndrome - 33 years of follow up. Fam Cancer 2024:10.1007/s10689-024-00416-w. [PMID: 39102097 DOI: 10.1007/s10689-024-00416-w] [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: 08/06/2024]
Abstract
BACKGROUND AND STUDY AIMS Lynch syndrome (LS) is a hereditary autosomal dominant condition, with an increased lifetime risk of developing malignancies including colorectal cancer (CRC). Current guidelines differ in recommended colonoscopy-surveillance intervals from 1 to 2 years. Although colonoscopy is considered a safe procedure, there are risks of severe adverse events (SAEs), such as perforation and bleeding, as well as adverse events (AEs), such as abdominal discomfort and post-colonoscopy gastrointestinal infections. Colonoscopy-related bleeding and perforation rates have been reported 0.17% and 0.11%, respectively. However, there are insufficient data regarding complications of colonoscopy-surveillance for LS patients. This study aims to investigate the risk of AEs among LS patients during colonoscopy in the Stockholm region. PATIENTS AND METHODS This retrospective cohort study includes 351 LS patients undergoing endoscopic surveillance at the Karolinska University Hospital, August 1989 - April 2021. Data from endoscopic surveillance colonoscopies were extracted from patients' medical records. RESULTS Of 1873 endoscopies in 351 LS patients, 12 complications (AEs) were documented within 30 days (0.64%) and with a total of 3 bleedings (SAEs, 0.16%). No perforations were identified. CONCLUSION Colonoscopy surveillance for LS patients shows a comparatively low risk of AEs per-examination. Colonoscopy complications per-patient, including both SAEs and AEs, show a significantly higher risk. Colonoscopy complications only including SAEs, show a comparatively low risk. Understanding the lifetime risk of surveillance-related colonoscopy complications is important when designing targeted surveillance programmes.
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Affiliation(s)
- Alexander Frank
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
| | - Sophie Walton Bernstedt
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Div. of Upper Gastrointestinal diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Nigin Jamizadeh
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Anna Forsberg
- Gastroenterology unit, Dept. of Medicine, Capio S:t Görans Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Hedin
- Gastroenterology unit, Dept. of Gastroenterology, Dermatovenereology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Johannes Blom
- Dept. of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Dept. of Surgery, Södersjukhuset, Stockholm, Sweden
| | - Ann-Sofie Backman
- Dept. of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology unit, Dept. of Medicine, Ersta Hospital, Stockholm, Sweden
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Berry E, Hostetter J, Bachtold J, Zamarripa S, Argenbright KE. Evaluating colonoscopy quality by performing provider type. J Natl Cancer Inst 2024; 116:1264-1269. [PMID: 38588561 PMCID: PMC11308165 DOI: 10.1093/jnci/djae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Colorectal cancer is the third most diagnosed cancer and the second leading cause of cancer death in the United States. Colonoscopy is an essential tool for screening, used as a primary approach and follow-up to an abnormal stool-based colorectal cancer screening result. Colonoscopy quality is often measured with 4 key indicators: bowel preparation, cecal intubation, mean withdrawal time, and adenoma detection. Colonoscopies are most often performed by gastroenterologists (GI), however, in rural and medically underserved areas, non-GI providers often perform colonoscopies. This study aims to evaluate the quality and safety of screening colonoscopies performed by non-GI practitioner, comparing their outcomes with those of GI providers. METHODS Descriptive statistics were used to characterize the study population. Results for quality indicators were stratified by provider type and compared. Statistical significance was determined using a P value of less than .05 as the threshold for all comparisons; all P values were 2-sided. RESULTS No statistical difference was found when comparing performance by provider type. Median performance for gastroenterologists, general surgeons, and family medicine providers ranged from 98% to 100% for cecal intubation; 97.4% to 100% for bowel preparation; 57.4% to 88.9% for male adenoma detection rate; 47.7% to 62.13% for female adenoma detection rate; and 0:12:10 to 0:20:16 for mean withdrawal time. All provider types met and exceeded the goal metric for each of the quality indicators (P < .001). CONCLUSIONS As a result of this analysis, we can expect non-GI practitioner to perform colonoscopies with similar quality to GI practitioner given the performance outcomes for the key quality metrics.
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Affiliation(s)
- Emily Berry
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
| | - Jeff Hostetter
- Department of Family and Community Medicine, University of North Dakota School of Medicine & Health Sciences, Bismark, ND, USA
| | | | - Sarah Zamarripa
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
| | - Keith E Argenbright
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
- University of Texas Southwestern Medical Center Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
- University of Texas Medical Center Peter O’Donnell Jr. School of Public Health, Dallas, TX, USA
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Lui RN, Chan AT. The Interval for Screening Colonoscopy-Is 15 the New 10? JAMA Oncol 2024; 10:864-865. [PMID: 38696179 DOI: 10.1001/jamaoncol.2024.0249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
- Department of Clinical Oncology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
- Institute of Digestive Disease, State Key Laboratory of Digestive Disease, Chinese University of Hong Kong, Hong Kong, China
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Immunology and Infectious Diseases, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts
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6
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He D, Chen J, Jiang X, Chen H, Huang J, Chen Z. Risk factors for synchronous high-risk polyps in patients with colorectal cancer. Front Surg 2024; 11:1424809. [PMID: 38978992 PMCID: PMC11228258 DOI: 10.3389/fsurg.2024.1424809] [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: 04/28/2024] [Accepted: 06/11/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose Colorectal cancer (CRC) patients may experience inadequate preoperative colonoscopy due to bowel obstruction or inadequate bowel preparation, leading to potential oversight of other polyps. We aimed to identify risk factors for CRC complicated with synchronous high-risk polyps. Methods A retrospective analysis of 6,674 CRC patients from December 2014 to September 2018 was conducted. High-risk polyps were defined as adenomas or serrated polyps that were ≥10 mm, or with tubulovillous/villous components or high-grade dysplasia. All other polyps were defined as low-risk polyps. Patients with complete pathological and clinical information were categorized into three groups: the no polyp group, the low-risk polyp group, and the high-risk polyp group. Univariate and multivariate logistic regression analyses were performed to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for all potential risk factors. Results Among the 4,659 eligible patients, 848 (18.2%) were found to have low-risk polyps, while 675 (14.5%) were diagnosed with high-risk polyps. In a multivariate logistic regression model, compared to patients without polyps, those with synchronous high-risk polyps were more likely to be male (OR = 2.07), aged 50 or older (OR = 2.77), have early-stage tumors (OR = 1.46), colon tumors (OR = 1.53), NRAS mutant tumors (OR = 1.66), and BRAF wild-type tumors (OR = 2.43). Conclusion Our study has identified several risk factors associated with the presence of synchronous high-risk polyps in CRC patients. Based on these findings, we recommend that patients who exhibit these high-risk factors undergo early follow-up of colonoscopy to detect synchronous polyps early.
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Affiliation(s)
- Degao He
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Anorectal Surgery, Shenzhen Longhua District Central Hospital, Shenzhen, Guangdong, China
| | - Junguo Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xuefei Jiang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hao Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Juanni Huang
- Department of Geriatrics, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zexian Chen
- Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
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Ali S, Mowery R, Hoff RT. Regarding "Issues of informed consent for non-specialists conducting colorectal cancer screenings". J Osteopath Med 2024; 0:jom-2024-0026. [PMID: 38855807 DOI: 10.1515/jom-2024-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Sareena Ali
- Department of Medicine, 21886 Advocate Lutheran General Hospital , Park Ridge, IL, USA
| | - Robert Mowery
- Department of Medicine, 21886 Advocate Lutheran General Hospital , Park Ridge, IL, USA
| | - Ryan T Hoff
- 144559 PeaceHealth Southwest Medical Center , Vancouver, WA, USA
- Elson S. Floyd College of Medicine, Washington State University, Vancouver, WA, USA
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Savino A, Rondonotti E, Rocchetto S, Piagnani A, Bina N, Di Domenico P, Segatta F, Radaelli F. GI genius endoscopy module: a clinical profile. Expert Rev Med Devices 2024; 21:359-372. [PMID: 38618982 DOI: 10.1080/17434440.2024.2342508] [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: 10/31/2023] [Accepted: 04/09/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION The identification of early-stage colorectal cancers (CRC) and the resection of pre-cancerous neoplastic lesions through colonoscopy allows to decrease both CRC incidence and mortality. However, colonoscopy miss rates up to 26% for adenomas and 9% for advanced adenomas have been reported. In recent years, artificial intelligence (AI) systems have been emerging as easy-to-use tools, potentially lowering the risk of missing lesions. AREAS COVERED This review paper focuses on GI Genius device (Medtronic Co. Minneapolis, MN, U.S.A.) a computer-assisted tool designed to assist endoscopists during standard white-light colonoscopies in detecting mucosal lesions. EXPERT OPINION Randomized controlled trials (RCTs) suggest that GI Genius is a safe and effective tool for improving adenoma detection, especially in CRC screening and surveillance colonoscopies. However, its impact seems to be less significant among experienced endoscopists and in real-world clinical scenarios compared to the controlled conditions of RCTs. Furthermore, it appears that GI Genius mainly enhances the detection of non-advanced, small polyps, but does not significantly impact the identification of advanced and difficult-to-detect adenoma. When using GI Genius, no complications were documented. Only a small number of studies reported an increased in withdrawal time or the removal of non-neoplastic lesions.
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Affiliation(s)
- Alberto Savino
- Division of Gastroenterology, Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | | | - Simone Rocchetto
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Alessandra Piagnani
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
| | - Niccolò Bina
- Gastroenterology Unit, Valduce Hospital, Como, Italy
| | - Pasquale Di Domenico
- Gastrointestinal Unit, Department of Medicine, Surgery & Dentistry Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Francesco Segatta
- Gastroenterology Unit, Valduce Hospital, Como, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Gastroenterology and Hepatology, University of Milan, Milan, Italy
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Moreels TG. How to implement adverse events as a quality indicator in gastrointestinal endoscopy. Dig Endosc 2024; 36:89-96. [PMID: 37485844 DOI: 10.1111/den.14641] [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: 06/19/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
Quality improvement through the registration of endoscopy-related adverse events (AEs) has been recognized by major international endoscopy societies as an important quality indicator. The theory behind this is easier to approve than its implementation in daily practice. The results of many valuable attempts have been published in the literature, mainly highlighting the diverse hurdles trying to capture events related to endoscopy and the sedation used for endoscopic procedures. The current review discusses the difficulties encountered attempting to register AEs and incidents related to endoscopic procedures. Government-driven and financed health-care databases with automated coupling of specific data seem the only efficient way to implement endoscopy-related AEs and outcomes on a prospective and complete basis. This will not only allow continuous confidential feedback to endoscopists in relation to the pooled national benchmark data, but also follow-up in time through data-driven credentialing aiming to progressively optimize these benchmark data.
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Affiliation(s)
- Tom G Moreels
- Department of Gastroenterology and Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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Tiankanon K, Aniwan S. What are the priority quality indicators for colonoscopy in real-world clinical practice? Dig Endosc 2024; 36:30-39. [PMID: 37422906 DOI: 10.1111/den.14635] [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: 03/01/2023] [Accepted: 07/06/2023] [Indexed: 07/11/2023]
Abstract
Colonoscopy is widely used as a colorectal cancer (CRC) screening tool. The effectiveness of a screening colonoscopy is associated with a decreased risk of CRC. However, colonoscopy is an operator-dependent procedure, and endoscopists' quality performance varies widely. This article reviewed the priority metrics and practices that contribute to high-quality screening colonoscopy in real-world clinical practice. With growing evidence, quality indicators have been subject to intense research and associated with reducing postcolonoscopy CRC incidence and mortality. Some quality metrics can reflect an endoscopy unit-based practice (i.e. quality of bowel preparation and withdrawal time). Other quality indicators primarily reflect individuals' skill and knowledge (i.e. cecal intubation rate, adenoma detection rate, and appropriately assigned follow-up colonoscopy interval). Measurement and improvement of priority quality indicators for colonoscopy should be made at both the endoscopist and unit levels. Substantial evidence supports the impact of high-quality colonoscopy in reducing the incidence of postcolonoscopy CRC.
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Affiliation(s)
- Kasenee Tiankanon
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Satimai Aniwan
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Lou S, Du F, Song W, Xia Y, Yue X, Yang D, Cui B, Liu Y, Han P. Artificial intelligence for colorectal neoplasia detection during colonoscopy: a systematic review and meta-analysis of randomized clinical trials. EClinicalMedicine 2023; 66:102341. [PMID: 38078195 PMCID: PMC10698672 DOI: 10.1016/j.eclinm.2023.102341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 05/11/2024] Open
Abstract
BACKGROUND The use of artificial intelligence (AI) in detecting colorectal neoplasia during colonoscopy holds the potential to enhance adenoma detection rates (ADRs) and reduce adenoma miss rates (AMRs). However, varied outcomes have been observed across studies. Thus, this study aimed to evaluate the potential advantages and disadvantages of employing AI-aided systems during colonoscopy. METHODS Using Medical Subject Headings (MeSH) terms and keywords, a comprehensive electronic literature search was performed of the Embase, Medline, and the Cochrane Library databases from the inception of each database until October 04, 2023, in order to identify randomized controlled trials (RCTs) comparing AI-assisted with standard colonoscopy for detecting colorectal neoplasia. Primary outcomes included AMR, ADR, and adenomas detected per colonoscopy (APC). Secondary outcomes comprised the poly missed detection rate (PMR), poly detection rate (PDR), and poly detected per colonoscopy (PPC). We utilized random-effects meta-analyses with Hartung-Knapp adjustment to consolidate results. The prediction interval (PI) and I2 statistics were utilized to quantify between-study heterogeneity. Moreover, meta-regression and subgroup analyses were performed to investigate the potential sources of heterogeneity. This systematic review and meta-analysis is registered with PROSPERO (CRD42023428658). FINDINGS This study encompassed 33 trials involving 27,404 patients. Those undergoing AI-aided colonoscopy experienced a significant decrease in PMR (RR, 0.475; 95% CI, 0.294-0.768; I2 = 87.49%) and AMR (RR, 0.495; 95% CI, 0.390-0.627; I2 = 48.76%). Additionally, a significant increase in PDR (RR, 1.238; 95% CI, 1.158-1.323; I2 = 81.67%) and ADR (RR, 1.242; 95% CI, 1.159-1.332; I2 = 78.87%), along with a significant increase in the rates of PPC (IRR, 1.388; 95% CI, 1.270-1.517; I2 = 91.99%) and APC (IRR, 1.390; 95% CI, 1.277-1.513; I2 = 86.24%), was observed. This resulted in 0.271 more PPCs (95% CI, 0.144-0.259; I2 = 65.61%) and 0.202 more APCs (95% CI, 0.144-0.259; I2 = 68.15%). INTERPRETATION AI-aided colonoscopy significantly enhanced the detection of colorectal neoplasia detection, likely by reducing the miss rate. However, future studies should focus on evaluating the cost-effectiveness and long-term benefits of AI-aided colonoscopy in reducing cancer incidence. FUNDING This work was supported by the Heilongjiang Provincial Natural Science Foundation of China (LH2023H096), the Postdoctoral research project in Heilongjiang Province (LBH-Z22210), the National Natural Science Foundation of China's General Program (82072640) and the Outstanding Youth Project of Heilongjiang Natural Science Foundation (YQ2021H023).
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Affiliation(s)
- Shenghan Lou
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Fenqi Du
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Wenjie Song
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Yixiu Xia
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Xinyu Yue
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Da Yang
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Binbin Cui
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Yanlong Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
| | - Peng Han
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
- Key Laboratory of Tumor Immunology in Heilongjiang, No.150 Haping Road, Harbin, Heilongjiang, 150081, China
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Faulx AL, Chak A. Endoscopic advances in gastroenterology. Gastroenterol Rep (Oxf) 2023; 11:goad046. [PMID: 37576952 PMCID: PMC10415171 DOI: 10.1093/gastro/goad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Affiliation(s)
- Ashley L Faulx
- Department of Gastroenterology and Hepatology, Louis Stokes VA Medical Center, Cleveland, OH, USA
- Division of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Amitabh Chak
- Division of Gastroenterology and Hepatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Gao P, Zhou K, Su W, Yu J, Zhou P. Endoscopic management of colorectal polyps. Gastroenterol Rep (Oxf) 2023; 11:goad027. [PMID: 37251504 PMCID: PMC10224796 DOI: 10.1093/gastro/goad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 05/31/2023] Open
Abstract
Colorectal polyps are premalignant lesions in the lower gastrointestinal tract. Endoscopic polypectomy is an effective strategy to prevent colorectal cancer morbidity and more invasive procedures. Techniques for the endoscopic resection of polyps keep evolving, and endoscopists are required to perform the most appropriate technique for each polyp. In this review, we outline the evaluation and classification of polyps, update the recommendations for optimal treatment, describe the polypectomy procedures and their strengths/weaknesses, and discuss the promising innovative methods or concepts.
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Affiliation(s)
| | | | - Wei Su
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
| | - Jia Yu
- Surgery Department, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
- Shanghai Medical College, Fudan University, Shanghai, P. R. China
| | - Pinghong Zhou
- Corresponding author. Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, P. R. China. Tel: +86-21-64041990;
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14
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He X, Lv X, Zhang B, Ying X, Hu C, Zhou X, Hu J. Adenoma Detection Rate in Average-Risk Population: An Observational Consecutive Retrospective Study. Cancer Control 2023; 30:10732748231193243. [PMID: 37528552 PMCID: PMC10399273 DOI: 10.1177/10732748231193243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/06/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Although colonoscopy is considered the most effective tool for reducing colorectal cancer-related morbidity, the age at which average-risk individuals begin colonoscopic screening is undetermined. This study aimed to compare the adenoma and advanced adenoma detection rates according to age and sex in a large average-risk population in the rural areas of Eastern China. METHODS This observational, single-center, retrospective study included patients with average colorectal cancer risk and examined the adenoma and advanced adenoma detection rates using age intervals of 5 years. We also compared the size and age of patients with and without advanced adenoma. RESULTS We included 18 928 patients with a median age of 54 years (range 15-90 years), including 10 143 men and 8785 women. The adenoma and advanced adenoma detection rates were 17.08% and 5.24%, respectively, and increased with age in the whole population. The adenoma detection rates increased from 8.97% (aged 40-44) to 14.98% (aged 45-49) and 6.24% (aged 45-49) to 11.00% (aged 50-54) in men and women (both P < .001), respectively. The advanced adenoma detection rates increased from 2.19% (aged 40-44) to 4.76% (aged 45-49) and 1.89% (aged 45-49) to 3.13% (aged 50-54) in men (P = .002) and women (P = .056), respectively. Patients with advanced adenomas were significantly older than those with non-advanced adenomas (P < .001). The tumors in the advanced adenoma group were significantly larger than those in the non-advanced adenoma group (P < .001). CONCLUSION The adenoma and advanced adenoma detection rates increased significantly in average-risk population aged 45 years and older, especially in men.
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Affiliation(s)
- Xiaoyan He
- Department of Gastroenterology, Dongyang Hospital affiliated to Wenzhou Medical University, Dongyang, China
| | - Xiangyin Lv
- Department of Gastroenterology, Dongyang Hospital affiliated to Wenzhou Medical University, Dongyang, China
| | - Binbin Zhang
- Department of Gastroenterology, Dongyang Hospital affiliated to Wenzhou Medical University, Dongyang, China
| | - Xiaoxuan Ying
- Department of Gastroenterology, Dongyang Hospital affiliated to Wenzhou Medical University, Dongyang, China
| | - Chiyu Hu
- Department of Gastroenterology, Dongyang Hospital affiliated to Wenzhou Medical University, Dongyang, China
| | - Xiaoying Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianwen Hu
- Department of Gastroenterology, Dongyang Hospital affiliated to Wenzhou Medical University, Dongyang, China
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