A new modality of colorectal cancer screening based on chronic disease management

BACKGROUND

To develop a new modality of colorectal cancer screening based on chronic disease management (CDM) to improve the participation rate of screening, and maximize the benefits of limited resources.

METHODS

Patients under CDM were assigned to screening intervention group (SI) and screening control group1 (SC1), residents from natural community were assigned to screening control group2 (SC2). A parallel controlled community intervention study was performed. Only SI would achieve "one-to-one" intervention services. Meanwhile, 200 subjects were selected from each of the three groups for the Knowledge-Attitude-Practice (KAP) questionnaire before and after intervention, named questionnaire intervention group(QI), questionnaire control group1(QC1) and questionnaire control group2(QC2). The outcome of the intervention was evaluated using the difference-in-differences method and multiple regression analysis.

RESULTS

The preliminary screening participation rate was 43.63%(473/1084) in SI, 14.32%(132/922) in SCI, and 5.87%(105/1789) in SC2. The baseline questionnaire showed low knowledge scores in the three questionnaire groups with no statistically significant differences, while attitude scores in QI and QC1 were significantly higher than QC2. The differences between baseline and terminal showed QI increased larger in knowledge and attitude scores than QC1 and QC2, while no difference was detected between QC1 and QC2.

CONCLUSION

The colorectal cancer screening model based on chronic disease management effectively improved the screening participation rate, and the "one-to-one" intervention and the inherent characteristics of the patient population under CDM were the core elements of the new modality.

Dual encoder-decoder-based deep polyp segmentation network for colonoscopy images

Detection of colorectal polyps through colonoscopy is an essential practice in prevention of colorectal cancers. However, the method itself is labor intensive and is subject to human error. With the advent of deep learning-based methodologies, and specifically convolutional neural networks, an opportunity to improve upon the prognosis of potential patients suffering with colorectal cancer has appeared with automated detection and segmentation of polyps. Polyp segmentation is subject to a number of problems such as model overfitting and generalization, poor definition of boundary pixels, as well as the model's ability to capture the practical range in textures, sizes, and colors. In an effort to address these challenges, we propose a dual encoder-decoder solution named Polyp Segmentation Network (PSNet). Both the dual encoder and decoder were developed by the comprehensive combination of a variety of deep learning modules, including the PS encoder, transformer encoder, PS decoder, enhanced dilated transformer decoder, partial decoder, and merge module. PSNet outperforms state-of-the-art results through an extensive comparative study against 5 existing polyp datasets with respect to both mDice and mIoU at 0.863 and 0.797, respectively. With our new modified polyp dataset we obtain an mDice and mIoU of 0.941 and 0.897 respectively.

Efficiency of Gastrointestinal Cancer Detection by Nematode-NOSE (N-NOSE)

BACKGROUND/AIM

Early detection of gastrointestinal cancer may reduce mortality. Recently, Caenorhabditis elegans has been reported to be capable of differentiating patients with cancers from healthy persons by the smell of urine. This novel technique using C. elegans olfaction has been named as Nematode-NOSE (N-NOSE).

MATERIALS AND METHODS

We collected 180 urine samples from patients with gastrointestinal cancer and 76 samples from healthy subjects. N-NOSE test was performed using these samples and N-NOSE index was obtained. Quantification of the olfactory behavior of C. elegans was performed as established in past studies. By receiver operating characteristic (ROC) analysis, we examined the diagnostic capability of N-NOSE.

RESULTS

ROC analysis revealed that N-NOSE showed an area under the curve value of more than 0.80, even in early-stage cancers.

CONCLUSION

C. elegans olfaction enabled the detection of gastrointestinal cancers from urine with high sensitivity, which can provide the basis for the development of N-NOSE as a gastrointestinal cancer screening test.

Rates of infection after colonoscopy and osophagogastroduodenoscopy in ambulatory surgery centres in the USA

OBJECTIVE

Over 15 million colonoscopies and 7 million osophagogastroduodenoscopies (OGDs) are performed annually in the USA. We aimed to estimate the rates of infections after colonoscopy and OGD performed in ambulatory surgery centres (ASCs).

DESIGN

We identified colonoscopy and OGD procedures performed at ASCs in 2014 all-payer claims data from six states in the USA. Screening mammography, prostate cancer screening, bronchoscopy and cystoscopy procedures were comparators. We tracked infection-related emergency department visits and unplanned in-patient admissions within 7 and 30 days after the procedures, examined infection sites and organisms and analysed predictors of infections. We investigated case-mix adjusted variation in infection rates by ASC.

RESULTS

The rates of postendoscopic infection per 1000 procedures within 7 days were 1.1 for screening colonoscopy, 1.6 for non-screening colonoscopy and 3.0 for OGD; all higher than screening mammography (0.6) but lower than bronchoscopy (15.6) and cystoscopy (4.4) (p<0.0001). Predictors of postendoscopic infection included recent history of hospitalisation or endoscopic procedure; concurrence with another endoscopic procedure; low procedure volume or non-freestanding ASC; younger or older age; black or Native American race and male sex. Rates of 7-day postendoscopic infections varied widely by ASC, ranging from 0 to 115 per 1000 procedures for screening colonoscopy, 0 to 132 for non-screening colonoscopy and 0 to 62 for OGD.

CONCLUSION

We found that postendoscopic infections are more common than previously thought and vary widely by facility. Although screening colonoscopy is not without risk, the risk is lower than diagnostic endoscopic procedures.

Characteristics of right-sided colonic neoplasia and colonoscopy barriers limiting their early detection and prognosis: a review of the literature

Colonoscopy provides less protection from colorectal cancer in the right colon than the left. Areas covered: This review examines patient outcomes and colonoscopy success rates to identify factors that limit the protective effect of colonoscopy in the right colon. The MEDLINE and Embase databases were searched for literature from 2000 onwards, on the long-term outcomes and differences in screening practice between the right and left colon. In total, 12 systematic reviews (including nine meta-analyses) and 44 primary data records were included. Differences in patient outcomes and colonoscopy practice were identified between the right and left colon, suggesting that several factors, many of which disproportionally affect the right colon, impact lesion detection rates. Shorter withdrawal times reduce detection rates, while longer times significantly increase detection; mostly of adenomas in the right colon. Colonoscope attachments often only show a significant improvement in detection rates in the right colon, suggesting detection is more challenging due to visibility of the right colonic mucosa. Higher bowel cleansing grades significantly improve detection rates in the right colon compared to the left. Expert commentary: These findings confirm the need for continued improvement of colonoscopy effectiveness, and obligatory quality assessment, overall and especially in the right colon.

Does antiaggregant administration lead to early diagnosis in proximal colon cancer?

OBJECTIVE:

Cancers of the proximal colon are often diagnosed in advanced stages with iron deficiency anemia and nonspecific symptoms. Aspirin and clopidogrel are commonly used antiaggregant agents for various clinical conditions. The aim of this study was to investigate the effects of antiaggregant medication on the early diagnosis of proximal colon cancer.

METHODS:

Cases of colon cancer patients who had received curative surgical procedures between January 1, 2013 and July 31, 2016 were retrospectively reviewed. The clinical and pathological results of patients who had used antiaggregant drugs were compared to those who had not.

RESULTS:

During the studied period, 246 colorectal cancer patients underwent curative surgical procedures. Of the 67 patients with proximal colon cancer who were included in the study, 27 (40.3%) had taken antiaggregant medication. The mean age of the antiaggregant group was 67.1 years (range: 34–88 years), while it was 58.3 years (range: 34–83 years) for the non-antiaggregant group; the difference between the 2 groups was statistically significant (p=0.03). A pathological evaluation revealed that 74.1% of the antiaggregant group was in the early stages (Stage I/II: 7/13), while 42.5% of the non-antiaggregant group was in the early stages (Stage I/II: 2/15); the difference was statistically significant (p=0.011).

CONCLUSION:

Antiaggregant medication has a positive effect on diagnosing proximal colon cancer at early stages. Patients using aspirin or clopidogrel should undergo a complete colonoscopic evaluation in the presence of gastrointestinal tract bleeding or newly developed anemia.

Exploration of the mechanism of colorectal cancer metastasis using microarray analysis

The aim of the present study was to investigate the mechanism of metastasis in colorectal cancer (CRC) using microRNA (miRNA) and mRNA expression profiles. The mRNA and miRNA expression profiles of the GSE2509 and GSE56350 datasets were obtained from the Gene Expression Omnibus database. The differentially expressed genes (DEGs) and differentially expressed miRNAs (DEMs) were identified using the limma software package. The Database for Annotation, Visualization and Integrated Discovery was used to perform Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of the DEGs. The predicted target genes associated with the DEMs were identified using the miRWalk database and the enrichment analysis was conducted using the clusterProfiler package. The miRNA-gene molecular interaction network was visualized using the Cytoscape software platform. A total of 544 DEGs and 42 DEMs were identified. DEGs were annotated in 320 GO terms and 11 KEGG pathways. Overall, 366 miRNA-gene pairs were identified and the miRNA-gene network was visualized. Furthermore, the predicted target genes were mainly classified in 12 pathways. The results of the present study suggest that fibronectin type III domain-containing 3B, cysteine rich transmembrane BMP regulator 1 and forkhead box J2 may be potential therapeutic and prognostic targets of metastatic CRC. In addition, pathways in cancer, the Wnt signaling pathway and extracellular matrix-receptor interaction may play a critical role in CRC metastasis.

Maneuverability and safety of a magnetic-controlled capsule endoscopy system to examine the human colon under real-time monitoring by colonoscopy: a pilot study (with video)

BACKGROUND AND AIMS

Colon capsule endoscopy has become an alternative method to evaluate the colonic mucosa without pain, sedation, and gas insufflation in recent years. The magnetic-controlled capsule endoscopy (MCCE) system is an innovative ingestible colon capsule. We performed a pilot study to assess its maneuverability and safety among subjects who volunteered to undergo colorectal cancer screening.

METHODS

Fifty-seven volunteers underwent both MCCE and colonoscopy procedures. The position of the MCCE was monitored after the capsule was swallowed. When the MCCE reached the cecum, it was controlled by a magnetic manipulator to observe the colonic mucosa under real-time monitoring by colonoscopy. The primary measurements included maneuverability, the level of cleanliness, lesions, and safety.

RESULTS

Five volunteers (8.78%) were excluded because of bowel preparation protocol deviations or failure to reach the cecum before the battery was exhausted. There was no capsule retention. Maneuverability of the MCCE to match the guidance of the magnetic manipulator was graded as good in 49 subjects (94.23%) and moderate in 3 (5.77%). It took 3.63 ± 1.14 hours for the MCCE to reach the cecum. In 52 subjects (100%) the MCCE reached the transverse colon positively, and in 41 subjects (78.84%) the MCCE reached the rectosigmoid colon within a limited time of 25 minutes. The bowel preparation for MCCE was rated as good or excellent in 84.61% of the volunteers. Six positive findings were identified by the MCCE in the colon, which were also confirmed by colonoscopy.

CONCLUSIONS

The MCCE showed promising maneuverability under real-time monitoring by colonoscopy. (Clinical trial registration number: NCT02536144.).