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Hijos-Mallada G, Saura N, Lué A, Velamazan R, Nieto R, Navarro M, Arechavaleta S, Chueca E, Gomollon F, Lanas A, Sostres C. A Point-of-Care Faecal Test Combining Four Biomarkers Allows Avoidance of Normal Colonoscopies and Prioritizes Symptomatic Patients with a High Risk of Colorectal Cancer. Cancers (Basel) 2023; 15:cancers15030721. [PMID: 36765678 PMCID: PMC9913693 DOI: 10.3390/cancers15030721] [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: 12/26/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023] Open
Abstract
Most colonoscopies performed to evaluate gastrointestinal symptoms detect only non-relevant pathologies. We aimed to evaluate the diagnostic accuracy of a qualitative point-of-care (POC) test combining four biomarkers (haemoglobin, transferrin, calprotectin, and lactoferrin), a quantitative faecal immunochemical test (FIT) for haemoglobin, and a quantitative faecal calprotectin (FC) test in symptomatic patients prospectively recruited. Colorectal cancer (CRC), adenoma requiring surveillance, inflammatory bowel disease (IBD), microscopic colitis, and angiodysplasia were considered significant pathologies. A total of 571 patients were included. Significant pathology was diagnosed in 118 (20.7%), including 30 CRC cases (5.3%). The POC test yielded the highest negative predictive values: 94.8% for a significant pathology and 100% for CRC or IBD if the four markers turned negative (36.8% of the patients). Negative predictive values of FIT, FC, and its combination for diagnosis of a significant pathology were 88.4%, 87.6%, and 90.8%, respectively. Moreover, the positive predictive value using the POC test was 82.3% for significant pathology when all biomarkers tested positive (6% of the patients), with 70.6% of these patients diagnosed with CRC or IBD. The AUC of the POC test was 0.801 (95%CI 0.754-0.848) for the diagnosis of a significant pathology. Therefore, this POC faecal test allows the avoidance of unnecessary colonoscopies and prioritizes high risk symptomatic patients.
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Affiliation(s)
- Gonzalo Hijos-Mallada
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
- Correspondence:
| | - Nuria Saura
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Alberto Lué
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Raúl Velamazan
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Rocío Nieto
- Departamento de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Mercedes Navarro
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | | | - Eduardo Chueca
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
| | - Fernando Gomollon
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
- Departamento de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Angel Lanas
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
- Departamento de Medicina, Universidad de Zaragoza, 50009 Zaragoza, Spain
- CIBER Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
| | - Carlos Sostres
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
- Instituto de Investigación Sanitaria (IIS) Aragón, 50009 Zaragoza, Spain
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Ismail MS, Murphy G, Semenov S, McNamara D. Comparing Colon Capsule Endoscopy to colonoscopy; a symptomatic patient’s perspective. BMC Gastroenterol 2022; 22:31. [PMID: 35073873 PMCID: PMC8785487 DOI: 10.1186/s12876-021-02081-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Colon Capsule Endoscopy (CCE) has proven efficacy in a variety of gastrointestinal diseases. Few studies have assessed patient-reported outcomes and preference between colonoscopy and CCE.
Methods
Patients from our centre who had both a CCE and colonoscopy within a 12-month period were identified. We performed over-the-phone interviews focused on satisfaction, comfort, and overall preference with a 10-point Likert scale. Electronic records were reviewed; reported Modified-Gloucester-Comfort-Scale (GCS) score, sedation, bowel preparation and endoscopist grade were documented. Data was compared between procedures. A Fishers exact test was used to compare proportions and a Student t-test was used to compare means, a p < 0.05 was considered significant.
Results
In all, 40 patients were identified, 57.5% (23/40) were female and the mean age was 48 years (24–78). All patients were referred for investigation of lower gastrointestinal symptoms as part of an ongoing study [Endosc Int Open. 2021;09(06):E965–70]. There was a significance difference in mean comfort (9.2 vs 6.7, p < 0.0001, 95% CI − 3.51 to − 1.44) but not satisfaction (8.3 vs 7.7, p = 0.2, 95% CI − 1.48 to 0.33) between CCE and colonoscopy. Main cause of dissatisfaction with CCE was bowel preparation and for colonoscopy was discomfort. Age and gender were not found to be variables. The correlation between GCS and patient reported values was weak (R = − 0.28). Overall, 77.5% (31/40) of patients would prefer a CCE if they required further bowel investigation. Of these, 77.4% (24/31) preferred a CCE despite the potential need for follow-up colonoscopy.
Conclusions
CCE has a high satisfaction rating (8.3 vs 7.7) and has a higher patient reported comfort rating (9.2 vs 6.7) than colonoscopy. Studies have confirmed CCE and colonoscopy have equivalent diagnostic yields. The majority of patients in our cohort prefer CCE to colonoscopy. CCE should be considered as an alternative to colonoscopy in selected individuals.
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Ismail MS, Semenov S, Sihag S, Manoharan T, Douglas AR, Reill P, Kelly M, Boran G, O’Connor A, Breslin N, O’Donnell S, Ryan B, McNamara D. Colon capsule endoscopy is a viable alternative to colonoscopy for the investigation of intermediate- and low-risk patients with gastrointestinal symptoms: results of a pilot study. Endosc Int Open 2021; 9:E965-E970. [PMID: 34079884 PMCID: PMC8159609 DOI: 10.1055/a-1401-9528] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/11/2021] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) is a recommended viable alternative to colonoscopy for colonic visualisation in a variety of clinical settings with proven efficacy in polyp detection, surveillance, screening and Inflammatory Bowel Disease (IBD) assessment. CCE efficacy in an unselected average risk symptomatic cohort has yet to be established. The aim of this study was to determine the feasibility of CCE imaging assessment in average risk symptomatic patients as an alternative to colonoscopy with and without additional biomarker assessment. Patients and methods This was a prospective, single-center comparison study of colonoscopy, CCE and biomarker assessment. Results Of 77 invited subjects, 66 underwent both a CCE and colonoscopy. A fecal immunochemical test (FIT) and fecal calprotectin (FC) were available in 56 and 59 subjects. In all 64 % (n = 42) had any positive finding with 16 (24 %) found to have significant disease (high-risk adenomas, IBD) on colonoscopy. The CCE completion rate was 76 %, five (8 %) had an inadequate preparation, the CCE polyp detection rate was high at 35 %. The sensitivity, specificity, positive and negative predictive values of CCE for significant disease were 81 %, 98 %, 93 % and 94 % respectively. In addition, three (5 %) significant small bowel diagnoses were made on CCE. FC and FIT were frequently elevated in patients with both colitis (5/7, 71 %) and high-risk adenomas (4/7 57 %). While both had a low positive predictive value for clinically significant disease, FIT 32 % and FC 26 %. Conclusions CCE is a safe and effective alternative to colonoscopy in symptomatic average risk patients with or without the addition of biomarker screening.
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Affiliation(s)
- Mohd Syafiq Ismail
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
| | - Serhiy Semenov
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
| | - Sandeep Sihag
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | | | | | - Phyllis Reill
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - Michael Kelly
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - Gerard Boran
- Department of Clinical Chemistry, Tallaght University Hospital, Dublin, Ireland
| | - Anthony O’Connor
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
| | - Niall Breslin
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Sarah O’Donnell
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Barbara Ryan
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Deirdre McNamara
- Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
- TAGG Research Centre, School of Medicine, Trinity College, Dublin, Ireland
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Nunoo-Mensah JW, Giordano P, Chung-Faye G. COVID-19: An Opportunity to Reimagine Colorectal Cancer Diagnostic Testing-A New Paradigm Shift. Clin Colorectal Cancer 2020; 19:227-230. [PMID: 32921580 PMCID: PMC7395219 DOI: 10.1016/j.clcc.2020.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph W Nunoo-Mensah
- Department of Colorectal Surgery, King's College Hospital Foundation NHS Trust, London, UK; Cleveland Clinic London, London, UK.
| | - Pasquale Giordano
- Department of Colorectal Surgery, Whipps Cross University Hospital, London, UK
| | - Guy Chung-Faye
- Department of Gastroenterology, King's College Hospital Foundation NHS Trust, London, UK
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