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Deding U, Bøggild H, Kaalby L, Hjelmborg J, Kobaek-Larsen M, Thygesen MK, Schelde-Olesen B, Bjørsum-Meyer T, Baatrup G. Socioeconomic differences in discrepancies between expected and experienced discomfort from colonoscopy and colon capsule endoscopy. Heliyon 2024; 10:e34274. [PMID: 39100485 PMCID: PMC11295845 DOI: 10.1016/j.heliyon.2024.e34274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/07/2024] [Accepted: 07/07/2024] [Indexed: 08/06/2024] Open
Abstract
Background Social inequalities in colorectal cancer screening participation are evident. Barriers to screening participation include discomfort from diagnostic modalities. We aimed to describe the discomfort experienced from colonoscopy and colon capsule endoscopy (CCE) and investigate the discrepancy between expected and experienced discomfort stratified by socioeconomic status. Methods A randomised controlled trial was conducted offering half of the colorectal cancer screening invitees the choice between CCE and colonoscopy after a positive faecal immunochemical test. This paper includes those who elected to undergo CCE. A positive CCE elicited referral for a therapeutic colonoscopy. Participants reported their discomfort from CCE and from any following colonoscopies in electronically distributed questionnaires. Discomfort was measured using visual analogue scales and compared between socioeconomic subgroups determined by educational level and income. Results The experienced discomfort from CCE and colonoscopy differed significantly between educational levels but not income levels. The bowel preparation contributed the most to the experienced discomfort in both CCE and colonoscopy. The discrepancy between expected and experienced discomfort from colonoscopy increased with increasing educational and income levels. A similar trend was seen in CCE between educational levels but not income levels. Conclusions None of the results indicated a higher discomfort in lower socioeconomic subgroups. Regardless of the investigation modality, the bowel preparation was the main contributor to experienced discomfort. The discrepancy between expected and experienced discomfort did not seem to be larger in lower socioeconomic subgroups, indicating that this is not a major barrier causing inequalities in screening uptake. This is the first study investigating individual discomfort discrepancy in both CCE and colonoscopy, while being able to stratify by socioeconomic status.
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Affiliation(s)
- Ulrik Deding
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lasse Kaalby
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - Jacob Hjelmborg
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Morten Kobaek-Larsen
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - Marianne Kirstine Thygesen
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - Benedicte Schelde-Olesen
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - Gunnar Baatrup
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
| | - CareForColon2015 study group
- Department of Clinical Research, University of Southern Denmark, Denmark
- Department of Surgery, Odense University Hospital, Denmark
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
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Selnes O, Thorndal C, Hansen LØ, Eskemose SR, Koulaouzidis A. Conference Report: The FutuRE oF MinimalLy InvasivE GI and Capsule DiagnosTics (REFLECT) Nyborg, Denmark, October 2023. Diagnostics (Basel) 2024; 14:458. [PMID: 38472931 DOI: 10.3390/diagnostics14050458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 03/14/2024] Open
Abstract
The gastrointestinal (GI) tract, particularly the small bowel (SB), can be challenging for novel investigation tools [...].
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Affiliation(s)
- Ola Selnes
- Surgical Research Unit, Odense University Hospital, 5700 Svendborg, Denmark
| | - Camilla Thorndal
- Surgical Research Unit, Odense University Hospital, 5700 Svendborg, Denmark
| | | | | | - Anastasios Koulaouzidis
- Surgical Research Unit, Odense University Hospital, 5700 Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204 Szczecin, Poland
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3
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Schelde-Olesen B, Bjørsum-Meyer T, Koulaouzidis A, Buijs MM, Herp J, Kaalby L, Baatrup G, Deding U. Interobserver agreement on landmark and flexure identification in colon capsule endoscopy. Tech Coloproctol 2023; 27:1219-1225. [PMID: 37036637 PMCID: PMC10638147 DOI: 10.1007/s10151-023-02789-z] [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: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE When an optical colonoscopy is carried out, Scope Guide can assist the endoscopist in determining the localization. In colon capsule endoscopy (CCE), this support is not available. To our knowledge, the interobserver agreement on landmark identification has never been studied. This study aims to investigate the interobserver agreement on landmark identification in CCE. METHODS An interobserver study was carried out comparing the landmark identification (the ileocecal valve, hepatic flexure, splenic flexure, and anus) in CCE investigations between an external private contractor and three in-house CCE readers with different levels of experience. All CCE investigations analyzed in this study were carried out as a part of the Danish screening program for colorectal cancer. Patients were between 50 and 74 years old with a positive fecal immunochemical test (FIT). A random sample of 20 CCE investigations was taken from the total sample of more than 800 videos. RESULTS Overall interobserver agreement on all landmarks was 51%. Interobserver agreement on the first cecal image (ileocecal valve), hepatic flexure, splenic flexure, and last rectal image (anus) was 72%, 29%, 22%, and 83%, respectively. The overall interobserver agreement, including only examinations with adequate bowel preparation (n = 16), was 54%, and for individual landmarks, 73%, 32%, 24%, and 85%. CONCLUSION Overall interobserver agreement on all four landmarks from CCE was poor. Measures are needed to improve landmark identification in CCE investigations. Artificial intelligence could be a possible solution to this problem.
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Affiliation(s)
- B Schelde-Olesen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark.
| | - T Bjørsum-Meyer
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - A Koulaouzidis
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204, Szczecin, Poland
- Department of Medicine, Odense University Hospital, Svendborg, Denmark
| | - M M Buijs
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - J Herp
- Applied AI and Data Science Group, Mærsk-Mc-Kinney Møller Institute, Faculty of Engineering, University of Southern Denmark, Odense, Denmark
- CAI-X (Centre for Clinical Artificial Intelligence) University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - L Kaalby
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - G Baatrup
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
| | - U Deding
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Surgery, Odense University Hospital, Baagoes Alle 31, 5700, Svendborg, Denmark
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Sakai CM, Ueda SKN, Caiado AHM, Ribeiro IB, Marinho FRT, de Rezende DT, Bustamante-Lopez LA, Nahas SC, de Moura DTH, de Moura EGH. A Head-to-Head Comparison of Computed Tomography Colonography, Optical Colonoscopy, and Colon Endoscopic Capsule for the Detection of Polyps After Partial Colectomy or Rectosigmoidectomy for Colorectal Cancer: A Pilot Study. Cureus 2023; 15:e38410. [PMID: 37273390 PMCID: PMC10232294 DOI: 10.7759/cureus.38410] [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] [Accepted: 03/21/2023] [Indexed: 06/06/2023] Open
Abstract
Background and objective Optical colonoscopy is the gold standard method for the diagnosis of colorectal cancer (CRC) and it allows for biopsy and resection, as well as documentation of synchronous lesions. CT colonography (CTC) and colon endoscopic capsule (CEC) are also recommended as alternative minimally invasive or non-invasive procedures. Prospective studies comparing these three approaches are scarce in the current literature. In light of this, the aim of this pilot study was to compare the efficacy of polyp detection between these three methods in patients with a history of curative surgical resection of CRC. Methods Patients were consecutively recruited and all procedures were sequentially conducted on the same day. The primary endpoint was the detection rate of polyps, whereas secondary endpoints were the detection of polyps according to size and location, and the adverse events caused by these procedures. Results A total of 21 patients were consecutively included and all of them underwent all three interventions. No adverse events, local recurrences, or metachronous lesions were detected. In two cases with elevated carcinoembryonic antigen (CEA), CTC unveiled distant metastasis. Optical colonoscopy registered a mean of 0.4 polyp >6 mm and 1.3 polyps <6 mm per patient. CTC unveiled only 0.5 polyp >6 mm/patient and no smaller lesions were documented, whereas findings for the colon capsule comprised an average of 0.4 polyps >6 mm and 0.7 polyps <6 mm per patient. Statistical difference was not demonstrated, except for virtual colonoscopy in terms of the total number of polyps detected in comparison to optical colonoscopy. Conclusions Optical colonoscopy showed superior results in comparison to virtual colonoscopy while there was no statistical difference in comparison to colon capsule. Notwithstanding occasional difficulties, all three techniques were well tolerated. Hence, decisions concerning the use of each diagnostic method should be based on their availability, professional expertise, contraindications, and patient preferences.
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Affiliation(s)
- Christiano Makoto Sakai
- Department of Gastroenterology, Faculty of Medicine, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | - Serli Kiyomi Nakao Ueda
- Department of Radiology, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | | | - Igor Braga Ribeiro
- Department of Gastroenterology, Faculty of Medicine, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | | | | | - Leonardo A Bustamante-Lopez
- Department of Gastroenterology, Faculty of Medicine, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
| | - Sergio C Nahas
- Colorectal Surgery, Hospital das Clínicas of the University of São Paulo, São Paulo, BRA
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Ngalim SH, Yusoff N, Johnson RR, Abdul Razak SR, Chen X, Hobbs JK, Lee YY. A review on mechanobiology of cell adhesion networks in different stages of sporadic colorectal cancer to explain its tumorigenesis. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2022; 175:63-72. [PMID: 36116549 DOI: 10.1016/j.pbiomolbio.2022.09.003] [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: 08/01/2021] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 06/15/2023]
Abstract
Sporadic colorectal cancer (CRC) is strongly linked to extraneous factors, like poor diet and lifestyle, but not to inherent factors like familial genetics. The changes at the epigenomics and signalling pathways are known across the sporadic CRC stages. The catch is that temporal information of the onset, the feedback loop, and the crosstalk of signalling and noise are still unclear. This makes it challenging to diagnose and treat colon cancer effectively with no relapse. Various microbial cells and native cells of the colon, contribute to sporadic CRC development. These cells secrete autocrine and paracrine for their bioenergetics and communications with other cell types. Imbalances of the biochemicals affect the epithelial lining of colon. One side of this epithelial lining is interfacing the dense colon tissue, while the other side is exposed to microbiota and excrement from the lumen. Hence, the epithelial lining is prone to tumorigenesis due to the influence of both biochemical and mechanical cues from its complex surrounding. The role of physical transformations in tumorigenesis have been limitedly discussed. In this context, cellular and tissue structures, and force transductions are heavily regulated by cell adhesion networks. These networks include cell anchoring mechanism to the surrounding, cell structural integrity mechanism, and cell effector molecules. This review will focus on the progression of the sporadic CRC stages that are governed by the underlaying cell adhesion networks within the epithelial cells. Additionally, current and potential technologies and therapeutics that target cell adhesion networks for treatments of sporadic CRC will be incorporated.
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Affiliation(s)
- Siti Hawa Ngalim
- Advanced Medical and Dental Institute, Universiti Sains Malaysia (USM) Bertam, 13200 Kepala Batas, Penang, Malaysia.
| | - Norwahida Yusoff
- School of Mechanical Engineering, Universiti Sains Malaysia (USM) Engineering Campus, 14300 Nibong Tebal, Penang, Malaysia
| | - Rayzel Renitha Johnson
- Advanced Medical and Dental Institute, Universiti Sains Malaysia (USM) Bertam, 13200 Kepala Batas, Penang, Malaysia
| | - Siti Razila Abdul Razak
- Advanced Medical and Dental Institute, Universiti Sains Malaysia (USM) Bertam, 13200 Kepala Batas, Penang, Malaysia
| | - Xinyue Chen
- Department of Physics and Astronomy, University of Sheffield, Hounsfield Road, Sheffield, S3 7RH, United Kingdom
| | - Jamie K Hobbs
- Department of Physics and Astronomy, University of Sheffield, Hounsfield Road, Sheffield, S3 7RH, United Kingdom
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia (USM) Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia
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Deding U, Kaalby L, Baatrup G, Kobaek-Larsen M, Thygesen MK, Epstein O, Bjørsum-Meyer T. The Effect of Prucalopride on the Completion Rate and Polyp Detection Rate of Colon Capsule Endoscopies. Clin Epidemiol 2022; 14:437-444. [PMID: 35401015 PMCID: PMC8985819 DOI: 10.2147/clep.s353527] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/12/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Ulrik Deding
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Correspondence: Ulrik Deding, Department of Surgery, Odense University Hospital, Baagøes Allé 15, SVB Bygning 13.02, Svendborg, 5700, Denmark, Tel +45 42574243, Email ;
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Kobaek-Larsen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Kirstine Thygesen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Owen Epstein
- Institute for Minimally Invasive Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Koulaouzidis A, Bjørsum-Meyer T, Toth E. Real-life practice data on colon capsule endoscopy: We need them fast! Endosc Int Open 2022; 10:E230-E231. [PMID: 35295244 PMCID: PMC8920598 DOI: 10.1055/a-1728-9371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Anastasios Koulaouzidis
- Department of Medicine, OUH Svendborg, Sygehus, Denmark,Department of Clinical Research, University, of Southern Denmark (SDU), Denmark,Department of Social Medicine & Public Health, Pomeranian Medical University, Poland
| | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
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Bjoersum-Meyer T, Spada C, Watson A, Eliakim R, Baatrup G, Toth E, Koulaouzidis A. What holds back colon capsule endoscopy from being the main diagnostic test for the large bowel in cancer screening? Gastrointest Endosc 2022; 95:168-170. [PMID: 34534495 DOI: 10.1016/j.gie.2021.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Thomas Bjoersum-Meyer
- Department of Surgery, Odense University Hospital, Svendborg, Denmark; University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense, Denmark
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy; Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angus Watson
- Highland Medical Education Centre, Centre for Health Science, Raigmore Hospital, Inverness, Scotland, UK
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark; University of Southern Denmark, Faculty of Health Science, Department of Clinical research, Odense, Denmark
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anastasios Koulaouzidis
- Department of Social Medicine and Public Health, Pomeranian Medical University, Szczecin, Poland
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Bjørsum-Meyer T, Koulaouzidis A, Baatrup G. Colon capsule endoscopy as an entry level test under the right circumstances. Colorectal Dis 2021; 23:3276-3277. [PMID: 34601795 DOI: 10.1111/codi.15935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Svendborg, Denmark.,Department of Clinical research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark.,Department of Clinical research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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10
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Deding U, Bjørsum-Meyer T, Kaalby L, Kobaek-Larsen M, Thygesen MK, Madsen JB, Kroijer R, Baatrup G. Colon capsule endoscopy in colorectal cancer screening: Interim analyses of randomized controlled trial CareForColon2015. Endosc Int Open 2021; 9:E1712-E1719. [PMID: 34790535 PMCID: PMC8589533 DOI: 10.1055/a-1546-8727] [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: 03/30/2021] [Accepted: 06/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The Danish CareForColon2015 trial, launched in 2020 as part of the Danish Colorectal Cancer Screening program, is the largest randomized controlled trial to date on colon capsule endoscopy (CCE). This paper presents the interim analysis with the objective of ensuring the safety of patients in the intervention group and evaluating the clinical performance of the trial's predefined clinical parameters. Patients and methods We evaluated the initial 234 CCEs according to quality, safety, and completion. The participation rates and preference distribution of all individuals invited were analyzed and sample size calculations were adjusted. Results Fecal immunochemical test and diagnostic participation rates were 62.1 % and 91.1 %, respectively. The completion rate for CCEs was 67.9 % and the rate of conclusive investigations was 80.3 %. The polyp detection rate (PDR) was high (73.5 %), only two (0.85 %) technical failures in 234 videos were observed, and six suspected cancers were identified (2.6 %). No major adverse events were recorded. The required number of invitations had been underestimated due to inaccurate assumptions in sample size calculations. Conclusions The trial was efficient and safe in terms of CCE quality and time to diagnostic investigation. Participation rates and PDRs were high. The proportion of suspected cancers was lower than expected and will be followed. The completion rate for CCEs was acceptable but lower than expected and the CCE procedure was reviewed for potential improvements and Resolor was added to the regime. The number of invitations for the intervention group of the trial has been adjusted from 62,107 to 185,153.
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Affiliation(s)
- Ulrik Deding
- Department of Surgery, Odense University Hospital, Svendborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Svendborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Svendborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Kobaek-Larsen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Kirstine Thygesen
- Department of Surgery, Odense University Hospital, Svendborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jeppe Buur Madsen
- Department of Biochemistry and Immunology, University Hospital Lillebaelt, Vejle, Denmark
| | - Rasmus Kroijer
- Department of Surgery, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Bjoersum-Meyer T, Skonieczna-Zydecka K, Cortegoso Valdivia P, Stenfors I, Lyutakov I, Rondonotti E, Pennazio M, Marlicz W, Baatrup G, Koulaouzidis A, Toth E. Efficacy of bowel preparation regimens for colon capsule endoscopy: a systematic review and meta-analysis. Endosc Int Open 2021; 9:E1658-E1673. [PMID: 34790528 PMCID: PMC8589531 DOI: 10.1055/a-1529-5814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) is an alternative to conventional colonoscopy (CC) in specific clinical settings. High completion rates (CRs) and adequate cleanliness rates (ACRs) are fundamental quality parameters if CCE is to be widely implemented as a CC equivalent diagnostic modality. We conducted a systematic review and meta-analysis to investigate the efficacy of different bowel preparations regimens on CR and ACR in CCE. Patients and methods We performed a systematic literature search in PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library. Data were independently extracted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The primary outcome measures (CR, ACR) were retrieved from the individual studies and pooled event rates were calculated. Results Thirty-four observational (OBS) studies (n = 3,789) and 12 randomized clinical trials (RCTs) (n = 1,214) comprising a total 5,003 patients were included. The overall CR was 0.798 (95 % CI, 0.764-0.828); the highest CRs were observed with sodium phosphate (NaP) + gastrografin booster (n = 2, CR = 0.931, 95 % CI, 0.820-0.976). The overall ACR was 0.768 (95 % CI, 0.735-0.797); the highest ACRs were observed with polyethylene glycol (PEG) + magnesium citrate (n = 4, ER = 0.953, 95 % CI, 0.896-0.979). Conclusions In the largest meta-analysis on CCE bowel preparation regimens, we found that both CRs and ACRs are suboptimal compared to the minimum recommended standards for CC. PEG laxative and NaP booster were the most commonly used but were not associated with higher CRs or ACRs. Well-designed studies on CCE should be performed to find the optimal preparation regimen.
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Affiliation(s)
| | | | - Pablo Cortegoso Valdivia
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy.
| | - Irene Stenfors
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Ivan Lyutakov
- Department of Gastroenterology, University Hospital “Tsaritsa Yoanna – ISUL”, Medical University Sofia, Bulgaria
| | | | - Marco Pennazio
- University Division of Gastroenterology, City of Health and Science University Hospital, Turin, Italy
| | - Wojciech Marlicz
- Department of Gastroenterology, Pomeranian Medical University, Szczecin, Poland,The Centre for Digestive Diseases, Endoklinika, Szczecin, Poland
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense Denmark
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, Szczecin, Poland
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
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Bjørsum-Meyer T, Baatrup G, Koulaouzidis A. Colon Capsule Endoscopy as a Diagnostic Adjunct in Patients with Symptoms from the Lower Gastrointestinal Tract. Diagnostics (Basel) 2021; 11:diagnostics11091671. [PMID: 34574011 PMCID: PMC8467213 DOI: 10.3390/diagnostics11091671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 02/07/2023] Open
Abstract
Prompted by the core idea of wireless capsule endoscopy as a painless gastrointestinal examination, and the easy adoption of small bowel capsule endoscopy, the armamentarium of the capsule-based imaging platforms has grown to include colon capsule devices as well [...].
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Affiliation(s)
- Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5230 Odense M, Denmark
- Correspondence: ; Tel.: +45-27896080
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5230 Odense M, Denmark
| | - Anastasios Koulaouzidis
- Department of Social Medicine & Public Health, Pomeranian Medical University, 70-204 Szczecin, Poland;
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Ravindran S, Munday J, Veitch AM, Broughton R, Thomas-Gibson S, Penman ID, McKinlay A, Fearnhead NS, Coleman M, Logan R. Bowel cancer screening workforce survey: developing the endoscopy workforce for 2025 and beyond. Frontline Gastroenterol 2021; 13:12-19. [PMID: 34970428 PMCID: PMC8666856 DOI: 10.1136/flgastro-2021-101790] [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: 01/18/2021] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 02/04/2023] Open
Abstract
AIM The demand for bowel cancer screening (BCS) is expected to increase significantly within the next decade. Little is known about the intentions of the workforce required to meet this demand. The Joint Advisory Group on Gastrointestinal Endoscopy (JAG), the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain and Ireland (ACPGBI) developed the first BCS workforce survey. The aim was to assess endoscopist career intentions to aid in future workforce planning to meet the anticipated increase in BCS colonoscopy. METHODS A survey was developed by JAG, BSG and ACPGBI and disseminated to consultant, clinical and trainee endoscopists between February and April 2020. Descriptive and comparative analyses were undertaken, supported with BCS data. RESULTS There were 578 respondents. Screening consultants have a median of one programmed activity (PA) per week for screening, accounting for 40% of their current endoscopy workload. 38% of current screening consultants are considering giving up colonoscopy in the next 2-5 years. Retirement (58%) and pension issues (23%) are the principle reasons for this. Consultants would increase their screening PAs by 70% if able to do so. The top three activities that endoscopists would relinquish to further support screening were outpatient clinics, acute medical/surgical on call and ward cover. An extra 155 colonoscopists would be needed to fulfil increased demand and planned retirement at current PAs. CONCLUSION This survey has identified a serious potential shortfall in screening colonoscopists in the next 5-10 years due to an ageing workforce and job plan pressures of aspirant BCS colonoscopists. We have outlined potential mitigations including reviewing job plans, improving workforce resources and supporting accreditation and training.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Surgery and Cancer, Imperial College London, London, UK
| | | | - Andrew M Veitch
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK,Bowel Screening Advisory Committee, Public Health England, London, UK
| | - Raphael Broughton
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Siwan Thomas-Gibson
- Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ian D Penman
- Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, UK,British Society of Gastroenterology, London, UK
| | - Alistair McKinlay
- British Society of Gastroenterology, London, UK,Department of Gastroenterology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Nicola S Fearnhead
- Colorectal Surgery, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK,Association of Coloproctology of Great Britain and Ireland, Royal College of Surgeons of England, London, UK
| | - Mark Coleman
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Robert Logan
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK,NHS England and NHS Improvement London, London, UK
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