1
|
Peng W, McKinnon-Crowley J, Huang Q, Mao B. Assessing Fear, Embarrassment, and Disgust in Colonoscopy: The Development of Measurement Instruments and Psychometric Evidence. HEALTH EDUCATION & BEHAVIOR 2024; 51:601-612. [PMID: 37293778 DOI: 10.1177/10901981231177075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Avoidance of colonoscopy is often associated with fear, embarrassment, and disgust aroused in screening procedures. However, each emotion can be linked to different challenges faced by patients. More research is needed to evaluate and address the causes of these respective emotions. AIM The purpose of this study was to develop and assess the scales of three negative emotions (i.e., fear, embarrassment, and disgust) caused by specific issues in colonoscopy screening. METHOD The measurement items were developed based on multiple common barriers in colonoscopy screening procedures. An online sample of 232 adults aged 45-75 was recruited from Amazon Mechanical Turk to test the scales. Explorative and confirmatory factor analyses were conducted to validate the measurement models. RESULTS Psychometric evidence demonstrated the factor structures of three negative emotions. Each emotional factor was caused by unique combinations of barriers in the preparation, screening, and recovery stages of colonoscopy. Most of the emotional factors were associated with attitudes and screening intention. CONCLUSION This study showed different dimensions of negative emotions and their underlying causes in colonoscopy. These findings will help assess specific causes of negative emotions in colonoscopy and develop effective interventions to improve screening uptake.
Collapse
Affiliation(s)
- Wei Peng
- Washington State University, Pullman, WA, USA
| | | | | | - Bingjing Mao
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
2
|
Ruano J, Gómez M, Romero E, Manzanera A. Leveraging a realistic synthetic database to learn Shape-from-Shading for estimating the colon depth in colonoscopy images. Comput Med Imaging Graph 2024; 115:102390. [PMID: 38714018 DOI: 10.1016/j.compmedimag.2024.102390] [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: 08/14/2023] [Revised: 03/30/2024] [Accepted: 04/25/2024] [Indexed: 05/09/2024]
Abstract
Colonoscopy is the choice procedure to diagnose, screening, and treat the colon and rectum cancer, from early detection of small precancerous lesions (polyps), to confirmation of malign masses. However, the high variability of the organ appearance and the complex shape of both the colon wall and structures of interest make this exploration difficult. Learned visuospatial and perceptual abilities mitigate technical limitations in clinical practice by proper estimation of the intestinal depth. This work introduces a novel methodology to estimate colon depth maps in single frames from monocular colonoscopy videos. The generated depth map is inferred from the shading variation of the colon wall with respect to the light source, as learned from a realistic synthetic database. Briefly, a classic convolutional neural network architecture is trained from scratch to estimate the depth map, improving sharp depth estimations in haustral folds and polyps by a custom loss function that minimizes the estimation error in edges and curvatures. The network was trained by a custom synthetic colonoscopy database herein constructed and released, composed of 248400 frames (47 videos), with depth annotations at the level of pixels. This collection comprehends 5 subsets of videos with progressively higher levels of visual complexity. Evaluation of the depth estimation with the synthetic database reached a threshold accuracy of 95.65%, and a mean-RMSE of 0.451cm, while a qualitative assessment with a real database showed consistent depth estimations, visually evaluated by the expert gastroenterologist coauthoring this paper. Finally, the method achieved competitive performance with respect to another state-of-the-art method using a public synthetic database and comparable results in a set of images with other five state-of-the-art methods. Additionally, three-dimensional reconstructions demonstrated useful approximations of the gastrointestinal tract geometry. Code for reproducing the reported results and the dataset are available at https://github.com/Cimalab-unal/ColonDepthEstimation.
Collapse
Affiliation(s)
- Josué Ruano
- Computer Imaging and Medical Applications Laboratory (CIM@LAB), Universidad Nacional de Colombia, 111321, Bogotá, Colombia
| | - Martín Gómez
- Unidad de Gastroenterología, Hospital Universitario Nacional, 111321, Bogotá, Colombia
| | - Eduardo Romero
- Computer Imaging and Medical Applications Laboratory (CIM@LAB), Universidad Nacional de Colombia, 111321, Bogotá, Colombia.
| | - Antoine Manzanera
- Unité d'Informatique et d'Ingénierie des Systémes (U2IS), ENSTA Paris, Institut Polytechnique de Paris, Palaiseau, 91762, Ile de France, France
| |
Collapse
|
3
|
Metaxas G, Papachristou A, Stathaki M. Colorectal cancer screening: Modalities and adherence. World J Gastroenterol 2024; 30:3048-3051. [DOI: 10.3748/wjg.v30.i24.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 05/18/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024] Open
Abstract
In the last decade, several studies have explored various modalities and strategies for colorectal cancer (CRC) screening, taking into account epidemiological data, individual characteristics, and socioeconomic factors. In this editorial, we comment further on a retrospective study by Agatsuma et al published in the recent issue of the World Journal of Gastroenterology. Our focus is on screening trends, particularly in relation to efforts to improve the currently suboptimal uptake among the general population worldwide, aiming to enhance early diagnosis rates of CRC. There is a need to raise awareness through health edu-cation programs and to consider the use of readily available, non-invasive screening methods. These strategies are crucial for attracting screen-eligible populations to participate in first-line screening, especially those in high- or average-risk groups and in regions with limited resources. Liquid biopsies and biomarkers represent rapidly evolving trends in screening and diagnosis; however, their clinical relevance has yet to be standardized.
Collapse
Affiliation(s)
- Georgios Metaxas
- Department of Surgery, Elena Venizelou Hospital, Athens 11521, Greece
| | | | - Martha Stathaki
- Department of Surgery, Elena Venizelou Hospital, Athens 11521, Greece
| |
Collapse
|
4
|
Catlow J, Sharp L, Wagnild J, Lu L, Bhardwaj-Gosling R, Ogundimu E, Kasim A, Brookes M, Lee T, McCarthy S, Gray J, Sniehotta F, Valori R, Westwood C, McNally R, Ruwende J, Sinclair S, Deane J, Rutter M. Nationally Automated Colonoscopy Performance Feedback Increases Polyp Detection: The NED APRIQOT Randomized Controlled Trial. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00449-X. [PMID: 38759827 DOI: 10.1016/j.cgh.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND & AIMS Postcolonoscopy colorectal cancer incidence and mortality rates are higher for endoscopists with low polyp detection rates. Using the UK's National Endoscopy Database (NED), which automatically captures real-time data, we assessed if providing feedback of case-mix-adjusted mean number of polyps (aMNP), as a key performance indicator, improved endoscopists' performance. Feedback was delivered via a theory-informed, evidence-based audit and feedback intervention. METHODS This multicenter, prospective, NED Automated Performance Reports to Improve Quality Outcomes Trial randomized National Health Service endoscopy centers to intervention or control. Intervention-arm endoscopists were e-mailed tailored monthly reports automatically generated within NED, informed by qualitative interviews and behavior change theory. The primary outcome was endoscopists' aMNP during the 9-month intervention. RESULTS From November 2020 to July 2021, 541 endoscopists across 36 centers (19 intervention; 17 control) performed 54,770 procedures during the intervention, and 15,960 procedures during the 3-month postintervention period. Comparing the intervention arm with the control arm, endoscopists during the intervention period: aMNP was nonsignificantly higher (7%; 95% CI, -1% to 14%; P = .08). The unadjusted MNP (10%; 95% CI, 1%-20%) and polyp detection rate (10%; 95% CI, 4%-16%) were significantly higher. Differences were not maintained in the postintervention period. In the intervention arm, endoscopists accessing NED Automated Performance Reports to Improve Quality Outcomes Trial webpages had a higher aMNP than those who did not (aMNP, 118 vs 102; P = .03). CONCLUSIONS Although our automated feedback intervention did not increase aMNP significantly in the intervention period, MNP and polyp detection rate did improve significantly. Engaged endoscopists benefited most and improvements were not maintained postintervention; future work should address engagement in feedback and consider the effectiveness of continuous feedback. www.isrctn.org ISRCTN11126923 .
Collapse
Affiliation(s)
- Jamie Catlow
- Population Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom; Gastroenterology, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Janelle Wagnild
- Department of Anthropology, Durham University, Durham, United Kingdom
| | - Liya Lu
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Rashmi Bhardwaj-Gosling
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom; Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, United Kingdom
| | - Emmanuel Ogundimu
- Department of Mathematical Sciences, Durham University, North-East, United Kingdom
| | | | - Matthew Brookes
- Department of Gastroenterology, Royal Wolverhampton Hospitals National Health Service Trust, Wolverhampton, United Kingdom; University of Wolverhampton, Wolverhampton, United Kingdom
| | - Thomas Lee
- Gastroenterology, Northumbria Healthcare National Health Service Foundation Trust, North Shields, United Kingdom
| | - Stephen McCarthy
- Northumbria University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Joanne Gray
- Northumbria University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | - Falko Sniehotta
- Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Roland Valori
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucester, United Kingdom
| | - Claire Westwood
- University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | - Richard McNally
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| | | | - Simon Sinclair
- Hartlepool National Health Service Foundation Trust, North Tees, Stockton on Tees, United Kingdom
| | - Jill Deane
- Hartlepool National Health Service Foundation Trust, North Tees, Stockton on Tees, United Kingdom
| | - Matt Rutter
- Hartlepool National Health Service Foundation Trust, North Tees, Stockton on Tees, United Kingdom; Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom
| |
Collapse
|
5
|
Sekiguchi M, Igarashi A, Toyoshima N, Takamaru H, Yamada M, Esaki M, Kobayashi N, Saito Y. Cost-effectiveness analysis of computer-aided detection systems for colonoscopy in Japan. Dig Endosc 2023; 35:891-899. [PMID: 36752676 DOI: 10.1111/den.14532] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/05/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The usefulness of computer-aided detection systems (CADe) for colonoscopy has been increasingly reported. In many countries, however, data on the cost-effectiveness of their use are lacking; consequently, CADe for colonoscopy has not been covered by health insurance. We aimed to evaluate the cost-effectiveness of colonoscopy using CADe in Japan. METHODS We conducted a simulation model analysis using Japanese data to examine the cost-effectiveness of colonoscopy with and without CADe for a population aged 40-74 years who received colorectal cancer (CRC) screening with a fecal immunochemical test (FIT). The rates of receiving FIT screening and colonoscopy following a positive FIT were set as 40% and 70%, respectively. The sensitivities of FIT for advanced adenomas and CRC Dukes' A-D were 26.5% and 52.8-78.3%, respectively. CADe colonoscopy was judged to be cost-effective when its incremental cost-effectiveness ratio (ICER) was below JPY 5,000,000 per quality-adjusted life-years (QALYs) gained. RESULTS Compared to conventional colonoscopy, CADe colonoscopy showed a higher QALY (20.4098 vs. 20.4088) and lower CRC incidence (2373 vs. 2415 per 100,000) and mortality (561 vs. 569 per 100,000). When the CADe cost was set at JPY 1000-6000, the ICER per QALY gained for CADe colonoscopy was lower than JPY 5,000,000 (JPY 796,328-4,971,274). The CADe cost threshold at which the ICER for CADe colonoscopy exceeded JPY 5,000,000 was JPY 6040. CONCLUSIONS Computer-aided detection systems for colonoscopy has the potential to be cost-effective when the CADe cost is up to JPY 6000. These results suggest that the insurance reimbursement of CADe for colonoscopy is reasonable.
Collapse
Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Department of Public Health, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nozomu Kobayashi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
6
|
Poļaka I, Mežmale L, Anarkulova L, Kononova E, Vilkoite I, Veliks V, Ļeščinska AM, Stonāns I, Pčolkins A, Tolmanis I, Shani G, Haick H, Mitrovics J, Glöckler J, Mizaikoff B, Leja M. The Detection of Colorectal Cancer through Machine Learning-Based Breath Sensor Analysis. Diagnostics (Basel) 2023; 13:3355. [PMID: 37958251 PMCID: PMC10648537 DOI: 10.3390/diagnostics13213355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy and the second most common cause of cancer-related deaths worldwide. While CRC screening is already part of organized programs in many countries, there remains a need for improved screening tools. In recent years, a potential approach for cancer diagnosis has emerged via the analysis of volatile organic compounds (VOCs) using sensor technologies. The main goal of this study was to demonstrate and evaluate the diagnostic potential of a table-top breath analyzer for detecting CRC. Breath sampling was conducted and CRC vs. non-cancer groups (105 patients with CRC, 186 non-cancer subjects) were included in analysis. The obtained data were analyzed using supervised machine learning methods (i.e., Random Forest, C4.5, Artificial Neural Network, and Naïve Bayes). Superior accuracy was achieved using Random Forest and Evolutionary Search for Features (79.3%, sensitivity 53.3%, specificity 93.0%, AUC ROC 0.734), and Artificial Neural Networks and Greedy Search for Features (78.2%, sensitivity 43.3%, specificity 96.5%, AUC ROC 0.735). Our results confirm the potential of the developed breath analyzer as a promising tool for identifying and categorizing CRC within a point-of-care clinical context. The combination of MOX sensors provided promising results in distinguishing healthy vs. diseased breath samples. Its capacity for rapid, non-invasive, and targeted CRC detection suggests encouraging prospects for future clinical screening applications.
Collapse
Affiliation(s)
- Inese Poļaka
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Department of Modelling and Simulation, Riga Technical University, LV-1048 Riga, Latvia
| | - Linda Mežmale
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia
- Riga East University Hospital, LV-1038 Riga, Latvia
- Faculty of Residency, Riga Stradins University, LV-1007 Riga, Latvia
- Health Centre 4, LV-1012 Riga, Latvia;
| | - Linda Anarkulova
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Faculty of Residency, Riga Stradins University, LV-1007 Riga, Latvia
- Health Centre 4, LV-1012 Riga, Latvia;
- Liepaja Regional Hospital, LV-3414 Liepaja, Latvia
| | - Elīna Kononova
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia;
| | - Ilona Vilkoite
- Health Centre 4, LV-1012 Riga, Latvia;
- Department of Doctoral Studies, Riga Stradins University, LV-1007 Riga, Latvia
| | - Viktors Veliks
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
| | - Anna Marija Ļeščinska
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Riga East University Hospital, LV-1038 Riga, Latvia
- Digestive Diseases Centre GASTRO, LV-1079 Riga, Latvia
| | - Ilmārs Stonāns
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
| | - Andrejs Pčolkins
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia
- Riga East University Hospital, LV-1038 Riga, Latvia
| | - Ivars Tolmanis
- Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia;
- Digestive Diseases Centre GASTRO, LV-1079 Riga, Latvia
| | - Gidi Shani
- Laboratory for Nanomaterial-Based Devices, Technion—Israel Institute of Technology, Haifa 3200003, Israel; (G.S.); (H.H.)
| | - Hossam Haick
- Laboratory for Nanomaterial-Based Devices, Technion—Israel Institute of Technology, Haifa 3200003, Israel; (G.S.); (H.H.)
| | | | - Johannes Glöckler
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081 Ulm, Germany; (J.G.); (B.M.)
| | - Boris Mizaikoff
- Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081 Ulm, Germany; (J.G.); (B.M.)
- Hahn-Schickard, 89077 Ulm, Germany
| | - Mārcis Leja
- Institute of Clinical and Preventive Medicine, University of Latvia, LV-1586 Riga, Latvia; (I.P.); (L.A.); (E.K.); (V.V.); (A.M.Ļ.); (I.S.); (A.P.); (M.L.)
- Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia
- Riga East University Hospital, LV-1038 Riga, Latvia
- Digestive Diseases Centre GASTRO, LV-1079 Riga, Latvia
| |
Collapse
|
7
|
Nass KJ, van Doorn SC, Fockens P, Rees CJ, Pellisé M, van der Vlugt M, Dekker E. High quality colonoscopy: using textbook process as a composite quality measure. Endoscopy 2023; 55:812-819. [PMID: 37019154 PMCID: PMC10465239 DOI: 10.1055/a-2069-6588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 04/04/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND : High quality colonoscopy is fundamental to good patient outcomes. "Textbook outcome" has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish the "textbook process" (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists. METHODS : To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. The achievement of TP was then applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 1 January 2018 and 1 August 2021 were analyzed. RESULTS : The Delphi consensus process was completed by 20 of 27 invited experts (74.1 %). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication; successful cecal intubation; adequate bowel preparation; adequate withdrawal time; acceptable patient comfort score; provision of post-polypectomy surveillance recommendations in line with guidelines; and the absence of the use of reversal agents, early adverse events, readmission, and mortality. In the two endoscopy services studied, TP was achieved in 5962/8227 colonoscopies (72.5 %). Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging per endoscopist from 41.0 % to 89.1 %. CONCLUSION : This study proposes a new composite measure for colonoscopy, namely "textbook process." TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as a measure in future quality assessment programs.
Collapse
Affiliation(s)
- Karlijn J. Nass
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sascha C. van Doorn
- Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
| | - Colin J. Rees
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maria Pellisé
- Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Suzuki S, Aniwan S, Gotoda T. Reply. Clin Gastroenterol Hepatol 2023; 21:2701-2702. [PMID: 36739932 DOI: 10.1016/j.cgh.2023.01.025] [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: 01/12/2023] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Sho Suzuki
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Satimai Aniwan
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| |
Collapse
|
9
|
Knudsen MD, Wang K, Wang L, Polychronidis G, Berstad P, Wu K, He X, Hang D, Fang Z, Ogino S, Chan AT, Giovannucci E, Wang M, Song M. Development and validation of a risk prediction model for post-polypectomy colorectal cancer in the USA: a prospective cohort study. EClinicalMedicine 2023; 62:102139. [PMID: 37599907 PMCID: PMC10432960 DOI: 10.1016/j.eclinm.2023.102139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Background Effective risk stratification tools for post-polypectomy colorectal cancer (PPCRC) are lacking. We aimed to develop an effective risk stratification tool for the prediction of PPCRC in three large population-based cohorts and to validate the tool in a clinical cohort. Methods Leveraging the integrated endoscopic, histopathologic and epidemiologic data in three U.S population-based cohorts of health professional (the Nurses' Health Study (NHS) I, II and Health Professionals Follow-up Study (HPFS)), we developed a risk score to predict incident PPCRC among 26,741 patients with a polypectomy between 1986 and 2017. We validated the PPCRC score in the Mass General Brigham (MGB) Colonoscopy Cohort (Boston, Massachusetts, U.S) of 76,603 patients with a polypectomy between 2007 and 2018. In all four cohorts, we collected detailed data on patients' demographics, endoscopic history, polyp features, and lifestyle factors at polypectomy. The outcome, incidence of PPCRC, was assessed by biennial follow-up questionnaires in the NHS/HPFS cohorts, and through linkage to the Massachusetts Cancer Registry in the MGB cohort. In all four cohorts, individuals who were diagnosed with CRC or died before baseline or within six months after baseline were excluded. We used Cox regression to calculate the hazard ratio (HR), 95% confidence interval (CI) and assessed the discrimination using C-statistics and reclassification using the Net Reclassification Improvement (NRI). Findings During a median follow-up of 12.8 years (interquartile range (IQR): 9.3, 16.7) and 5.1 years (IQR: 2.7, 7.8) in the NHS/HPFS and MGB cohorts, we documented 220 and 241 PPCRC cases, respectively. We identified a PPCRC risk score based on 11 predictors. In the validation cohort, the PPCRC risk score showed a strong association with PPCRC risk (HR for high vs. low, 3.55, 95% CI, 2.59-4.88) and demonstrated a C-statistic (95% CI) of 0.75 (0.70-0.79), and was discriminatory even within the low- and high-risk polyp groups (C-statistic, 0.73 and 0.71, respectively) defined by the current colonoscopy surveillance recommendations, leading to a NRI of 45% (95% CI, 36-54%) for patients with PPCRC. Interpretation We developed and validated a risk stratification model for PPCRC that may be useful to guide tailored colonoscopy surveillance. Further work is needed to determine the optimal surveillance interval and test the added value of other predictors of PPCRC beyond those included in the current study, along with implementation studies. Funding US National Institutes of Health, the American Cancer Society, the South-Eastern Norway Regional Health Authority, the Deutsche Forschungsgemeinschaft.
Collapse
Affiliation(s)
- Markus Dines Knudsen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Section of Bowel Cancer Screening, Cancer Registry of Norway, Ullernchausseen 64, Oslo, Norway
- Division of Surgery, Inflammatory Diseases and Transplantation, Department of Transplantation Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway
| | - Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Liang Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Centre of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshaner Rd, Yuexiu District, Guangzhou, Guangdong Province, China
| | - Georgios Polychronidis
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Department of General Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, Heidelberg, Germany
| | - Paula Berstad
- Section of Bowel Cancer Screening, Cancer Registry of Norway, Ullernchausseen 64, Oslo, Norway
| | - Kana Wu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Xiaosheng He
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
- Department of Colorectal Surgery, The Six Affiliated Hospital, Sun Yat-sen University, 135, Xingang Xi Road, Guangzhou, China
| | - Dong Hang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, China
| | - Zhe Fang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Department of Pathology, Program in Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, USA
- Broad Institute of MIT and Harvard, Merkin Building, 415 Main St, Cambridge, MA, USA
| | - Andrew T. Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| |
Collapse
|
10
|
He X, Chen Y, Zhou X, Lu C. Clinical Course and Prognosis of Isolated Terminal Ileal Ulcers. ARCHIVES OF IRANIAN MEDICINE 2023; 26:434-438. [PMID: 38301105 PMCID: PMC10685738 DOI: 10.34172/aim.2023.66] [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: 05/05/2022] [Accepted: 07/17/2022] [Indexed: 02/03/2024]
Abstract
BACKGROUND Isolated terminal ileal ulcers (ITIUs) may be a clue to hidden intestinal diseases. However, there are no specific guidelines for ITIUs. METHODS We retrospectively screened subjects undergoing colonoscopy at The First Affiliated Hospital, Zhejiang University from March 2014 to July 2019, and included patients with ITIUs in the study. Some patients underwent further examination of the entire small intestine. Subsequently, patients with undetermined ITIUs received empiric therapy or observational follow-up. At least one year after baseline colonoscopy, telephone follow-up was performed to collect prognostic information. RESULTS A total of 120 (0.3%) patients undergoing colonoscopy in our center were found with ITIUs. Fourteen patients underwent further examination of the entire small intestine, six of whom were found with additional small bowel ulcers, but it did not significantly help the diagnosis. We obtained follow-up information from 41 undiagnosed patients. Over an average follow-up of 35.4 months, there was no significant difference in the prognosis of patients receiving empiric therapy or observational follow-up. The clinical and endoscopic outcomes improved or remain unchanged in most patients. In logistic regression analysis, gender, age, chief complaint, number of ulcers, and follow-up strategy had no significant impact on prognosis. CONCLUSION Patients with nonspecific ITIUs usually improve without any therapy, and observational follow-up may be a reasonable strategy.
Collapse
Affiliation(s)
- Xinjue He
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Chen
- Department of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xinxin Zhou
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chao Lu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
11
|
Neilson LJ, Dew R, Hampton JS, Sharp L, Rees CJ. Quality in colonoscopy: time to ensure national standards are implemented? Frontline Gastroenterol 2023; 14:392-398. [PMID: 37581182 PMCID: PMC10423601 DOI: 10.1136/flgastro-2022-102371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/21/2023] [Indexed: 08/16/2023] Open
Abstract
Background High-quality colonoscopy is crucial to ensure complete mucosal visualisation and to maximise detection of pathology. Previous audits showing variable quality have prompted national and international colonoscopy improvement programmes, including the development of quality assurance standards and key performance indicators (KPIs). The most widely used marker of mucosal visualisation is the adenoma detection rate (ADR), however, histological confirmation is required to calculate this. We explored the relationship between core colonoscopy KPIs. Methods Data were collected from colonoscopists in eight hospitals in North East England over a 6-month period, as part of a quality improvement study. Procedural information was collected including number of colonoscopies, caecal intubation rate (CIR), ADR and polyp detection rate (PDR). Associations between KPIs and colonoscopy performance were analysed. Results 9265 colonoscopies performed by 118 endoscopists were included. Mean ADR and PDR per endoscopist were 16.6% (range 0-36.3, SD 7.4) and 27.2% (range 0-57.5, SD 9.3), respectively. Mean number of colonoscopies conducted in 6 months was 78.5 (range 4-334, SD 61). Mean CIR was 91.2% (range 55.5-100, SD 6.6). Total number of colonoscopies and ADR>15% were significantly associated (p=0.04). Undertaking fewer colonoscopies and using hyoscine butylbromide less frequently was significantly associated with ADR<15%. CIR, endoscopist grade, % male patients, mean patient age and CIR were not significantly related to ADR<15%. In adjusted analyses, factors which affected ADR were PDR and mean patient age. Conclusion Colonoscopists who perform fewer than the nationally stipulated minimum of 100 procedures per year had significantly lower ADRs. This study demonstrates that PDR can be used as a marker of ADR; providing age is also considered.
Collapse
Affiliation(s)
- Laura J Neilson
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Region Endoscopy Group, North East England, UK
| | - Rosie Dew
- School of Medicine, University of Sunderland, Sunderland, UK
| | - James S Hampton
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northern Region Endoscopy Group, North East England, UK
- Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
12
|
Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
Collapse
Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| |
Collapse
|
13
|
Zhang K, Bile AM, Feng X, Xu Y, Li Y, She Q, Li G, Wu J, Xiao W, Ding Y, Deng B. Image acquisition as novel colonoscopic quality indicator: a single-center retrospective study. Front Oncol 2023; 13:1090464. [PMID: 37223689 PMCID: PMC10200908 DOI: 10.3389/fonc.2023.1090464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/24/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose In order to reduce the incidence and mortality of colorectal cancer, improving the quality of colonoscopy is the top priority. At present, the adenoma detection rate is the most used index to evaluate the quality of colonoscopy. So, we further verified the relevant factors influencing the quality of colonoscopy and found out the novel quality indicators by studying the relationship between the influencing factors and the adenoma detection rate. Materials/methods The study included 3824 cases of colonoscopy from January to December 2020. We retrospectively recorded the age and sex of the subjects; the number, size, and histological features of lesions; withdrawal time and the number of images acquired during colonoscopy. We analyzed the associated factors affecting adenoma and polyp detection, and verified their effectiveness with both univariate and multivariate logistic regression analyses. Results Logistic regression analyses showed that gender, age, withdrawal time and the number of images acquired during colonoscopy could serve as independent predictors of adenoma/polyp detection rate. In addition, adenoma detection rate (25.36% vs. 14.29%) and polyp detection rate (53.99% vs. 34.42%) showed a marked increase when the number of images taken during colonoscopy was ≥29 (P<0.001). Conclusions Gender, age, withdrawal time and the number of images acquired during colonoscopy are influencing factors for the detection of colorectal adenomas and polyps. And we can gain higher adenoma/polyp detection rate when endoscopists capture more colonoscopic images.
Collapse
Affiliation(s)
- Ke Zhang
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Graduate School, Dalian Medical University, Dalian, ;China
| | - Abdiwahid Mohamed Bile
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Medical College, Yangzhou University, Yangzhou, China
| | - Xinyi Feng
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Medical College, Yangzhou University, Yangzhou, China
| | - Yemin Xu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Medical College, Yangzhou University, Yangzhou, China
| | - Yaoyao Li
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qiang She
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Guiqing Li
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Jian Wu
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Weiming Xiao
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yanbing Ding
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Bin Deng
- Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| |
Collapse
|
14
|
Magier S, Jahandideh D, Pourmorady J, Masoud A. SPLIT-DOSE BOWEL PREPARATION IS SUPERIOR TO STRAIGHT-DOSE IN HOSPITALIZED PATIENTS UNDERGOING INPATIENT COLONOSCOPY. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:39-47. [PMID: 37194778 DOI: 10.1590/s0004-2803.202301000-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/08/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. OBJECTIVE The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. METHODS A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. RESULTS Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). CONCLUSION Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.
Collapse
Affiliation(s)
- Samantha Magier
- Yale-New Haven Hospital, Yale School of Medicine, United States
| | | | | | - Amir Masoud
- Yale-New Haven Hospital, Yale School of Medicine, United States
- Connecticut Gastroenterology, Hartford Healthcare, United States
| |
Collapse
|
15
|
Testoni PA, Notaristefano C, Soncini M, Hassan C, Monica F, Radaelli F, Triossi O, Pasquale L, Neri M, Cannizzaro R, Leandro G. An Italian prospective multicenter study on colonoscopy practice and quality: What has changed in the last 10 years. Dig Liver Dis 2023; 55:99-106. [PMID: 36266206 DOI: 10.1016/j.dld.2022.09.007] [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: 06/22/2022] [Revised: 09/15/2022] [Accepted: 09/15/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND A relevant number of adenomas can be missed during colonoscopy. AIMS Assess the current status of colonoscopy procedures in Italian centers. METHODS A prospective observational study involving 17 hospitals (34 endoscopists) included consecutive patients undergoing standard colonoscopy. In the first phase, endoscopists performed consecutive colonoscopies. In the second phase, retraining via an online learning platform was planned, while in the third phase data were collected analogously to phase 1. RESULTS A total of 3,504 patients were enrolled. Overall, a BBPS score ≥6 was obtained in 95.6% of cases (94.8% and 96.9% in the pre- and post-training phases, respectively). 88.4% of colonoscopies had a withdrawal time ≥6 min (88.2% and 88.7% in the pre- and post-training phases). Median adenoma detection rate (ADR) was 39.1%, with no significant differences between the pre- and post-training phases (40.1% vs 36.9%; P = 0.83). In total, 81% of endoscopists had a ADR performance above the 25% threshold. CONCLUSION High colonoscopy quality standards are achieved by the Italian hospitals involved. Quality improvement initiatives and repeated module-based colonoscopy-training have been promoted in Italy during the last decade, which appear to have had a significant impact on quality colonoscopy metrics together with the activation of colorectal cancer screening programs.
Collapse
Affiliation(s)
- Pier Alberto Testoni
- Division of Gastroenterology and G.I. Endoscopy, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy.
| | - Chiara Notaristefano
- Division of Gastroenterology and G.I. Endoscopy, Vita Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Marco Soncini
- Department of Internal Medicine, A. Manzoni Hospital, ASST Lecco, Italy
| | - Cesare Hassan
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy, Cattinara Academic Hospital, Trieste, Italy
| | | | - Omero Triossi
- Gastroenterology Unit, Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Luigi Pasquale
- Gastroenterology Unit, S. O. Frangipane Hospital of A. Irpino, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Chieti, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Gioacchino Leandro
- National Institute of Gastroenterology "S. De Bellis" Research Hospital, Castellana Grotte, Italy
| | | |
Collapse
|
16
|
Walls M, Houwen BBSL, Rice S, Seager A, Dekker E, Sharp L, Rees CJ. The effect of the endoscopic device Endocuff™/Endocuff vision™ on quality standards in colonoscopy: A systematic review and meta-analysis of randomized trials. Colorectal Dis 2022; 25:573-585. [PMID: 36471638 DOI: 10.1111/codi.16444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/30/2022]
Abstract
AIM The adenoma detection rate (ADR) is an important quality measure, with a high ADR reflecting high-quality colonoscopy. This systematic review and meta-analysis aimed to assess the effects of Endocuff™/Endocuff Vision™-assisted colonoscopy (EAC) versus standard colonoscopy (SC) on ADR and other clinical, patient and resource-use outcomes. METHOD MEDLINE, EMBASE, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials were searched for full papers reporting randomized studies comparing EAC with SC. The primary outcome was ADR. Secondary outcomes comprised key polyp/adenoma detection, procedure-related, patient-related and health economic measures. Random effects meta-analyses provided pooled estimates of outcomes [risk ratio (RR) or mean difference (MD), with 95% confidence intervals (CI)]. RESULTS Twelve parallel-group randomized controlled trials (RCTs) and three crossover RCTs with data on 9140 patients were included. EAC significantly increased the ADR (RR 1.18, 95% CI 1.09-1.29), mean adenomas per procedure (MAP) (MD 0.19, 95% CI 0.06-0.33), polyp detection rate (PDR) (RR 1.20, 95% CI 1.10-1.30) and mean polyps per procedure (MPP) (MD 0.39, 95% CI 0.14-0.63) versus SC. EAC significantly increased segmental PDR versus SC in the sigmoid (RR 2.02, 95% CI 1.64-2.49), transverse (RR 1.63, 95% CI 1.09-2.42), ascending (RR 1.74, 95% CI 1.26-2.41) and caecal segments (RR 1.91, 95% CI 1.29-2.82). Procedure-related variables did not differ between arms. There were insufficient data for meta-analysis of health economic or patient-centred outcomes. CONCLUSIONS EAC increased ADR, MAP, PDR and MPP versus SC without detrimental effects on procedure measures. Cost-effectiveness and patient experience data are lacking and would be valuable to inform practice recommendations.
Collapse
Affiliation(s)
- Martin Walls
- South Tyneside District Hospital, South Shields, Tyne and Wear, UK.,Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Alexander Seager
- South Tyneside District Hospital, South Shields, Tyne and Wear, UK.,Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| | - Colin J Rees
- South Tyneside District Hospital, South Shields, Tyne and Wear, UK.,Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle-upon-Tyne, Tyne and Wear, UK
| |
Collapse
|
17
|
Chen Y, Sun J, Lu Y, Fu L, Xiang X, Liu Y, Zhuo X, Kurban M, Li C. Efficacy and safety of midazolam combined with dezocine for sedation and analgesia in digestive endoscopy: A prospective open single-center study. Front Pharmacol 2022; 13:945597. [PMID: 36408218 PMCID: PMC9669085 DOI: 10.3389/fphar.2022.945597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/13/2022] [Indexed: 07/27/2023] Open
Abstract
Objective: Digestive endoscopy is an important means of diagnosing and treating gastrointestinal diseases and a tool for screening and monitoring early gastrointestinal tumors. Digestive endoscopy can be performed using midazolam combined with dezocine for sedation and analgesia. This study explored the efficacy and safety of midazolam combined with dezocine. Methods: A total of 135 patients undergoing digestive endoscopy in the Department of Gastrointestinal Endoscopy of the Sixth Affiliated Hospital, Sun Yat-sen University, from June 2021 to September 2021, were enrolled and non-blindly and non-randomly divided into a sedation-endoscopy-group (SEG, n = 45), anesthesia-endoscopy-group (AEG, n = 44), and ordinary-endoscopy-group (OEG, n = 46). Vital signs, levels of sedation and analgesia, the degree of pain during colonoscopy, satisfaction, and the incidence of complications were compared among the three groups. Results: There were no statistically significant differences in vital signs (blood pressure, pulse, respiration, and blood oxygen saturation) among the three groups before endoscopy (p > 0.05). The AEG reported no pain during colonoscopy, and the pain score during colonoscopy for the SEG was lower than that for the OEG (1.11 ± 1.21 vs. 3.00 ± 1.16, p < 0.001). The scores for satisfaction were 8.84 ± 1.30 points in the SEG, 8.95 ± 1.10 points in the AEG, and 6.37 ± 0.90 points in the OEG; the differences were statistically significant (p < 0.001). The total incidence of complications in the AEG was 38.64% (17/44), which was significantly higher than that in the SEG [13.33% (6/45)] and OEG [13.04% (6/46)] (p < 0.001). In the SEG, the overall incidence of complications in women was significantly higher than that in men (p = 0.027). Conclusion: Digestive endoscopy using midazolam combined with dezocine for sedation makes patients more comfortable, more satisfied and more compliant than the ordinary endoscopy. Additionally, it is comparable to endoscopy under general anesthesia with propofol with regard to comfort, satisfaction, and patient compliance and comparable to the ordinary endoscopy with regard to safety. Considering the shortage of anesthesiologists, the application of midazolam combined with dezocine in digestive endoscopy is worthy of clinical popularization. This study has been registered in the Hospital Ethics Committee of the Sun Yat-sen University Sixth Affiliated Hospital (Ethical Number: 2021ZSLYEC-182).
Collapse
Affiliation(s)
- Yongpeng Chen
- Department of Gastrointestinal Endoscopy, 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
| | - Jiachen Sun
- Department of Gastrointestinal Endoscopy, 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
| | - Yi Lu
- Department of Gastrointestinal Endoscopy, 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
| | - Liping Fu
- Department of Gastrointestinal Endoscopy, 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
| | - Xueyuan Xiang
- Department of Gastrointestinal Endoscopy, 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
| | - Yanan Liu
- Department of Gastrointestinal Endoscopy, 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
| | - Xianhua Zhuo
- Department of Otolaryngology Head and Neck Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mirigul Kurban
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
- Department of Small Bowel Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chujun Li
- Department of Gastrointestinal Endoscopy, 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
| |
Collapse
|
18
|
Sekiguchi M, Westerberg M, Ekbom A, Hultcrantz R, Forsberg A. Detection rates of colorectal neoplasia during colonoscopies and their associated factors in the SCREESCO study. J Gastroenterol Hepatol 2022; 37:2120-2130. [PMID: 36062316 DOI: 10.1111/jgh.15990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Colonoscopy quality, including lesion detectability, is variable, and factors influencing lesion detection are not fully understood. This study investigated lesion detection rates during colonoscopies and the associated factors in the SCREEning of Swedish COlons (SCREESCO) study. METHODS In this cross-sectional analysis of data from SCREESCO, a large-scale randomized controlled trial of colorectal cancer screening in the Swedish population aged 60 years, we assessed data of first-time colonoscopies performed in both colonoscopy and fecal immunochemical test (FIT) arms. RESULTS This study included 16 552 individuals. The adenoma detection rate was 23.9% and 37.8% in colonoscopy and FIT arms, respectively. Regarding colonoscopy procedures, a withdrawal time ≥ 6 min was associated with higher detection rates of advanced adenomas (adjusted odds ratio [AOR] 2.474, 95% confidence interval [CI] 1.295-4.723), adenomas (2.181, 1.515-3.140), and proximal serrated lesions (pSLs) (1.713, 1.007-2.915). Antispasmodic use was associated with higher detection rates of these lesions and sessile serrated lesions (SSLs) (AOR, 95% CI: 1.523, 1.295-1.791; 1.361, 1.217-1.522; 1.450, 1.247-1.687; and 1.810, 1.512-2.167, respectively). Insertion time > 20 min was related to lower detection rates of adenomas, pSLs, and SSLs (AOR, 95% CI: 0.753, 0.639-0.887; 0.640, 0.495-0.828; and 0.704, 0.518-0.955, respectively). The relationship between a recent period and higher detection rates of pSLs and SSLs was also demonstrated. CONCLUSION Lesion detectability in SCREESCO was mostly acceptable with room for improvement. In addition to sufficient withdrawal time, antispasmodic use and acquiring skills enabling short insertion time may improve lesion detection. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT02078804.
Collapse
Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center/Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center, Institute for Cancer Control, Tokyo, Japan
| | - Marcus Westerberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ekbom
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Forsberg
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Detection of Anal Intraepithelial Neoplasia and Anal Squamous Cell Carcinoma on Colonoscopy. ACG Case Rep J 2022; 9:e00792. [PMID: 35756724 PMCID: PMC9225483 DOI: 10.14309/crj.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this case series is to review the endoscopic detection of anal intraepithelial neoplasia and anal squamous cell carcinoma including the role of rectal retroflexion and narrow-band imaging. Four cases of anal intraepithelial neoplasia were incidentally discovered in women aged 55–71 years. Anal lesions identified included sessile polyps, nodular mucosa, and circumferential polyps. A fifth patient, who presented with abdominal pain, was found to have a 3 cm anal squamous cell carcinoma on diagnostic colonoscopy, despite a negative colonoscopy 21 months earlier. In the absence of contraindications, retroflexion should be performed on all patients. Suspicious anal mucosa warrants biopsy.
Collapse
|
20
|
Lightdale JR, Walsh CM, Oliva S, Jacobson K, Huynh HQ, Homan M, Hojsak I, Gillett PM, Furlano RI, Fishman DS, Croft NM, Brill H, Bontems P, Amil-Dias J, Utterson EC, Tavares M, Rosh JR, Riley MR, Narula P, Mamula P, Mack DR, Liu QY, Lerner DG, Leibowitz IH, Otley AR, Kramer RE, Ambartsumyan L, Connan V, McCreath GA, Thomson MA. Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopic Procedures: A Joint NASPGHAN/ESPGHAN Guideline. J Pediatr Gastroenterol Nutr 2022; 74:S30-S43. [PMID: 34402486 DOI: 10.1097/mpg.0000000000003264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION High-quality pediatric gastrointestinal procedures are performed when clinically indicated and defined by their successful performance by skilled providers in a safe, comfortable, child-oriented, and expeditious manner. The process of pediatric endoscopy begins when a plan to perform the procedure is first made and ends when all appropriate patient follow-up has occurred. Procedure-related standards and indicators developed to date for endoscopy in adults emphasize cancer screening and are thus unsuitable for pediatric medicine. METHODS With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopic procedures. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach. RESULTS The PEnQuIN working group achieved consensus on 14 standards for pediatric endoscopic procedures, as well as 30 indicators that can be used to identify high-quality procedures. These were subcategorized into three subdomains: Preprocedural (3 standards, 7 indicators), Intraprocedural (8 standards, 18 indicators), and Postprocedural (3 standards, 5 indicators). A minimum target for the key indicator, "rate of adequate bowel preparation," was set at ≥80%. DISCUSSION It is recommended that all facilities and individual providers performing pediatric endoscopy worldwide initiate and engage with the procedure-related standards and indicators developed by PEnQuIN to identify gaps in quality and drive improvement.
Collapse
Affiliation(s)
- Jenifer R Lightdale
- Department of Pediatrics, Division of Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catharine M Walsh
- Department of Paediatrics and the Wilson Centre, Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning Institutes, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Umberto I - University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, British Columbia's Children's Hospital and British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hien Q Huynh
- Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Matjaž Homan
- Department of Gastroenterology, Faculty of Medicine, Hepatology and Nutrition, University Children's Hospital, University of Ljubljana, Ljubljana, Slovenia
| | - Iva Hojsak
- Referral Center for Pediatric Gastroenterology and Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, University J.J. Strossmayer Medical School, Osijek, Croatia
| | - Peter M Gillett
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Raoul I Furlano
- Pediatric Gastroenterology & Nutrition, Department of Pediatrics, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nicholas M Croft
- Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Herbert Brill
- Department of Pediatrics, Division of Gastroenterology & Nutrition, McMaster Children's Hospital, McMaster University, William Osler Health System, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Bontems
- Division of Pediatrics, Department of Pediatric Gastroenterology, Queen Fabiola Children's University Hospital, ICBAS - Université Libre de Bruxelles, Brussels, Belgium
| | - Jorge Amil-Dias
- Pediatric Gastroenterology, Department of Pediatrics, Centro Hospitalar Universitário S. João, Porto, Portugal
| | - Elizabeth C Utterson
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital, St. Louis, MO, United States
| | - Marta Tavares
- Division of Pediatrics, Pediatric Gastroenterology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, ICBAS - Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Joel R Rosh
- Division of Pediatric Gastroenterology, Department of Pediatrics, Goryeb Children's Hospital, Icahn School of Medicine at Mount Sinai, Morristown, NJ, United States
| | - Matthew R Riley
- Department of Pediatric Gastroenterology, Providence St. Vincent's Medical Center, Portland, OR, United States
| | - Priya Narula
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - David R Mack
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Quin Y Liu
- Division of Gastroenterology and Hepatology, Medicine and Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Diana G Lerner
- Division of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, Children's of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ian H Leibowitz
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Children's National Medical Center, George Washington University, Washington, DC, United States
| | - Anthony R Otley
- Gastroenterology & Nutrition, Department of Pediatrics, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert E Kramer
- Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children's Hospital of Colorado, University of Colorado, Aurora, CO, United States
| | - Lusine Ambartsumyan
- Department of Pediatrics, Division of Gastroenterology and Hepatology, Seattle Children's Hospital, University of Washington, Seattle, WA, United States
| | - Veronik Connan
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Graham A McCreath
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mike A Thomson
- Department of Paediatric Gastroenterology, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
| |
Collapse
|
21
|
Rosvall A, Annersten Gershater M, Kumlien C, Toth E, Axelsson M. Patient-Reported Experience Measures for Colonoscopy: A Systematic Review and Meta-Ethnography. Diagnostics (Basel) 2022; 12:diagnostics12020242. [PMID: 35204332 PMCID: PMC8871001 DOI: 10.3390/diagnostics12020242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/17/2022] [Indexed: 12/10/2022] Open
Abstract
Patient experience is defined as a major quality indicator that should be routinely measured during and after a colonoscopy, according to current ESGE guidelines. There is no standard approach measuring patient experience after the procedure and the comparative performance of the different colonoscopy-specific patient-reported experience measures (PREMs) is unclear. Therefore, the aim was to develop a conceptual model describing how patients experience a colonoscopy, and to compare the model against colonoscopy-specific PREMs. A systematic search for qualitative research published up to December 2021 in PubMed, Cochrane, CINAHL, and PsycINFO was conducted. After screening and quality assessment, data from 13 studies were synthesised using meta-ethnography. Similarities and differences between the model and colonoscopy-specific PREMs were identified. A model consisting of five concepts describes how patients experience undergoing a colonoscopy: health motivation, discomfort, information, a caring relationship, and understanding. These concepts were compared with existing PREMs and the result shows that there is agreement between the model and existing PREMs for colonoscopy in some parts, while partial agreement or no agreement is present in others. These findings suggest that new PREMs for colonoscopy should be developed, since none of the existing colonoscopy-specific PREMs fully cover patients’ experiences.
Collapse
Affiliation(s)
- Annica Rosvall
- Department of Care Science, Faculty of Health and Society, Malmö University, 214 28 Malmö, Sweden; (M.A.G.); (C.K.); (M.A.)
- Correspondence:
| | - Magdalena Annersten Gershater
- Department of Care Science, Faculty of Health and Society, Malmö University, 214 28 Malmö, Sweden; (M.A.G.); (C.K.); (M.A.)
| | - Christine Kumlien
- Department of Care Science, Faculty of Health and Society, Malmö University, 214 28 Malmö, Sweden; (M.A.G.); (C.K.); (M.A.)
- Department of Cardio-Thoracic and Vascular Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, 214 28 Malmö, Sweden; (M.A.G.); (C.K.); (M.A.)
| |
Collapse
|
22
|
Palmier R, Degand T, Aho S, Lepage C, Facy O, Michiels C, Manfredi S. A colonoscopy quality improvement intervention in an endoscopy unit. Sci Rep 2022; 12:817. [PMID: 35039559 PMCID: PMC8763865 DOI: 10.1038/s41598-022-04786-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 12/13/2021] [Indexed: 12/13/2022] Open
Abstract
Many studies identified colonoscopy quality indicators in order to improve performance and safety. We conducted a colonoscopy improvement study. Our study was designed according to a Plan-Do-Study-Act cycle: first recording of our quality indicators and identification of shortcomings, second identification of improvement targets and implementation of new procedures, third second recording of quality indicators, fourth validation of procedures and identification of new goals. Quality indicators derived from European and French guidelines were recorded before and after our improvement actions. We were mainly interested in the quality indicators of the colonic preparation, the description of the diagnosed lesions and on the examination reports. The data of 134 patients prospectively included in January-February 2017 were compared to 133 patients included in May-June 2019, after implementation of improvement procedures, in the digestive endoscopy unit of the university hospital of Dijon, France. Our intervention, and in particular the implementation of new standardized forms, improved preparation quality: Boston Bowel Preparation Scale scores increased significantly from 7.8 to 8.2. Cecal intubation rate increased by 6%, and more adenomas were diagnosed and removed (+3.3%). Adenoma detection rate increased significantly from 26 to 42%. The completion of withdrawal time measure improved from 6.7 to 100%. Our study led to the rapid implementation of corrective actions and improved quality in our unit and in our personal practice. This quality improvement strategy could be easily implemented in every digestive endoscopy unit.
Collapse
Affiliation(s)
- Rémi Palmier
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Thibault Degand
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Serge Aho
- Département d'hygiène Hospitalière, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Côme Lepage
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Olivier Facy
- Département de Chirurgie Digestive et Oncologique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Christophe Michiels
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Sylvain Manfredi
- Département d'hépato Gastroentérologie et Endoscopie Digestive, Centre Hospitalier Universitaire de Dijon, Dijon, France. .,Hepato-Gastroenterology Unit, University Hospital, Dijon, France.
| |
Collapse
|
23
|
The long term participation trend for the colorectal cancer screening after the 2011 triple disaster in Minamisoma City, Fukushima, Japan. Sci Rep 2021; 11:23851. [PMID: 34903779 PMCID: PMC8668878 DOI: 10.1038/s41598-021-03225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Colorectal cancer (CRC) screening is a well-established cancer screening method, and its effectiveness depends on maintaining a high participation rate in the target population. In this study, we analyzed the trends in CRC screening participation rates over 10 years in Minamisoma City, where residents were forced to evacuate after the 2011 triple disaster in Fukushima, Japan. The immunochemical fecal occult blood test is provided as municipal CRC screening. We calculated the annual CRC screening participation rate and analyzed the factors associated with participation in screening. Overall, 4069 (12.3%) and 3839 (11.7%) persons participated in CRC screening in 2009 and 2010, respectively; however, the number decreased significantly to 1090 (3.4%) in 2011 when the earthquake occurred. Over the following 3 years, the rate gradually recovered. Multivariable logistic analysis showed that age < 65 years, living alone, and evacuation were significant associated factors for non-participation after 2011 (p < 0.05). In conclusion, the CRC screening participation rate decreased significantly during the Great East Japan Earthquake but recovered over the next 3 years. Further analysis of factors preventing CRC screening participation and research on the long-term effects of its post-disaster decline are important to consider in assessing the need for intervention in post-disaster cancer screening.
Collapse
|
24
|
Patients' Experiences Before, During, and After a Colonoscopy Procedure: A Qualitative Study. Gastroenterol Nurs 2021; 44:392-402. [PMID: 34860190 DOI: 10.1097/sga.0000000000000569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
Although colonoscopy is a common examination, there is limited research focusing on how patients experience this procedure. It is important that a colonoscopy is tolerated, as it may lead to lifesaving diagnostics and treatment. This study aims to explore adult patients' experience of undergoing a colonoscopy regarding the time prior to, during, and after the procedure. This was a qualitative study with individual interviews (n = 24) and a purposeful sample that was analyzed using thematic analysis. The analysis revealed four themes. The first, "making up one's mind," describes how the participants gathered information and reflected emotionally about the forthcoming procedure. The hope of clarification motivated them to proceed. In the theme "getting ready," self-care was in focus while the participants struggled to follow the instructions and carry out the burdensome cleansing. The next theme, "going through," illuminates' experiences during the colonoscopy and highlights the importance of feeling involved and respected. The last theme, "finally over," is characterized by experiences of relief, tiredness, and a desire for clarity. The healthcare professionals' ability to meet the participants' needs is vital, given that the experiences are highly individual. These findings contribute to a variegated image of how patients experience the process of undergoing a colonoscopy.
Collapse
|
25
|
Analysis of Post-Colonoscopy Colorectal Cancer and Its Subtypes in a Screening Programme. Cancers (Basel) 2021; 13:cancers13205105. [PMID: 34680254 PMCID: PMC8533900 DOI: 10.3390/cancers13205105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
Using the algorithm of the World Endoscopy Organisation (WEO), we have studied retrospectively all colorectal cancers, both detected and non-detected by the Basque Country screening programme from 2009 to 2017. In the screening programme 61,335 colonoscopies were performed following a positive Faecal Immunochemical test (FIT) (≥20 µg Hb/g faeces) and the 128 cases of post-colonoscopy colorectal cancer (PCCRC) detected were analysed. Among them, 50 interval type PCCRCs were diagnosed (before the recommended surveillance), 0.8 cases per 1000 colonoscopies performed, and 78 non-interval type PCCRCs (in the surveillance carried out at the recommended time or delayed), 1.3 per 1000 colonoscopies. Among the non-interval type PCCRCs, 61 cases were detected in the surveillance carried out at the recommended time (type A) and 17 when the surveillance was delayed (type B), 1 case per 1000 colonoscopies performed and 0.28 cases per 1000 colonoscopies performed, respectively. Interval type PCCRC is less frequent than non-interval type PCCRC. In interval type PCCRCs, CRCs detected in advanced stages (stages III-IV) were significantly more frequent than those detected in early stages, compared to those of non-interval type PCCRCs (OR = 3.057; 95% CI, 1.410-6.625; p < 0.005). Non-interval type B PCCRCs are less frequent than non-interval type A PCCRCs, but the frequency of advanced stages is higher in interval type B PCCRCs.
Collapse
|
26
|
Matkovic Z, Zildzic M. Colonoscopic Evaluation of Lower Gastrointestinal Bleeding (LGIB): Practical Approach. Med Arch 2021; 75:274-279. [PMID: 34759447 PMCID: PMC8563031 DOI: 10.5455/medarh.2021.75.274-279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Haematochesia (Lower Gastrointestinal Bleeding (LGIB) is the most common reason for endoscopic examination. Generaly it is caused by hemorrhoids and diverticular disease, but other anorectal conditions can also lead to LGIB. Recurrent bleeding may result in secondary iron deficiency anemia. Colonoscopy is the primary diagnostic option for establishing a diagnosis of colonic bleeding. OBJECTIVE This study aimed to analyze symptoms and endoscopic finding (specialy hemorrhoids) who may be sources of LGIB.Second goal of this study is to estimate time from onset of symptoms to performance of a colonoscopy. METHODS A retrospective study included 603 adult patients who underwent colonoscopy in General Hospital "Sv. Apostol Luka", Doboj, Bosnia and Herzegovina, between 1.1.2020 and 31.12.2020. RESULTS Average age of the examined population was 62±13,3years. According to the gender they were mostly men. To be exact,by percentage it was 53.7% of men and 46,3% of women, or by number: 324 men and 279 women. The most common indications for colonoscopy were LGIB (48,8%), abdominal pain and irregular stool. Most frequent endoscopic findings were hemorrhoids 42%. Normal findings had almost one third of all examinated patients. Combined findings-presence of more clinical entities in one patient were presented in 95 cases. In the group with hemorrhoids were almost two thirds of males, but there was no gender difference noted in between group with LGIB and without LGIB. More than half patients were older than 61 years. Anemia was presented in almost 20% of cases. Significantly it is higher frequency of abdominal pain, irregular stool and weight loss observed on the group without LGIB. Also, significantly more frequently patients with LGIB underwent colonoscopy in 0-30 days when compared with patients without LGIB (p=0,016). CONCLUSION In patients with haematochezia, taking a careful medical history is mandatory. Hemorrhoids, diverticular disease and colorectal cancers are the most common causes of bleeding. Patients with LGIB and abdominal pain were previously examined with colonoscopy. Completely colonoscopy is advocated to detect probable proximal lesions.
Collapse
Affiliation(s)
- Zoran Matkovic
- General Hospital “Sv. Apostol Luka“ Doboj, Doboj, Bosnia and Herzegovina
| | - Muharem Zildzic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
27
|
Shiha MG, Al-Rifaie A, Thoufeeq M. Impact of the National Endoscopy Database (NED) on colonoscopy withdrawal time: a tertiary centre experience. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000699. [PMID: 34215571 PMCID: PMC8256742 DOI: 10.1136/bmjgast-2021-000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/08/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Colonoscopy withdrawal time (CWT) is a key performance indicator affecting polyp detection rate (PDR) and adenoma detection rate (ADR). However, studies have shown wide variation in CWT and ADR between different endoscopists. The National Endoscopy Database (NED) was implemented to enable quality assurance in all endoscopy units across the UK and also to reduce variation in practice. We aimed to assess whether CWT changed since the introduction of NED and whether CWT affected PDR. METHODS We used NED to retrospectively collect data regarding CWT and PDR of 25 endoscopists who performed (n=4459 colonoscopies) in the four quarters of 2019. We then compared this data to their performance in 2016, before using NED (n=4324 colonoscopies). RESULTS Mean CWT increased from 7.66 min in 2016 to 9.25 min in 2019 (p=0.0001). Mean PDR in the two periods was 29.9% and 28.3% (p=0.64). 72% of endoscopists (18/25) had CWT>6 min in 2016 versus 100% (25/25) in 2019, the longer CWT in 2019 positively correlated with the PDR (r=0.50, p=0.01). Gastroenterology consultants and trainee endoscopists had longer CWT compared with colorectal surgeons both before and after using NED. CONCLUSION NED usage increased withdrawal times in colonoscopy. Longer withdrawal times were associated with higher PDR. A national colonoscopy audit using data from NED is required to evaluate whether wide variations in practice across endoscopy units in the UK still exist and to ensure minimum colonoscopy quality standards are achieved.
Collapse
Affiliation(s)
- Mohamed G Shiha
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ammar Al-Rifaie
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
28
|
Fraser AG, Rose T, Wong P, Lane M, Frankish P. Improved detection of adenomas and sessile serrated polyps is maintained with continuous audit of colonoscopy. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000425. [PMID: 32675086 PMCID: PMC7368474 DOI: 10.1136/bmjgast-2020-000425] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 12/12/2022] Open
Abstract
Background The audit process may help improve performance indicators for colonoscopy quality but it is unclear whether this is sustained over several years. Methods 44138 procedures for 28 endoscopists from 2004 to 2019 were analysed for polyp detection rate and withdrawal time. From 2012, 14 endoscopists were analysed with additional data on polyp histology and number of polyps removed. Results Polyp detection increased from 40.7% in 2004 to 62.2% in 2019; removal of polyps>1 cm remained constant (11%). Adenoma detection rate was 25.8% in 2012 and 28.3% in 2019. Sessile serrated polyp (SSP) detection rate increased from 4.5% to 14.7%; most of the increase was in the first 2 years of the histology part of the audit. There was a significant correlation of adenoma detection rate with mean number of adenomas (r=0.72, p=0.004) and a significant correlation of SSP detection with mean number of SSPs (r=0.85, p=0.0001). Conclusion The audit process appears to encourage a higher rate of polyp detection. This was due to increased detection of smaller polyps and increased detection of SSPs.
Collapse
Affiliation(s)
- Alan Gordon Fraser
- Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | | | | | | |
Collapse
|
29
|
Barnell EK, Kang Y, Barnell AR, Kruse KR, Fiske J, Pittz ZR, Khan AR, Huebner TA, Holmes FL, Griffith M, Griffith OL, Chaudhuri AA, Wurtzler EM. Multitarget Stool RNA Test for Noninvasive Detection of Colorectal Neoplasias in a Multicenter, Prospective, and Retrospective Cohort. Clin Transl Gastroenterol 2021; 12:e00360. [PMID: 34029233 PMCID: PMC8148418 DOI: 10.14309/ctg.0000000000000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Effective colorectal cancer (CRC) prevention and screening requires sensitive detection of all advanced neoplasias (CRC and advanced adenomas [AA]). However, existing noninvasive screening approaches cannot accurately detect adenomas with high sensitivity. METHODS Here, we describe a multifactor assay (RNA-FIT test) that combines 8 stool-derived eukaryotic RNA biomarkers, patient demographic information (smoking status), and a fecal immunochemical test (FIT) to sensitively detect advanced colorectal neoplasias and other non-advanced adenomas in a 1,305-patient, average-risk, prospective cohort. This cohort was supplemented with a 22-patient retrospective cohort consisting of stool samples obtained from patients diagnosed with AA or CRC before treatment or resection. Participants within these cohorts were evaluated with the RNA-FIT assay and an optical colonoscopy. RNA-FIT test results were compared with colonoscopy findings. RESULTS Model performance was assessed through 5-fold internal cross-validation of the training set (n = 939) and by using the model on a hold out testing set (n = 388). When used on the hold out testing set, the RNA-FIT test attained a 95% sensitivity for CRC (n = 22), 62% sensitivity for AA (n = 52), 25% sensitivity for other non-AA (n = 139), 80% specificity for hyperplastic polyps (n = 74), and 85% specificity for no findings on a colonoscopy (n = 101). DISCUSSION The RNA-FIT assay demonstrated clinically relevant detection of all grades of colorectal neoplasia, including carcinomas, AAs, and ONAs. This assay could represent a noninvasive option to screen for both CRC and precancerous adenomas.
Collapse
Affiliation(s)
- Erica K. Barnell
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Yiming Kang
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
| | - Andrew R. Barnell
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
| | - Kimberly R. Kruse
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
| | - Jared Fiske
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
| | - Zachary R. Pittz
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
| | - Adnan R. Khan
- Department of Pathology, Integrated Cellular and Molecular Diagnostics, Greenbelt, Maryland, USA
- Elligo Health Research, Austin, Texas, USA
| | - Thomas A. Huebner
- Elligo Health Research, Austin, Texas, USA
- Department of Pathology, Division of Gastrointestinal and Liver Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Malachi Griffith
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Obi L. Griffith
- McDonnell Genome Institute, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Aadel A. Chaudhuri
- Department of Genetics, Washington University School of Medicine, St. Louis, Missouri, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Elizabeth M. Wurtzler
- Division of Gastroenterology and Hepatology, Geneoscopy Inc., St. Louis, Missouri, USA
| |
Collapse
|
30
|
Wu X, Zhang Y, Hu T, He X, Zou Y, Deng Q, Ke J, Lian L, He X, Zhao D, Cai X, Chen Z, Wu X, Fan JB, Gao F, Lan P. A novel cell-free DNA methylation-based model improves the early detection of colorectal cancer. Mol Oncol 2021; 15:2702-2714. [PMID: 33694305 PMCID: PMC8486566 DOI: 10.1002/1878-0261.12942] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/21/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023] Open
Abstract
Screening for early‐stage disease is vital for reducing colorectal cancer (CRC)‐related mortality. Methylation of circulating tumor DNA has been previously used for various types of cancer screening. A novel cell‐free DNA (cfDNA) methylation‐based model which can improve the early detection of CRC is warranted. For our study, we collected 313 tissue and 577 plasma samples from patients with CRC, advanced adenoma (AA), non‐AA and healthy controls. After quality control, 187 tissue DNA samples (91 non‐malignant tissue from CRC patients, 26 AA and 70 CRC) and 489 plasma cfDNA samples were selected for targeted DNA methylation sequencing. We further developed a cfDNA methylation model based on 11 methylation biomarkers for CRC detection in the training cohort (area under curve [AUC] = 0.90 (0.85–0.94]) and verified the model in the validation cohort (AUC = 0.92 [0.88–0.96]). The cfDNA methylation model robustly detected patients pre‐diagnosed with early‐stage CRC (AUC = 0.90 [0.86–0.95]) or AA (AUC = 0.85 [0.78–0.91]). Here we established and validated a non‐invasive cfDNA methylation model based on 11 DNA methylation biomarkers for the detection of early‐stage CRC and AA. The utilization of the model in clinical practice may contribute to the early diagnosis of CRC.
Collapse
Affiliation(s)
- Xianrui Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Yunfeng Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Tuo Hu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaowen He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yifeng Zou
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiling Deng
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia Ke
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Lian
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaosheng He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dezhi Zhao
- AnchorDx Medical Co. Ltd, Guangzhou, China
| | - Xuyu Cai
- AnchorDx Medical Co. Ltd, Guangzhou, China
| | - Zhiwei Chen
- AnchorDx Medical Co. Ltd, Guangzhou, China.,AnchorDx, Inc., Fremont, CA, USA
| | - Xiaojian Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-Bing Fan
- AnchorDx Medical Co. Ltd, Guangzhou, China.,Department of Pathology, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Feng Gao
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| |
Collapse
|
31
|
Lin SY, Yaow CYL, Ng CH, Wong NW, Tham HY, Chong CS. Different position from traditional left lateral for colonoscopy? A meta-analysis and systematic review of randomized control trials. Chronic Dis Transl Med 2021; 7:27-34. [PMID: 34013177 PMCID: PMC8110879 DOI: 10.1016/j.cdtm.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Colonoscopy requires the intubation of the cecum for screening of colorectal diseases. The conventional position used for colonoscopy is the left lateral position (LLP). However, alternative positions have also been utilized to enhance the success of intubation. Thus, the aim of this study was to perform a meta-analysis of the different positions to determine the effectiveness of the individual positions for successful colonoscopy. METHODS Medline, Embase and Cochrane trials electronic databases were searched for studies on colonoscopy positions. The primary outcome was defined as the cecal intubation rate. Pooled risk ratios (RR) and 95% confidence intervals (CI) for the rates of cecal intubation were estimated. Secondary outcomes such as the cecal intubation time and adenoma detection rate were further analyzed qualitatively. RESULTS After reviewing 644 identified records, 7 randomized control trials (RCT) studies were included. No significant difference was observed in either comparisons, between the LLP vs. supine position (SP) (RR = 1.01, 95% CI, 0.98 to 1.04, P = 0.55) or the LLP vs. prone position (PP) (RR = 1.02, 95% CI, 0.98 to 1.06, P = 0.27). CONCLUSIONS Amidst available literature, the use of other positions can be considered when performing colonoscopy. These further highlights that the existential practice is based predominantly on familiarity instead of evidence-based-research.
Collapse
Affiliation(s)
- Snow Yunni Lin
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Clyve Yu Leon Yaow
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Cheng Han Ng
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Neng Wei Wong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Hui Yu Tham
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore 119228, Singapore
| |
Collapse
|
32
|
Shin R, Lee S, Han KS, Sohn DK, Moon SH, Choi DH, Kye BH, Son HJ, Lee SI, Si S, Kang WK. Guidelines for accreditation of endoscopy units: quality measures from the Korean Society of Coloproctology. Ann Surg Treat Res 2021; 100:154-165. [PMID: 33748029 PMCID: PMC7943281 DOI: 10.4174/astr.2021.100.3.154] [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: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Colonoscopy is an effective method of screening for colorectal cancer (CRC), and it can prevent CRC by detection and removal of precancerous lesions. The most important considerations when performing colonoscopy screening are the safety and satisfaction of the patient and the diagnostic accuracy. Accordingly, the Korean Society of Coloproctology (KSCP) herein proposes an optimal level of standard performance to be used in endoscopy units and by individual colonoscopists for screening colonoscopy. These guidelines establish specific criteria for assessment of safety and quality in screening colonoscopy. Methods The Colonoscopy Committee of the KSCP commissioned this Position Statement. Expert gastrointestinal surgeons representing the KSCP reviewed the published evidence to identify acceptable quality indicators and indicators that lacked sufficient evidence. Results The KSCP recommends an optimal standard list for quality control of screening colonoscopy in the following 6 categories: training and competency of the colonoscopist, procedural quality, facilities and equipment, performance indicators and auditable outcomes, disinfection of equipment, and sedation and recovery of the patient. Conclusion The KSCP recommends that endoscopy units performing CRC screening evaluate 6 key performance measures during daily practice.
Collapse
Affiliation(s)
- Rumi Shin
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea.,Department of Surgery, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Seongdae Lee
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Kyung-Su Han
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Dae Kyung Sohn
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Sang Hui Moon
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Dong Hyun Choi
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Bong-Hyeon Kye
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Hae-Jung Son
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Sun Il Lee
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Sumin Si
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea
| | - Won-Kyung Kang
- The Colonoscopy Committee, The Korean Society of Coloproctology (KSCP), Seoul, Korea.,Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
33
|
Saito H, Tanimoto T, Ozawa T, Ishihara S, Fujishiro M, Shichijo S, Hirasawa D, Matsuda T, Endo Y, Tada T. Automatic anatomical classification of colonoscopic images using deep convolutional neural networks. Gastroenterol Rep (Oxf) 2020; 9:226-233. [PMID: 34316372 PMCID: PMC8309686 DOI: 10.1093/gastro/goaa078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/25/2020] [Accepted: 05/13/2020] [Indexed: 01/10/2023] Open
Abstract
Background A colonoscopy can detect colorectal diseases, including cancers, polyps, and inflammatory bowel diseases. A computer-aided diagnosis (CAD) system using deep convolutional neural networks (CNNs) that can recognize anatomical locations during a colonoscopy could efficiently assist practitioners. We aimed to construct a CAD system using a CNN to distinguish colorectal images from parts of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Method We constructed a CNN by training of 9,995 colonoscopy images and tested its performance by 5,121 independent colonoscopy images that were categorized according to seven anatomical locations: the terminal ileum, the cecum, ascending colon to transverse colon, descending colon to sigmoid colon, the rectum, the anus, and indistinguishable parts. We examined images taken during total colonoscopy performed between January 2017 and November 2017 at a single center. We evaluated the concordance between the diagnosis by endoscopists and those by the CNN. The main outcomes of the study were the sensitivity and specificity of the CNN for the anatomical categorization of colonoscopy images. Results The constructed CNN recognized anatomical locations of colonoscopy images with the following areas under the curves: 0.979 for the terminal ileum; 0.940 for the cecum; 0.875 for ascending colon to transverse colon; 0.846 for descending colon to sigmoid colon; 0.835 for the rectum; and 0.992 for the anus. During the test process, the CNN system correctly recognized 66.6% of images. Conclusion We constructed the new CNN system with clinically relevant performance for recognizing anatomical locations of colonoscopy images, which is the first step in constructing a CAD system that will support us during colonoscopy and provide an assurance of the quality of the colonoscopy procedure.
Collapse
Affiliation(s)
- Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | | | - Tsuyoshi Ozawa
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan.,Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Soichiro Ishihara
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan.,Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Tomoki Matsuda
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
| | - Yuma Endo
- AI Medical Service, Inc., Tokyo, Japan
| | - Tomohiro Tada
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan.,Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,AI Medical Service, Inc., Tokyo, Japan
| |
Collapse
|
34
|
Evaluation of Key Performance Indicators (KPIs) for Sustainable Postgraduate Medical Training: An Opportunity for Implementing an Innovative Approach to Advance the Quality of Training Programs at the Saudi Commission for Health Specialties (SCFHS). SUSTAINABILITY 2020. [DOI: 10.3390/su12198030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Kingdom of Saudi Arabia is undergoing a major transformation in response to a revolutionary vision of 2030, given that healthcare reform is one of the top priorities. With the objective of improving healthcare and allied professional performance in the Kingdom to meet the international standards, the Saudi Commission for Health Specialties (SCFHS) has recently developed a strategic plan that focuses on expanding training programs’ capacity to align with the increasing demand for the country’s healthcare workforce, providing comprehensive quality assurance and control to ensure training programs uphold high quality standards, and providing advanced training programs benchmarked against international standards. In this research paper, we describe our attempt for developing a general framework for key performance indicators (KPIs) and the related metrics, with the aim of contributing to developing new strategies for better medical training compatible with the future. We present the results of a survey conducted in the Kingdom of Saudi Arabia (KSA), for the enhancement of quality of postgraduate medical training. The recent developments in the field of learning analytics present an opportunity for utilizing big data and artificial intelligence in the design and implementation of socio-technical systems with significant potential social impact. We summarize the key aspects of the Training Quality Assurance Initiative and suggest a new approach for designing a new data and services ecosystem for personalized health professionals training in the KSA. The study also contributes to the theoretical knowledge on the integration of sustainability and medical training and education by proposing a framework that can enhance future initiatives from various health organizations.
Collapse
|
35
|
Bronzwaer MES, Vleugels JLA, van Doorn SC, Dijkgraaf MGW, Fockens P, Dekker E. Are adenoma and serrated polyp detection rates correlated with endoscopists' sensitivity of optical diagnosis? Endoscopy 2020; 52:763-772. [PMID: 32349138 DOI: 10.1055/a-1151-8691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
UNLABELLED INTRODUCTION : Endoscopists with a high adenoma detection rate (ADR) and proximal serrated polyp detection rate (PSPDR) detect these polyps more frequently, which may be attributable to better recognition of their endoscopic features. Little is known about the association between endoscopic lesion detection and differentiation skills. Therefore, we evaluated the correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps. METHODS We performed an exploratory post-hoc analysis of the DISCOUNT-2 study, including complete colonoscopies after a positive fecal immunochemical test (FIT) performed by endoscopists who performed ≥ 50 colonoscopies. The correlations between the ADR, PSPDR, and the sensitivity of optical diagnosis were calculated using Pearson's rho correlation coefficient. RESULTS 24 endoscopists performed ≥ 50 colonoscopies, resulting in a total of 2889 colonoscopies. The overall ADR was 84.5 % (range 71.4 % - 95.3 %) and overall PSPDR was 13.7 % (4.3 % - 29.0 %). The sensitivity of optical diagnosis for adenomas and serrated polyps were 94.5 % (83.3 % - 100 %) and 74.0 % (37.5 % - 94.1 %), respectively. No correlation could be demonstrated between the ADR and the sensitivity of optical diagnosis for adenomas (-0.20; P = 0.35) or between the PSPDR and the sensitivity of optical diagnosis for serrated polyps (-0.12; P = 0.57). CONCLUSIONS In a homogeneous FIT-positive population, no correlation between the ADR, PSPDR, and the sensitivity of optical diagnosis for adenomas and serrated polyps could be demonstrated. These exploratory results suggest that lesion detection and differentiation require different endoscopic skills. Further prospective studies are needed; until then, monitoring of both performance indicators is important to secure optimal efficacy of FIT-based colorectal cancer screening.
Collapse
Affiliation(s)
- Maxime E S Bronzwaer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jasper L A Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Sascha C van Doorn
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
36
|
Forbes N, Boyne DJ, Mazurek MS, Hilsden RJ, Sutherland RL, Pader J, Ruan Y, Shaheen AA, Wong C, Lamidi M, Lorenzetti DL, Brenner DR, Heitman SJ. Association Between Endoscopist Annual Procedure Volume and Colonoscopy Quality: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:2192-2208.e12. [PMID: 32240836 DOI: 10.1016/j.cgh.2020.03.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In addition to monitoring adverse events (AEs) and post-colonoscopy colorectal cancers (PCCRC), indicators for assessing colonoscopy quality include adenoma detection rate (ADR) and cecal intubation rate (CIR). It is unclear whether there is an association between annual colonoscopy volume and ADR, CIR, AEs, or PCCRC. METHODS We searched publication databases through March 2019 for studies assessing the relationship between annual colonoscopy volume and outcomes, including ADR, CIR, AEs, or PCCRC. Pooled odds ratios (ORs) were calculated using DerSimonian and Laird random effects models. Sensitivity analyses were performed to assess for potential methodological or clinical factors associated with outcomes. RESULTS We performed a systematic review of 9235 initial citations, generating 27 retained studies comprising 11,276,244 colonoscopies. There was no association between procedural volume and ADR (OR, 1.00; 95% CI, 0.98-1.02 per additional 100 annual procedures). CIR improved with each additional 100 annual procedures (OR, 1.17; 95% CI, 1.08-1.28). There was a non-significant trend toward decreased overall AEs per additional 100 annual procedures (OR, 0.95; 95% CI, 0.90-1.00). There was considerable heterogeneity among most analyses. CONCLUSIONS In a systematic review and meta-analysis, we found higher annual colonoscopy volumes to correlate with higher CIR, but not with ADR or PCCRC. Trends toward fewer AEs were associated with higher annual colonoscopy volumes. There are few data available from endoscopists who perform fewer than 100 annual colonoscopies. Studies are needed on extremes in performance volumes to more clearly elucidate associations between colonoscopy volumes and outcomes.
Collapse
Affiliation(s)
- Nauzer Forbes
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta
| | - Devon J Boyne
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - Matthew S Mazurek
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - R Liam Sutherland
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Joy Pader
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta
| | - Yibing Ruan
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Abdel Aziz Shaheen
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Clarence Wong
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Mubasiru Lamidi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta
| | - Diane L Lorenzetti
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Health Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta; Forzani & MacPhail Colon Cancer Screening Centre, Alberta Health Services, Calgary, Alberta.
| |
Collapse
|
37
|
Aziz M, Sharma S, Ghazaleh S, Fatima R, Acharya A, Ghanim M, Sheikh T, Lee-Smith W, Hamdani SU, Nawras A. The anti-spasmodic effect of peppermint oil during colonoscopy: a systematic review and meta-analysis. MINERVA GASTROENTERO 2020; 66. [DOI: 10.23736/s1121-421x.20.02652-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
38
|
Zhao S, Deng XL, Wang L, Ye JW, Liu ZY, Huang B, Kan Y, Liu BH, Zhang AP, Li CX, Li F, Tong WD. The impact of sedation on quality metrics of colonoscopy: a single-center experience of 48,838 procedures. Int J Colorectal Dis 2020; 35:1155-1161. [PMID: 32300884 DOI: 10.1007/s00384-020-03586-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Investigation of the role of sedation during colonoscopy is meaningful as the advantages of colonoscopy performing with sedation are still controversial. METHODS Medical records of patients who underwent colonoscopy in our institution were retrospectively analyzed. The sedation rate, adenoma detection rate (ADR), polyp detection rate (PDR), cecal intubation rate (CIR), iatrogenic colonic perforation rate (ICP) were calculated. RESULTS A total of 48,838 colonoscopies (24,498 in males) dated from July 2007 to February 2017 were analyzed. The median age was 50 years (range 16-85 years). An overall sedation rate was 80.38%. The PDR was 26.77%, and was not statistically different between colonoscopy with or without sedation (26.67% vs 27.22, p = 0.474). ADR was 12.9% regardless of applying sedation or not (13.0% vs 12.44%, p = 0.337). The CIR was 87.42% in all examinations with an adjusted CIR of 90.34%, and was higher when performed with sedation than without sedation (88.92% vs 80.64%, p < 0.0001). Five cases (0.01%) of ICP were reported, all of which occurred in patients under sedation. CONCLUSIONS The use of sedation is associated with increased CIR, but ADR and PDR remain unchanged with or without sedation. However, perforation rate, albeit very low, is significantly higher in sedated patients.
Collapse
Affiliation(s)
- Song Zhao
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Xiao-Lian Deng
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Li Wang
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Jing-Wang Ye
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Zheng-Yong Liu
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Bin Huang
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Ying Kan
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Bao-Hua Liu
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - An-Ping Zhang
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Chun-Xue Li
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Fan Li
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China
| | - Wei-Dong Tong
- Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China.
| |
Collapse
|
39
|
Shandro BM, Emrith K, Slabaugh G, Poullis A, Smith ML. Optical imaging technology in colonoscopy: Is there a role for photometric stereo? World J Gastrointest Endosc 2020; 12:138-148. [PMID: 32477448 PMCID: PMC7243575 DOI: 10.4253/wjge.v12.i5.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer. However, up to a third of adenomas may be missed at colonoscopy, and the majority of post-colonoscopy colorectal cancers are thought to arise from these. Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa. However, these topographic features are not enhanced by white light colonoscopy, and the endoscopist must infer these from two-dimensional cues. This may contribute to the number of missed lesions. A variety of optical imaging technologies have been developed commercially to enhance surface topography. However, existing techniques enhance surface topography indirectly, and in two dimensions, and the evidence does not wholly support their use in routine clinical practice. In this narrative review, co-authored by gastroenterologists and engineers, we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate, and review the development of photometric stereo (PS) for colonoscopy. PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography. This imaging technique has several potential clinical applications in colonoscopy, including adenoma detection, polyp classification, and facilitating polypectomy, an inherently three-dimensional task. However, the development of PS for colonoscopy is at an early stage. We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.
Collapse
Affiliation(s)
- Benjamin M Shandro
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Khemraj Emrith
- Centre for Machine Vision, University of the West of England, Bristol BS16 1QY, United Kingdom
| | - Gregory Slabaugh
- Department of Computer Science, City, University of London, London EC1V 0HB, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Melvyn L Smith
- Centre for Machine Vision, University of the West of England, Bristol BS16 1QY, United Kingdom
| |
Collapse
|
40
|
The Role of VEGFA, COX2, HUR and CUGBP2 in Predicting the Response to Neoadjuvant Therapy in Rectal Cancer Patients. ACTA ACUST UNITED AC 2020; 56:medicina56040192. [PMID: 32331433 PMCID: PMC7230171 DOI: 10.3390/medicina56040192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/18/2022]
Abstract
Background and objectives: The effectiveness of neoadjuvant therapy, which is commonly used for stage II-III rectal cancer (RC) treatment, is limited. Genes associated with the pathogenesis of RC could determine response to this treatment. Therefore, the aim of this study was to investigate the potential predictive value of VEGFA, COX2, HUR and CUGBP2 genes and the associations between post-treatment changes in gene expression and the efficacy of neoadjuvant therapy. Materials and Methods: Biopsies from RC and healthy rectal tissue of 28 RC patients were collected before neoadjuvant therapy and 6-8 weeks after neoadjuvant therapy. The expression levels of VEGFA, COX2, HUR, CUGBP2 genes were evaluated using a quantitative real-time polymerase chain reaction. Results: The results reveal a significantly higher expression of VEGFA, COX2 and HUR mRNA in RC tissue compared to healthy rectal tissue (p < 0.05), and elevated VEGFA gene expression in pre-treatment tissues was associated with a better response to neoadjuvant therapy based on T-stage downstaging (p < 0.05). The expression of VEGFA, HUR and CUGBP2 genes significantly decreased after neoadjuvant therapy (p < 0.05). Responders to treatment demonstrated a significantly stronger decrease of VEGFA and COX2 expression after neoadjuvant therapy than non-responders (p < 0.05). Conclusions: The findings of this study suggest that the pre-treatment VEGFA gene expression might have predictive value for the response to neoadjuvant therapy, while the post-treatment decrease in VEGFA and COX2 gene expression could indicate the effectiveness of neoadjuvant therapy in RC patients.
Collapse
|
41
|
Liu C, Ding SS, Zhang K, Liu LN, Guo LH, Sun LP, Zhang YF, Sun XM, Ren WW, Zhao CK, Li XL, Wang Q, Xu XR, Xu HX. Correlation between ultrasound consolidated score and simple endoscopic score for determining the activity of Crohn's disease. Br J Radiol 2020; 93:20190614. [PMID: 32101466 DOI: 10.1259/bjr.20190614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to develop an ultrasound consolidated score (UCS) in determining the activity of Crohn's disease (CD) and evaluate it with reference to simple endoscopic score (SES). METHODS From June 2014 to June 2017, 66 patients with CD were retrospectively enrolled in this study. Each patient underwent endoscopy and transabdominal ultrasound (US) examination. The morphological symmetry, echogenicity of bowel wall, bowel wall layer structure, echogenicity of peri-bowel fat, bowel wall thickness (BWT), and Limberg type on power Doppler US were assessed with transabdominal US, and an UCS scoring system was developed based on these characteristics. Endoscopic results were used as the reference standard and SES was calculated to determine the CD activity. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance for determining CD activity and the correlation between UCS and SES was assessed using Spearman correlation analysis. RESULTS 330 intestinal segments in 66 patients were included. The UCS of the segments in the remission phase ranged from 3.0 to 9.0 (mean, 3.6 ± 0.9) whereas in the active phase from 3.0 to 20.0 (mean, 10.6 ± 4.0) (p < 0.001). The cut-off value of UCS was 6. The associated area under ROC curve, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 0.980, 88.3%, 95.5%, 93.8%, 91.3%, and 92.3%, respectively. The correlation coefficient between UCS and SES was 0.90, which was higher than the correlation coefficient of 0.83 between BWT and SES. CONCLUSIONS The newly developed UCS with transabdominal US has a good performance and potentially provides an effective alternative for evaluating the activity of CD. ADVANCES IN KNOWLEDGE UCS is an effective method to evaluate the activity of CD because it provides comprehensive information of the disease. Therefore, it could be employed as an alternative for diagnosis of CD.
Collapse
Affiliation(s)
- Chang Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shi-Si Ding
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Kun Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Lin-Na Liu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yi-Feng Zhang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiao-Min Sun
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Wei-Wei Ren
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Chong-Ke Zhao
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Qiao Wang
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiao-Rong Xu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China.,Ultrasound Research and Education Institute, Tongji University Cancer Center, Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Tongji University School of Medicine, Shanghai, 200072, China
| |
Collapse
|
42
|
Impact of a real-time automatic quality control system on colorectal polyp and adenoma detection: a prospective randomized controlled study (with videos). Gastrointest Endosc 2020; 91:415-424.e4. [PMID: 31454493 DOI: 10.1016/j.gie.2019.08.026] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Quality control can decrease variations in the performance of colonoscopists and improve the effectiveness of colonoscopy to prevent colorectal cancers. Unfortunately, routine quality control is difficult to carry out because a practical method is lacking. The aim of this study was to develop an automatic quality control system (AQCS) and assess whether it could improve polyp and adenoma detection in clinical practice. METHODS First, we developed AQCS based on deep convolutional neural network models for timing of the withdrawal phase, supervising withdrawal stability, evaluating bowel preparation, and detecting colorectal polyps. Next, consecutive patients were prospectively randomized to undergo routine colonoscopies with or without the assistance of AQCS. The primary outcome of the study was the adenoma detection rate (ADR) in the AQCS and control groups. RESULTS A total of 659 patients were enrolled and randomized. A total of 308 and 315 patients were analyzed in the AQCS and control groups, respectively. AQCS significantly increased the ADR (0.289 vs 0.165, P < .001) and the mean number of adenomas per procedure (0.367 vs 0.178, P < .001) compared with the control group. A significant increase was also observed in the polyp detection rate (0.383 vs 0.254, P = .001) and the mean number of polyps detected per procedure (0.575 vs 0.305, P < .001). In addition, the withdrawal time (7.03 minutes vs 5.68 minutes, P < .001) and adequate bowel preparation rate (87.34% vs 80.63%, P = .023) were superior for the AQCS group. CONCLUSIONS AQCS could effectively improve the performance of colonoscopists during the withdrawal phase and significantly increase polyp and adenoma detection. (Clinical trial registration number: NCT03622281.).
Collapse
|
43
|
Neilson LJ, Patterson J, von Wagner C, Hewitson P, McGregor LM, Sharp L, Rees CJ. Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™. Frontline Gastroenterol 2020; 11:209-217. [PMID: 32419912 PMCID: PMC7223270 DOI: 10.1136/flgastro-2019-101321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Measuring patient experience is important for evaluating the quality of patient care, identifying aspects requiring improvement and optimising patient outcomes. Patient Reported Experience Measures (PREMs) should, ideally, be patient derived, however no such PREMs for gastrointestinal (GI) endoscopy exist. This study explored the experiences of patients undergoing GI endoscopy and CT colonography (CTC) in order to: identify aspects of care important to them; determine whether the same themes are relevant across investigative modalities; develop the framework for a GI endoscopy PREM. METHODS Patients aged ≥18 years who had undergone oesophagogastroduodenoscopy (OGD), colonoscopy or CTC for symptoms or surveillance (but not within the national bowel cancer screening programme) in one hospital were invited to participate in semi-structured interviews. Recruitment continued until data saturation. Inductive thematic analysis was undertaken. RESULTS 35 patients were interviewed (15 OGD, 10 colonoscopy, 10 CTC). Most patients described their experience chronologically, and five 'procedural stages' were evident: before attending for the test; preparing for the test; at the hospital, before the test; during the test; after the test. Six themes were identified: anxiety; expectations; choice & control; communication & information; comfort; embarrassment & dignity. These were present for all three procedures but not all procedure stages. Some themes were inter-related (eg, expectations & anxiety; communication & anxiety). CONCLUSION We identified six key themes encapsulating patient experience of GI procedures and these themes were evident for all procedures and across multiple procedure stages. These findings will be used to inform the development of the Newcastle ENDOPREM™.
Collapse
Affiliation(s)
- Laura J Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Joanne Patterson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Speech and Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Paul Hewitson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Linda Sharp
- Population Health Sciences Institute & Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute & Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| |
Collapse
|
44
|
He YS, Su JR, Li Z, Zuo XL, Li YQ. Application of artificial intelligence in gastrointestinal endoscopy. J Dig Dis 2019; 20:623-630. [PMID: 31639272 DOI: 10.1111/1751-2980.12827] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/07/2019] [Accepted: 10/20/2019] [Indexed: 02/06/2023]
Abstract
With recent significant improvements in artificial intelligence (AI), especially in the field of deep learning, an increasing number of studies have evaluated the use of AI in endoscopy to detect and diagnose gastrointestinal (GI) lesions. The present review summarizes current publications on the use of AI in GI endoscopy and focuses on the challenges and future of AI-aided systems. We expect AI to provide an effective and practical method for endoscopists in lesion detection and characterization as well as in quality control in endoscopy. However, so far, most studies have remained at the preclinical stage. More attention should be paid in the future to the use of AI in real-life clinical applications.
Collapse
Affiliation(s)
- Yi Shan He
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Jing Ran Su
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Xiu Li Zuo
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yan Qing Li
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.,Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI Tumor, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| |
Collapse
|
45
|
|
46
|
Gajda M, Kowalska M. The Web-Based Randomized Controlled Intervention as the Enhancer of Cancer Prevention. ACTA ACUST UNITED AC 2019; 55:medicina55080434. [PMID: 31382569 PMCID: PMC6723358 DOI: 10.3390/medicina55080434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Cancer is an unresolved public health issue in society. With the advent of the internet and the development in the technological sector, access to basic health-related information has become more frequent among patients and healthy individuals. The aim of this study is to evaluate the impact of educational intervention on the participant’s willingness to undergo selected medical procedures in case of suspected cancer. Materials and Methods: From 14 May 2015 to 13 November 2016, a total of 1118 who visited the Polish scientific website were enrolled in the ‘Polish Online Randomized Intervention aimed at Neoplasm Avoidance’ (PORINA) and randomized into two groups (educational and control). The original Cancer Knowledge Index (CKI) was used for the evaluation of participants’ cancer-related knowledge. They were asked to declare whether they would consent to undergo selected medical procedures necessary for cancer diagnosis or treatment. Results: Most participants declared their readiness to undergo abdominal ultrasonography, computed tomography, and a nevi excision. The most noticeable changes were found for potential consent to undergo breast fine needle aspiration, mammography and gastroscopy. Conclusions: The level of oncological knowledge has an impact on individual decision to consent to particular medical procedures. Conducted educational intervention has significantly increased the readiness to undergo selected medical procedures.
Collapse
Affiliation(s)
- Maksymilian Gajda
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Str., 40-752 Katowice, Poland.
| | - Małgorzata Kowalska
- Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Medyków 18 Str., 40-752 Katowice, Poland
| |
Collapse
|
47
|
Effect of video monitor size on polyp detection: a prospective, randomized, controlled trial. Gastrointest Endosc 2019; 90:254-258.e2. [PMID: 30986402 DOI: 10.1016/j.gie.2019.03.1172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The adenoma detection rate (ADR) is the most important quality metric for colonoscopy. Numerous factors are known to influence ADR. However, no data on the effect of monitor size on ADR exist. The aim of this study was to compare the ADR and polyp detection rate (PDR) achieved using 2 different-size video monitors (19-inch diagonal and 32-inch diagonal). METHODS In a single-center, prospective, randomized clinical trial, endoscopists were randomized on a daily basis to perform routine ambulatory colonoscopies with either a 32-inch diagonal or a 19-inch diagonal video monitor. RESULTS The study was conducted between October 2013 and April 2014 in an outpatient center of a tertiary referral hospital. Fifteen endoscopists performed 1795 outpatient colonoscopies (mean age, 55 years; 56% women; screening, 56%). There was no substantial difference in baseline patient characteristics between the 2 arms. The overall ADR (27.4% vs 27.9%; P = .80) and PDR (32.8% vs 34.4%; P = .50) were not significantly different between the 32-inch and 19-inch monitor group, respectively. The findings were not significantly altered when stratified by indication, cecal intubation, bowel preparation, operator experience, and time of endoscopy as well as in a multivariable model that included these variables as potential confounders (all P > .05). Overall, the ADR and PDR for each individual endoscopist did not appear to be influenced by monitor size. CONCLUSIONS The results of this trial do not support the notion that larger video monitors improve ADR. Future efforts to increase ADR should focus on other aspects of colonoscopy. (Clinical trial registration number: NCT01952418.).
Collapse
|
48
|
Subramaniam K, Ang PW, Neeman T, Fadia M, Taupin D. Post-colonoscopy colorectal cancers identified by probabilistic and deterministic linkage: results in an Australian prospective cohort. BMJ Open 2019; 9:e026138. [PMID: 31230004 PMCID: PMC6596957 DOI: 10.1136/bmjopen-2018-026138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Post-colonoscopy colorectal cancers (PCCRCs) are recognised as a critical quality indicator. Benchmarking of PCCRC rate has been hampered by the strong influence of different definitions and methodologies. We adopted a rigorous methodology with high-detail individual data to determine PCCRC rates in a prospective cohort representing a single jurisdiction. SETTING We performed a cohort study of individuals who underwent colonoscopy between 2001 and 2008 at a single centre serving Australian Capital Territory (ACT) and enclaving New South Wales (NSW) region. These individuals were linked to subsequent colorectal cancer (CRC) diagnosis, within 5 years of a negative colonoscopy, through regional cancer registries and hospital records using probabilistic and deterministic record linkage. All cases were verified by pathology review. Predictors of PCCRCs were extracted. PARTICIPANTS 7818 individuals had a colonoscopy in the cohort. Linkage to cancer registries detected 384 and 98 CRCs for notification dates of 2001-2013 (ACT) and 2001-2010 (NSW). A further 55 CRCs were identified from a search of electronic medical records using International Classification of Diseases-10 diagnosis codes. After verification and exclusions, 385/537 CRCs (58% male) were included. PRIMARY OUTCOME MEASURE PCCRC rates. RESULTS There were 15 PCCRCs in our cohort. The PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was estimated as 0.192% (95% CI 0.095 to 0.289). The index colonoscopy prior to PCCRC was more likely to show diverticulosis (p=0.017 for association, OR 3.56, p=0.014) and have poor bowel preparation (p=0.017 for association, OR 4.19, p=0.009). CONCLUSION In this population-based cohort study, the PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was 0.192%. These data show the 'real world' accuracy of colonoscopy for CRC exclusion.
Collapse
Affiliation(s)
- Kavitha Subramaniam
- Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - P W Ang
- Cancer Research, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Teresa Neeman
- Statistical Consulting Unit, Australian National University, Canberra, Australia
| | - Mitali Fadia
- Department of Anatomical Pathology, ACT Pathology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Doug Taupin
- Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Cancer Research, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
49
|
Rees CJ, Koo S, Anderson J, McAlindon M, Veitch AM, Morris AJ, Bhandari P, East JE, Webster G, Oppong KW, Penman ID. British society of gastroenterology Endoscopy Quality Improvement Programme (EQIP): overview and progress. Frontline Gastroenterol 2019; 10:148-153. [PMID: 31205655 PMCID: PMC6540284 DOI: 10.1136/flgastro-2018-101073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/08/2019] [Indexed: 02/04/2023] Open
Abstract
High quality gastrointestinal (GI) endoscopy improves patient care. Raising standards in endoscopy improves diagnostic accuracy, management of pathology and ultimately improves outcomes. Historical identification of significant variation in colonoscopy quality led to the development of the Joint Advisory Group (JAG) on GI Endoscopy, the Global Rating Scale (GRS), JAG Endoscopy Training System (JETS) training and certification. These measures led to major improvements in UK endoscopy but significant variation in practice still exists. To improve quality further the British Society of Gastroenterology Endoscopy Quality Improvement (EQIP) has been established with the aim of raising quality and reducing variation in the quality of UK endoscopy. A multifaceted approach to quality improvement (QI) will be undertaken and is described in this manuscript. Upper GI EQIP will support adoption of standards alongside regional upskilling courses. Lower GI EQIP will focus on supporting endoscopists to achieve current standards alongside approaches to reducing postcolonoscopy colorectal cancer rates. Endoscopic retrograde cholangiopancreatography EQIP will adopt a regional approach of using local data to support network-based QI. Newer areas of endoscopy practice such as small bowel endoscopy and endoscopic ultrasound will focus on identifying key performance indicators as well as standardising training and accreditation pathways. EQIP will also support QI in management of GI bleeding as well as standardising the approach to new techniques and technologies. Where evidence is lacking, approaches to gather new evidence and support the translation into clinical practice will be supported.
Collapse
Affiliation(s)
- Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK,Department of Gastroenterology, South Tyneside, South Shields, UK
| | - Sara Koo
- Department of Gastroenterology, South Tyneside, South Shields, UK
| | - John Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Gloucestershire Hospitals, Cheltenham, Gloucestershire, UK
| | - Mark McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Andrew M Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals, Wolverhampton, UK
| | - Allan John Morris
- Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital Portsmouth, Southhampton, UK
| | - James E East
- Translational Gastroenterology Unit, and Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - George Webster
- Department of Gastroenterology, University College Hospital, London, UK
| | - Kofi W Oppong
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - Ian D Penman
- Department of Gastroenterology, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
50
|
Ngu WS, Bevan R, Tsiamoulos ZP, Bassett P, Hoare Z, Rutter MD, Clifford G, Totton N, Lee TJ, Ramadas A, Silcock JG, Painter J, Neilson LJ, Saunders BP, Rees CJ. Improved adenoma detection with Endocuff Vision: the ADENOMA randomised controlled trial. Gut 2019; 68:280-288. [PMID: 29363535 PMCID: PMC6352411 DOI: 10.1136/gutjnl-2017-314889] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Low adenoma detection rates (ADR) are linked to increased postcolonoscopy colorectal cancer rates and reduced cancer survival. Devices to enhance mucosal visualisation such as Endocuff Vision (EV) may improve ADR. This multicentre randomised controlled trial compared ADR between EV-assisted colonoscopy (EAC) and standard colonoscopy (SC). DESIGN Patients referred because of symptoms, surveillance or following a positive faecal occult blood test (FOBt) as part of the Bowel Cancer Screening Programme were recruited from seven hospitals. ADR, mean adenomas per procedure, size and location of adenomas, sessile serrated polyps, EV removal rate, caecal intubation rate, procedural time, patient experience, effect of EV on workload and adverse events were measured. RESULTS 1772 patients (57% male, mean age 62 years) were recruited over 16 months with 45% recruited through screening. EAC increased ADR globally from 36.2% to 40.9% (P=0.02). The increase was driven by a 10.8% increase in FOBt-positive screening patients (50.9% SC vs 61.7% EAC, P<0.001). EV patients had higher detection of mean adenomas per procedure, sessile serrated polyps, left-sided, diminutive, small adenomas and cancers (cancer 4.1% vs 2.3%, P=0.02). EV removal rate was 4.1%. Median intubation was a minute quicker with EAC (P=0.001), with no difference in caecal intubation rate or withdrawal time. EAC was well tolerated but caused a minor increase in discomfort on anal intubation in patients undergoing colonoscopy with no or minimal sedation. There were no significant EV adverse events. CONCLUSION EV significantly improved ADR in bowel cancer screening patients and should be used to improve colonoscopic detection. TRIAL REGISTRATION NUMBER NCT02552017, Results; ISRCTN11821044, Results.
Collapse
Affiliation(s)
- Wee Sing Ngu
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | - Roisin Bevan
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton, UK
| | | | | | - Zoë Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Matthew D Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton, UK
| | - Gayle Clifford
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | - Nicola Totton
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Thomas J Lee
- Department of Gastroenterology, Northumbria NHS Trust, North Tyneside, UK
| | - Arvind Ramadas
- Department of Gastroenterology, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - John G Silcock
- Department of Gastroenterology, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - John Painter
- Department of Gastroenterology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Laura J Neilson
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK
| | | | - Colin J Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, UK,Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| |
Collapse
|