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Ogura K, Ichijima R, Ikehara H, Sugita T, Yamaguchi D, Nagata Y, Esaki M, Minoda Y, Ono H, Hotta K, Kiriyama S, Sumiyoshi T, Kanmura Y. Comparison of remimazolam and midazolam for sedation during colonoscopy in Japanese patients: A propensity score matching analysis. DEN OPEN 2025; 5:e412. [PMID: 39050143 PMCID: PMC11266431 DOI: 10.1002/deo2.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/27/2024]
Abstract
Objectives To compare the efficacy and safety of sedation with midazolam and remimazolam for colorectal endoscopy. Methods This single-center, two-arm, post-hoc analysis of the REM-IICTJP01 study investigated the efficacy and safety of remimazolam for gastrointestinal endoscopic sedation. We enrolled 40 and 208 patients who underwent colonoscopy under remimazolam and midazolam sedation, respectively, during the same period. The primary outcome was the time from the end of the colonoscopy until discharge. The secondary outcomes included the time from the end of the colonoscopy until awakening, dosage, and adverse events. Propensity score matching was employed to eliminate the effect of confounding factors. Results Thirty-seven patients in each group were matched. After propensity matching, the time to awakening after colonoscopy was 28.0 (13.0-37.0) min in the midazolam group and 0 (0-0) min in the remimazolam group; moreover, the time till discharge was 40.0 (35.0-46.5) min in the midazolam group and 0 (0-5.0) min in the remimazolam group, both of which were significantly shorter in the remimazolam group (p < 0.01). The number of additional doses was 0 (0-0) and 2 (1-3) in the midazolam and remimazolam groups, respectively. The total dose was 2.0 (2.0-3.5) and 6.0 (5.0-7.0) mg in the midazolam and remimazolam groups, respectively. Conclusions Remimazolam yielded significantly faster times to awakening and discharge safely compared to midazolam.
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Affiliation(s)
- Kanako Ogura
- Department of Medicine Nihon University School of MedicineDivision of Gastroenterology and HepatologyTokyoJapan
- Department of GastroenterologyNagata Surgery and Gastroenterological ClinicTokyoJapan
| | - Ryoji Ichijima
- Department of Medicine Nihon University School of MedicineDivision of Gastroenterology and HepatologyTokyoJapan
- Department of GastroenterologyKiriyama ClinicGunmaJapan
| | - Hisatomo Ikehara
- Department of Medicine Nihon University School of MedicineDivision of Gastroenterology and HepatologyTokyoJapan
- Department of GastroenterologyInternal MedicineKitasato University School of MedicineKanagawaJapan
| | - Tomomi Sugita
- Department of Medicine Nihon University School of MedicineDivision of Gastroenterology and HepatologyTokyoJapan
| | - Daisuke Yamaguchi
- Department of GastroenterologyNational Hospital Organization Ureshino Medical CenterSagaJapan
| | - Yasuhiko Nagata
- Department of GastroenterologyNagata Surgery and Gastroenterological ClinicTokyoJapan
| | - Mitsuru Esaki
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory ScienceGraduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Hiroyuki Ono
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Kinichi Hotta
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | | | | | - Yuichi Kanmura
- Department of AnesthesiologyFujimoto General HospitalMiyazakiJapan
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Adán Merino L, Mora Soler AM, Ponferrada Díaz Á. Surveillance recommendations after endoscopic resection of colorectal polyps. Med Clin (Barc) 2024; 163:143-148. [PMID: 38849270 DOI: 10.1016/j.medcli.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Luisa Adán Merino
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España.
| | - Ana María Mora Soler
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
| | - Ángel Ponferrada Díaz
- Servicio de Aparato Digestivo, Hospital Universitario Infanta Leonor, Madrid, España
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Hasegawa I, Suzuki S, Yamamura T, Aniwan S, Chiu HM, Laohavichitra K, Chirapongsathorn S, Kuo CY, Yoshida N, Ang TL, Takezawa T, Rerknimitr R, Ishikawa H, Gotoda T. Linked color imaging improves colorectal lesion detection especially for low performance endoscopists: An international trial in Asia. J Gastroenterol Hepatol 2024; 39:1374-1381. [PMID: 38602345 DOI: 10.1111/jgh.16576] [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: 10/05/2023] [Revised: 12/21/2023] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND AND AIM Linked color imaging (LCI) is an image-enhanced endoscopy technique that accentuates the color difference between red and white, potentially improving the adenoma detection rate (ADR). However, it remains unclear whether LCI performance in detecting colorectal lesions differs based on endoscopists' experience levels. We aimed to evaluate the differences in LCI efficacy based on the experience levels of endoscopists by conducting an exploratory analysis. METHODS In this post hoc analysis of an international randomized controlled trial comparing the detection of adenoma and other lesions using colonoscopy with LCI and high-definition white light imaging (WLI), we included patients from 11 institutions across four countries/regions: Japan, Thailand, Taiwan, and Singapore. We retrospectively reviewed differences in the lesion detection of LCI according to endoscopists' colonoscopy history or ADR. RESULTS We included 1692 and 1138 patients who underwent colonoscopies performed by 54 experts (experience of ≥ 5000 colonoscopies) and by 43 non-experts (experience of < 5000 colonoscopies), respectively. Both expert and non-expert groups showed a significant improvement in ADR with LCI compared to WLI (expert, 61.7% vs 46.4%; P < 0.001; non-expert, 56.6% vs 46.4%; P < 0.001). LCI had no effect on sessile serrated lesion detection rate in non-experts (3.1% vs 2.5%; P = 0.518). LCI significantly improved detection rates in endoscopists with relatively low detection performance, defined as an ADR < 50%. CONCLUSIONS This exploratory study analyzed data from a previous trial and revealed that LCI is useful for both experts and non-experts and is even more beneficial for endoscopists with relatively low detection performance using WLI.
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Affiliation(s)
- Issei Hasegawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satmai Aniwan
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Sakkarin Chirapongsathorn
- Department of Medicine, Division of Gastroenterology and Hepatology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Chen-Ya Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
| | - Takahito Takezawa
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Rungsun Rerknimitr
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuji Gotoda
- Department of Medicine, Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
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Yoshida N, Maeda-Minami A, Ishikawa H, Mutoh M, Tomita Y, Kobayashi R, Hashimoto H, Inoue K, Hirose R, Dohi O, Itoh Y, Mano Y. Prevalence of colonoscopy in Japan using a large-scale health claims data compared to esophagogastroduodenoscopy. J Gastroenterol 2024; 59:457-467. [PMID: 38466371 DOI: 10.1007/s00535-024-02087-x] [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: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE Prevalence of colonoscopy (CS) is an important countermeasure against colorectal cancer (CRC). In this study, we used large-scale data for a comparison of CS with esophagogastroduodenoscopy (EGD) in Japan. METHODS This was a retrospective descriptive study. Commercially anonymized patient data were collected from various health insurance societies (JMDC, Inc. Tokyo, Japan) generated from the insurance registry, receipts (inpatient, outpatient, and prescription), and health checkup data. The data also included healthy subjects who had never been examined in a hospital. The data of 2,760,048 persons who were 50-75 years old during January 2012-December 2019 were extracted from the original data source. The annual rate, the prevalence rate (frequency of those undergoing at least one endoscopy during the period), and the percentage of repeaters (undergoing endoscopy at least twice during the period) of CS were calculated and compared to those of EGD. RESULTS The annual rates in 2012/2015/2019 were 3.4%/4.5%/5.3% for CS, respectively, and increased gradually from 2012 to 2019. Those rates were 7.0%/7.9%/7.4% for EGD, respectively, and did not increase. The prevalence rates of CS and EGD were 25.3% and 36.2%, respectively, among the 137,246 participants over 8 years. The prevalence rates of individuals in their 50 s/60 s/70 s were 23.0%/25.9%/31.4% for CS and 33.0%/37.6%/40.7% for EGD, respectively. The proportions of males/females were 27.9%/20.7% for CS, and 36.4%/35.8% for EGD, respectively. The repeat rates of CS and EGD were 40.3% and 44.8%, respectively, over 8 years. CONCLUSIONS Using large-scale data, we determined the status of CS and EGD in Japan.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Ayako Maeda-Minami
- Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michihiro Mutoh
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yasunari Mano
- Department of Clinical Drug Informatics, Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
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Oda Y. Analysis based on the opportunities for detecting huge numbers of consecutive colorectal cancers would help identify the reality of clinical practices. Dig Endosc 2024. [PMID: 38764156 DOI: 10.1111/den.14816] [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: 03/05/2024] [Accepted: 04/15/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Yasushi Oda
- Oda GI Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
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Yoshida N, Suzuki S, Inoue K, Aniwan S, Chiu HM, Laohavichitra K, Chirapongsathorn S, Yamamura T, Kuo CY, Ang TL, Takezawa T, Rerknimitr R, Ishikawa H. Analysis of the Characteristics of Coexisting Lesions in Colorectal Cancer Patients in an International Study: A Subgroup Analysis of the ATLAS Trial. Digestion 2024; 105:280-290. [PMID: 38631318 DOI: 10.1159/000538955] [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: 02/10/2024] [Accepted: 04/16/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION We investigated coexisting lesion types in patients with invasive colorectal cancer (CRC) in a multinational study for comprehending the adenoma-carcinoma and serrated pathway about the development of CRC. METHODS We retrospectively reviewed 3,050 patients enrolled in the international randomized controlled trial (ATLAS study) to evaluate the colorectal polyp detection performance of image-enhanced endoscopy in 11 institutions in four Asian countries/regions. In the current study, as a subgroup analysis of the ATLAS study, 92 CRC patients were extracted and compared to 2,958 patients without CRC to examine the effects of age, sex, and coexisting lesion types (high-grade adenoma [HGA], low-grade adenoma with villous component [LGAV], 10 adenomas, adenoma ≥10 mm, sessile serrated lesions [SSLs], and SSLs with dysplasia [SSLD]). Additional analyses of coexisting lesion types were performed according to sex and location of CRC (right- or left-sided). RESULTS A multivariate analysis showed that HGA (odds ratio [95% confidence interval] 4.29 [2.16-8.18]; p < 0.01), LGAV (3.02 [1.16-7.83], p = 0.02), and age (1.04 [1.01-1.06], p = 0.01) were independently associated with CRC. According to sex, the coexisting lesion types significantly associated with CRC were LGAV (5.58 [1.94-16.0], p < 0.01) and HGA (4.46 [1.95-10.20], p < 0.01) in males and HGA (4.82 [1.47-15.80], p < 0.01) in females. Regarding the location of CRC, SSLD (21.9 [1.31-365.0], p = 0.03) was significant for right-sided CRC, and HGA (5.22 [2.39-11.4], p < 0.01) and LGAV (3.46 [1.13-10.6], p = 0.02) were significant for left-sided CRC. CONCLUSIONS The significant coexisting lesions in CRC differed according to sex and location. These findings may contribute to comprehending the pathogenesis of CRC.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan,
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satimai Aniwan
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Sakkarin Chirapongsathorn
- Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Chen-Ya Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore, Singapore
| | - Takahito Takezawa
- Division of Gastroenterology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Rungsun Rerknimitr
- Center of Excellence in Endoscopy for Gastrointestinal Oncology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Sekiguchi M, Kishida Y, Ikematsu H, Konno M, Mizuguchi Y, Hotta K, Imai K, Ito S, Takada K, Shiomi A, Yasui H, Tsukamoto S, Hirano H, Kobayashi N, Saito Y, Inaba A, Shinmura K, Konishi J, Ozawa H, Fujita S, Murakami Y, Matsuda T. Proportions and characteristics of interval cancer in annual fecal immunochemical test screening and postcolonoscopy colorectal cancer: Results from a Japanese multicenter prospective study using questionnaires, the C-DETECT study. Dig Endosc 2024. [PMID: 38433322 DOI: 10.1111/den.14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/28/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES There are several types of colorectal cancer (CRC) according to the detection methods and intervals, including interval CRC (iCRC) and postcolonoscopy CRC (PCCRC). We aimed to examine their proportions and characteristics. METHODS We conducted a multicenter prospective study using questionnaires in Japan ("C-DETECT study"), in which differences in CRC characteristics according to detection methods and intervals were examined from consecutive adult patients. Because the annual fecal immunochemical test (FIT) was used in population-based screening, the annual FIT-iCRC was assessed. RESULTS In total, 1241 CRC patients (1064 with invasive CRC) were included. Annual FIT-iCRC (a), 3-year PCCRC (b), and CRC detected within 1 year after a positive FIT with noncompliance to colonoscopy (c) accounted for 4.5%, 7.0%, and 3.9% of all CRCs, respectively, and for 3.9%, 5.4%, and 4.3% of invasive CRCs, respectively. The comparison among these (a, b, c) and other CRCs (d) demonstrated differences in the proportions of ≥T2 invasion ([a] 58.9%, [b] 44.8%, [c] 87.5%, [d] 73.0%), metastasis ([a] 33.9%, [b] 21.8%, [c] 54.2%, [d] 43.9%), right-sided CRC ([a] 42.9%, [b] 40.2%, [c] 18.8%, [d] 28.6%), and female sex ([a] 53.6%, [b] 49.4%, [c] 27.1%, [d] 41.6%). In metastatic CRC, (a) and (b) showed a higher proportions of BRAF mutations ([a] [b] 12.0%, [c] [d] 3.1%). CONCLUSIONS Annual FIT-iCRC and 3-year PCCRC existed in nonnegligible proportions. They were characterized by higher proportions of right-sided tumors, female sex, and BRAF mutations. These findings suggest that annual FIT-iCRC and 3-year PCCRC may have biological features different from those of other CRCs.
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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
| | | | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Maki Konno
- Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan
| | | | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colorectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hidekazu Hirano
- Department of Gastrointestinal Medical Oncology, 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
| | - Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Jun Konishi
- Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan
| | - Heita Ozawa
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Shin Fujita
- Department of Surgery, Tochigi Cancer Center, Tochigi, Japan
| | | | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
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8
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Sano Y, Hotta K, Matsuda T, Murakami Y, Fujii T, Kudo SE, Oda Y, Ishikawa H, Saito Y, Kobayashi N, Sekiguchi M, Ikematsu H, Katagiri A, Konishi K, Takeuchi Y, Iishi H, Igarashi M, Kobayashi K, Sada M, Osera S, Shinohara T, Yamaguchi Y, Hasuda K, Morishima T, Miyashiro I, Shimoda T, Taniguchi H, Fujimori T, Ajioka Y, Yoshida S. Endoscopic Removal of Premalignant Lesions Reduces Long-Term Colorectal Cancer Risk: Results From the Japan Polyp Study. Clin Gastroenterol Hepatol 2024; 22:542-551.e3. [PMID: 37544420 DOI: 10.1016/j.cgh.2023.07.021] [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: 12/01/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND & AIMS To date, no regional evidence of long-term colorectal cancer (CRC) risk reduction after endoscopic premalignant lesion removal has been established. We aimed to analyze this over a long-term follow-up evaluation. METHODS This was a prospective cohort study of participants from the Japan Polyp Study conducted at 11 Japanese institutions. Participants underwent scheduled follow-up colonoscopies after a 2-round baseline colonoscopy process. The primary outcome was CRC incidence after randomization. The observed/expected ratio of CRC was calculated using data from the population-based Osaka Cancer Registry. Secondary outcomes were the incidence and characteristics of advanced neoplasia (AN). RESULTS A total of 1895 participants were analyzed. The mean number of follow-up colonoscopies and the median follow-up period were 2.8 years (range, 1-15 y) and 6.1 years (range, 0.8-11.9 y; 11,559.5 person-years), respectively. Overall, 4 patients (all males) developed CRCs during the study period. The observed/expected ratios for CRC in all participants, males, and females, were as follows: 0.14 (86% reduction), 0.18, and 0, respectively, and 77 ANs were detected in 71 patients (6.1 per 1000 person-years). Of the 77 ANs detected, 31 lesions (40.3%) were laterally spreading tumors, nongranular type. Nonpolypoid colorectal neoplasms (NP-CRNs), including flat (<10 mm), depressed, and laterally spreading, accounted for 59.7% of all detected ANs. Furthermore, 2 of the 4 CRCs corresponded to T1 NP-CRNs. CONCLUSIONS Endoscopic removal of premalignant lesions, including NP-CRNs, effectively reduced CRC risk. More than half of metachronous ANs removed by surveillance colonoscopy were NP-CRNs. The Japan Polyp Study: University Hospital Medical Information Network Clinical Trial Registry: University Hospital Medical Information Network Clinical Trial Registry, C000000058; cohort study: UMIN000040731.
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Affiliation(s)
- Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care, Sano Hospital, Kobe, Japan.
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan.
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
| | | | | | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yasushi Oda
- Oda Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nozomu Kobayashi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Atsushi Katagiri
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kazuo Konishi
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyasu Iishi
- Department of Gastroenterology, Itami City Hospital, Itami, Japan
| | - Masahiro Igarashi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Miwa Sada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Shozo Osera
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Tomoaki Shinohara
- Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Saku, Japan
| | | | - Kiwamu Hasuda
- Hattori Gastrointestinal Endoscopy and Gastroenterology Clinic, Kumamoto, Japan
| | | | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Hirokazu Taniguchi
- Pathology and Clinical Laboratory Division, JR Tokyo General Hospital, Tokyo, Japan
| | | | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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9
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Chiu HM. The Evolving Landscape of Colorectal Cancer Screening and Colonoscopy Practice: Insights From the Japan Polyp Study. Clin Gastroenterol Hepatol 2024; 22:486-487. [PMID: 37922999 DOI: 10.1016/j.cgh.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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10
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Wong MCS, Leung EYM, Chun SCC, Deng Y, Lam T, Tang RSY, Huang J. Recurrence rates of advanced colorectal neoplasia (ACN) in subjects with baseline ACN followed up at different surveillance intervals. Dig Liver Dis 2023; 55:1742-1749. [PMID: 37127494 DOI: 10.1016/j.dld.2023.03.019] [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: 11/14/2022] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Current clinical guidelines recommend that a baseline finding of advanced colorectal neoplasia (ACN) should be followed-up within 1-3 years. AIM We compared the recurrence rate of ACN at 1 year vs. 3 years among individuals with ACN detected and polypectomised at baseline colonoscopy. METHODS We extracted data from eligible patients in a Chinese population database from 2008 to 2018. The outcome variables included recurrence of advanced adenoma and advanced neoplasia, respectively, at follow-up colonoscopy. Binary logistic regression modeling was constructed to examine the association between length of surveillance and the outcome variables, controlling for risk factors of colorectal cancer, including age, gender, smoking, alcohol drinking, body mass index and chronic diseases. RESULTS We included 147,270 subjects who have received a baseline colonoscopy from our dataset. They were aged 69.3 years and 59.7% of them were male subjects. The crude 1-year and 3-year recurrence rate of ACN was 7.57% and 7.74%. From a binary logistic regression model, individuals with surveillance colonoscopy performed at 3 years did not have significantly higher recurrence rate of ACN than those followed-up at 1 year. CONCLUSIONS No statistically significantly difference in recurrence of ACN between individuals who received workup at 1vs. 3 years. These findings support a 3-year surveillance period after baseline ACN was polypectomised.
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Affiliation(s)
- Martin C S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; The Chinese Academy of Medical Sciences and The Peking Union Medical College, Beijing, China; The School of Public Health, The Peking University, Beijing, China
| | - Eman Yee-Man Leung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Sam C C Chun
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Yunyang Deng
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Thomas Lam
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR
| | - Raymond S Y Tang
- S.H. Ho Centre for Digestive Health, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR
| | - Junjie Huang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
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11
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Hsu WF, Chiu HM. Optimization of colonoscopy quality: Comprehensive review of the literature and future perspectives. Dig Endosc 2023; 35:822-834. [PMID: 37381701 DOI: 10.1111/den.14627] [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: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 06/30/2023]
Abstract
Colonoscopy is crucial in preventing colorectal cancer (CRC) and reducing associated mortality. This comprehensive review examines the importance of high-quality colonoscopy and associated quality indicators, including bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate (ADR), complete resection, specimen retrieval, complication rates, and patient satisfaction, while also discussing other ADR-related metrics. Additionally, the review draws attention to often overlooked quality aspects, such as nonpolypoid lesion detection, as well as insertion and withdrawal skills. Moreover, it explores the potential of artificial intelligence in enhancing colonoscopy quality and highlights specific considerations for organized screening programs. The review also emphasizes the implications of organized screening programs and the need for continuous quality improvement. A high-quality colonoscopy is crucial for preventing postcolonoscopy CRC- and CRC-related deaths. Health-care professionals must develop a thorough understanding of colonoscopy quality components, including technical quality, patient safety, and patient experience. By prioritizing ongoing evaluation and refinement of these quality indicators, health-care providers can contribute to improved patient outcomes and develop more effective CRC screening programs.
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Affiliation(s)
- Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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12
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Baile-Maxía S, Jover R. Surveillance after colorectal polyp resection. Best Pract Res Clin Gastroenterol 2023; 66:101848. [PMID: 37852710 DOI: 10.1016/j.bpg.2023.101848] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 07/02/2023] [Indexed: 10/20/2023]
Abstract
Post-polypectomy surveillance has proven to reduce colorectal cancer (CRC) incidence in patients with high-risk polyps, but it implies a major burden on colonoscopy units. Therefore, it should be targeted to individuals with a higher risk. Different societies have published guidelines on surveillance after resection of polyps, with notable discrepancies among them, and many recommendations come from low-quality evidence based on surrogate measures, such as risk of advanced adenoma, and not CRC risk. In this review, we aimed to summarize the evidence supporting post-polypectomy surveillance, compare the recently updated major guidelines, and discuss the existing discrepancies on this topic. Briefly, patients with adenomas ≥10 mm or high-grade dysplasia and patients with serrated polyps ≥10 mm or dysplasia are generally considered to have an increased risk of metachronous CRC and require surveillance, whereas the indication of surveillance is not clearly established in patients without these high-risk features.
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Affiliation(s)
- Sandra Baile-Maxía
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
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13
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Bonnington SN, Hungin APS, Nickerson C, Wright S, Sharp L, Rutter MD. Colorectal cancer and advanced adenoma incidence during post-polypectomy surveillance: a national cohort study in the English Bowel Cancer Screening Programme. Endoscopy 2023; 55:740-753. [PMID: 37185968 DOI: 10.1055/a-2060-0615] [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] [Indexed: 05/17/2023]
Abstract
BACKGROUND Improved colonoscopy quality has led to debate about whether all post-polypectomy surveillance is justified. We evaluated surveillance within the English Bowel Cancer Screening Programme (BCSP) to determine the yield of surveillance and identify predictive factors for surveillance outcome. METHODS We performed a retrospective cohort study of individuals undergoing post-polypectomy surveillance between July 2006 and January 2017. BCSP records were linked to the National Cancer Registration Database to identify interval-type post-colonoscopy colorectal cancers (CRCs). Advanced adenoma and CRC at surveillance were documented. CRC incidence was compared with the general population using standardized incidence ratios (SIRs). Predictors of advanced adenomas at first surveillance (S1), and CRC during follow-up, were identified. RESULTS 44 151 individuals (23 078 intermediate risk; 21 073 high risk) underwent 64 544 surveillance episodes. Advanced adenoma and CRC yields were, respectively, 10.0 % and 0.5 % at S1, 8.5 % and 0.4 % at S2, and 10.8 % and 0.4 % at S3. S1 yield was lowest in those with one index adenoma ≥ 10 mm (advanced adenoma 6.1 %; CRC 0.3 %). The SIR was 0.76 (95 %CI 0.66-0.88), accounted for by the intermediate risk group (intermediate risk SIR 0.61, 95 %CI 0.49-0.75; high risk SIR 0.95, 95 %CI 0.79-1.15). Adenoma multiplicity, presence of a large nonpedunculated adenoma, and greater villous component were associated with advanced adenoma at S1. Older age and multiplicity were significantly associated with CRC risk. CONCLUSION This large, national analysis found low levels of CRC in those undergoing surveillance and low advanced adenoma yield in most subgroups. Less intensive surveillance in some subgroups is warranted, and surveillance may be avoided in those with a single large adenoma.
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Affiliation(s)
- Stewart N Bonnington
- Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - A Pali S Hungin
- Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | | | - Suzanne Wright
- NHS Cancer Screening Programmes, Sheffield, United Kingdom
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Matthew D Rutter
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, United Kingdom
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14
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Shimada S, Hotta K, Takada K, Imai K, Ito S, Kishida Y, Kawata N, Yoshida M, Yamamoto Y, Maeda Y, Minamide T, Ishiwatari H, Matsubayashi H, Ono H. Complete endoscopic removal rate of detected colorectal polyps in a real world out-patient practical setting. Scand J Gastroenterol 2023; 58:422-428. [PMID: 36250663 DOI: 10.1080/00365521.2022.2132533] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Colonoscopy with adenomatous polypectomy reduces the incidence and mortality of colorectal cancer. We introduced a strategy of removing all neoplastic polyps in single-session out-patient colonoscopy using cold polypectomy. We aimed to investigate the achievement of single-session complete removal rate of detected colorectal polyps in clinical practice. MATERIALS AND METHODS This retrospective study included colonoscopy-scheduled 40-79-year-old outpatients, with at least one colorectal neoplasm, between January 2015 and December 2016. Exclusion criteria were: colorectal neoplasms 21 mm or larger in size; pre-examination for colorectal surgery or endoscopic submucosal dissection; colonoscopy performed by health check program; ongoing antithrombotic treatment; inflammatory bowel disease; familial adenomatous polyposis. We defined 'clean colon' as the removal of all detected neoplastic polyps in a single-session colonoscopy. We evaluated clean colon rate, factors relating to clean colon failure and complications. RESULTS We evaluated 2527 patients (mean age 68 years; 799 women) with 8203 colorectal polyps (7675 adenomas, 423 serrated lesions, 105 Tis and T1 cancers). In 1-4 mm polyps, cold snare polypectomy (CSP; 51.8%) and cold forceps polypectomy (CFP; 45.8%) were applied. Clean colon rates were 95.1% per patient and 97.1% per lesion. The significant factors denoting clean colon failure were inadequate bowel preparation, ≥5 lesions, and the most advanced estimated histology of adenocarcinoma, on multivariate analyses. Post-polypectomy bleeding requiring endoscopic hemostasis occurred in five patients (0.2%) who had undergone endoscopic mucosal resection (EMR) or hot snare polypectomy (HSP). Perforation occurred in one patient (0.04%) with EMR. CONCLUSIONS The clean colon rates were satisfactory in single-session out-patient colonoscopy using cold polypectomy.
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Affiliation(s)
- Seitaro Shimada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoichi Yamamoto
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yuki Maeda
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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15
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Arai J, Aoki T, Hayakawa Y, Niikura R, Ishibashi R, Suzuki N, Tsuji Y, Yamada A, Ushiku T, Fujishiro M. Risk and preventive factors of early-onset colorectal neoplasms: endoscopic and histological database analysis. J Gastroenterol Hepatol 2023; 38:259-268. [PMID: 36302073 DOI: 10.1111/jgh.16045] [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: 05/25/2022] [Revised: 10/14/2022] [Accepted: 10/22/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The incidence of early-onset colorectal neoplasms has been increasing in both Western and Eastern countries. However, the risks and preventive factors for these neoplasms in Eastern countries remain unclear. METHODS The data of 5580 patients who underwent colonoscopy between 2016 and 2021 were retrospectively evaluated. The primary outcome was advanced colorectal neoplasm (ACRN), defined as advanced adenomas (adenoma ≥10 mm, or with high-grade dysplasia or villous component) or adenocarcinoma. The clinical factors associated with ACRNs were determined for each age category (≤50 and >50 years), and the differences between the two categories were assessed. Odds ratios adjusted for age and sex were calculated. RESULTS Among 1001 patients (age ≤50 years), ACRN was found in 94 (9.4%). In this younger category, male sex (adjusted odds ratio [aOR]:2.34, 95% confidence interval [CI]:1.51-3.63) and a family history of colorectal cancer (aOR:2.14, 95% CI:1.17-3.89) were significantly associated with higher odds of developing ACRNs. ACRNs were detected in 726 (15.9%) of 4579 patients (age >50 years). In the older age category, smoking (aOR:1.32, 95% CI:1.08-1.63) was significantly associated with a higher risk of ACRNs. Exercise of >3.5 metabolic equivalent of task (METs) (aOR,0.80; 95% CI:0.67-0.96) was significantly associated with a lower risk of ACRNs. CONCLUSION The development of early-onset ACRNs was primarily associated with congenital factors, whereas that of late-onset ACRNs was associated with acquired ones. Colonoscopy is recommended for young male patients, particularly for those with a family history of colorectal cancer.
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Affiliation(s)
- Junya Arai
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Rei Ishibashi
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Nobumi Suzuki
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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16
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Uozumi T, Saito Y, Toyoshima N, Takamaru H, Sekiguchi M, Yamada M, Abe S. Effective use of image-enhanced endoscopy and endoscopic submucosal dissection for multiple flat non-polypoid colorectal neoplasms. Endoscopy 2022; 54:E684-E685. [PMID: 35180795 DOI: 10.1055/a-1753-9294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Takeshi Uozumi
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Hiroyuki Takamaru
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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17
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Misawa M. Will artificial intelligence-assisted colonoscopy work in cancer screening programs? Endoscopy 2022; 54:1180-1181. [PMID: 35913068 DOI: 10.1055/a-1890-5043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
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18
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Yoshida N, Ishikawa H, Otani T, Goto C, Matsuda T, Takeuchi Y, Sano Y, Itoh Y, Suzuki S, Mutoh M. Aspirin-Mediated Prevention of Colorectal Adenomas Recurrence is Affected by Blood Biochemistry and Nutritional Intake. Cancer Prev Res (Phila) 2022; 15:837-846. [PMID: 36075073 DOI: 10.1158/1940-6207.capr-22-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/03/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
Aspirin has been shown to prevent the onset of colorectal adenoma and cancer. This study aimed to identify patient characteristics and blood chemistry factors related to the effect of aspirin. A total of 231 men and 59 women who participated in our previous randomized clinical study in 2007-2009 using aspirin or placebo (J-CAPP study) were analyzed. Interaction of aspirin with age at entry, body mass index (BMI), alcohol intake, blood biochemistry, and nutrients calculated from a semiquantitative food frequency questionnaire were analyzed on the basis of the presence of adenomas 2 years later. Our study showed that suppression of adenoma by aspirin was not affected by age or BMI. Among men, significant suppression of adenoma by aspirin was seen with triglyceride (TG) <167 mg/dL (P = 0.02), total cholesterol (T-cho) ≥220 mg/dL (P = 0.01), high-density lipoprotein (HDL) ≥60 mg/dL (P < 0.01), and low-density lipoprotein (LDL) ≥140 mg/dL (P = 0.01), aspartate aminotransferase (AST) <30 IU/L (P = 0.01), alanine aminotransferase <30 IU/L (P = 0.04), and gamma-glutamyl transpeptidase <60 IU/L (P = 0.04). In addition, the interaction was significant with TG ≥/<167 mg/dL (P = 0.02), T-cho ≥/<220 mg/dL (P = 0.03), HDL ≥/<60 mg/dL (P = 0.02), LDL ≥/<140 mg/dL (P = 0.03), and AST ≥/<30 IU/L (P = 0.01). Daily nutrient intake associated with aspirin was <2,000 mg sodium (P = 0.06) and ≥850 μg retinol equivalent (P = 0.05) among men, indicating a marginal effect on adenoma suppression. No significant differences were detected among women due to the small sample size. In conclusion, lipid metabolism and liver function were correlated with the suppressive effect of aspirin on the recurrence of colorectal adenoma. PREVENTION RELEVANCE Aspirin has been shown to prevent the onset of colorectal adenoma and cancer, and its effect modifications have been analyzed. Lipid metabolism and liver function were correlated with the suppressive effect of aspirin on the recurrence of colorectal adenoma.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takahiro Otani
- Department of Public Health, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Chiho Goto
- Department of Health and Nutrition, Nagoya Bunri University, Aichi, Japan
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology and Department of Genetic Oncology, Division of Hereditary Tumors, Osaka International Cancer Institute, Osaka, Japan
| | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally Invasive Endoscopic Care (iMEC), Sano Hospital, Hyogo, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sadao Suzuki
- Department of Public Health, Graduate School of Medical Sciences, Nagoya City University, Aichi, Japan
| | - Michihiro Mutoh
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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19
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - 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
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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20
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Ijspeert JEG, van Toledo DEFWM, Dekker E. Proximal serrated polyp detection rate and interval post-colonoscopy colorectal cancer risk – Authors' reply. Lancet Gastroenterol Hepatol 2022; 7:907-908. [DOI: 10.1016/s2468-1253(22)00273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 10/14/2022]
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21
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Kudo SE, Misawa M, Mori Y, Kawabata Y, Maeda Y, Miyachi H, Mori K. Identification of a small, depressed type of colorectal invasive cancer by an artificial intelligence-assisted detection system. Endoscopy 2022; 54:E592-E593. [PMID: 34933368 DOI: 10.1055/a-1704-8103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan.,Clinical Effectiveness Research Group, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yurie Kawabata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
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22
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Asokkumar R, Chiu HM, Kaltenbach T, Matsuda T, Soetikno R. Proximal serrated polyp detection rate and interval post-colonoscopy colorectal cancer risk. Lancet Gastroenterol Hepatol 2022; 7:907. [DOI: 10.1016/s2468-1253(22)00237-0] [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: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 10/14/2022]
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23
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Iwatate M, Hirata D, Francisco CPD, Co JT, Byeon J, Joshi N, Banerjee R, Quach DT, Aye TT, Chiu H, Lau LHS, Ng SC, Ang TL, Khomvilai S, Li X, Ho S, Sano W, Hattori S, Fujita M, Murakami Y, Shimatani M, Kodama Y, Sano Y. Efficacy of international web-based educational intervention in the detection of high-risk flat and depressed colorectal lesions higher (CATCH project) with a video: Randomized trial. Dig Endosc 2022; 34:1166-1175. [PMID: 35122323 PMCID: PMC9540870 DOI: 10.1111/den.14244] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Three subcategories of high-risk flat and depressed lesions (FDLs), laterally spreading tumors non-granular type (LST-NG), depressed lesions, and large sessile serrated lesions (SSLs), are highly attributable to post-colonoscopy colorectal cancer (CRC). Efficient and organized educational programs on detecting high-risk FDLs are lacking. We aimed to explore whether a web-based educational intervention with training on FIND clues (fold deformation, intensive stool/mucus attachment, no vessel visibility, and demarcated reddish area) may improve the ability to detect high-risk FDLs. METHODS This was an international web-based randomized control trial that enrolled non-expert endoscopists in 13 Asian countries. The participants were randomized into either education or non-education group. All participants took the pre-test and post-test to read 60 endoscopic images (40 high-risk FDLs, five polypoid, 15 no lesions) and answered whether there was a lesion. Only the education group received a self-education program (video and training questions and answers) between the tests. The primary outcome was a detection rate of high-risk FDLs. RESULTS In total, 284 participants were randomized. After excluding non-responders, the final data analyses were based on 139 participants in the education group and 130 in the non-education group. The detection rate of high-risk FDLs in the education group significantly improved by 14.7% (66.6-81.3%) compared with -0.8% (70.8-70.0%) in the non-education group. Similarly, the detection rate of LST-NG, depressed lesions, and large SSLs significantly increased only in the education group by 12.7%, 12.0%, and 21.6%, respectively. CONCLUSION Short self-education focusing on detecting high-risk FDLs was effective for Asian non-expert endoscopists. (UMIN000042348).
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Affiliation(s)
- Mineo Iwatate
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Daizen Hirata
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
- Department of Gastroenterology and HepatologyKindai UniversityOsakaJapan
| | | | - Jonard Tan Co
- Institute of Digestive and Liver DiseasesSt. Luke’s Medical CenterTaguig CityPhilippines
| | - Jeong‐Sik Byeon
- Department of GastroenterologyAsan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Neeraj Joshi
- Gastro Enterology UnitNepal Cancer Hospital and Research CentreLalitpurNepal
| | - Rupa Banerjee
- Medical GastroenterologyAsian Institute of GastroenterologyNew DelhiIndia
| | - Duc Trong Quach
- University of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
| | | | - Han‐Mo Chiu
- Department of Internal MedicineNational Taiwan University HospitalTaipeiTaiwan
| | - Louis H. S. Lau
- Department of Medicine and TherapeuticsFaculty of MedicineInstitute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - Siew C. Ng
- Department of Medicine and TherapeuticsFaculty of MedicineInstitute of Digestive DiseaseThe Chinese University of Hong KongHong KongChina
| | - Tiing Leong Ang
- Department of Gastroenterology and HepatologyChangi General HospitalSingHealthSingapore
| | - Supakij Khomvilai
- Surgical EndoscopyColorectal DivisionDepartment of SurgeryFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Xiao‐Bo Li
- Division of Gastroenterology and HepatologyKey Laboratory of Gastroenterology and HepatologyMinistry of Health, Renji HospitalSchool of MedicineShanghai Institute of Digestive DiseaseShanghai Jiao Tong UniversityShanghaiChina
| | - Shiaw‐Hooi Ho
- Department of MedicineFaculty of MedicineUniversity of MalayaKuala LumpurMalaysia
| | - Wataru Sano
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Santa Hattori
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | - Mikio Fujita
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
| | | | - Masaaki Shimatani
- The Third Department of Internal MedicineDivision of Gastroenterology and HepatologyKansai Medical University Medical CenterOsakaJapan
| | - Yuzo Kodama
- Division of GastroenterologyDepartment of Internal MedicineKobe University Graduate School of MedicineHyogoJapan
| | - Yasushi Sano
- Gastrointestinal Center and Institute of Minimally‐invasive Endoscopic Care (iMEC)Sano HospitalHyogoJapan
- Kansai Medical UniversityOsakaJapan
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24
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Sekiguchi M, Matsuda T, Hotta K, Saito Y. Post-polypectomy surveillance: the present and the future. Clin Endosc 2022; 55:489-495. [PMID: 35811404 PMCID: PMC9329642 DOI: 10.5946/ce.2022.097] [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: 03/14/2022] [Accepted: 04/10/2022] [Indexed: 11/14/2022] Open
Abstract
An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.
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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
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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25
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Matsuda T. Expectations for and challenges in population-based endoscopic gastric and colorectal cancer screening. Dig Endosc 2022; 34 Suppl 2:15-19. [PMID: 34180080 DOI: 10.1111/den.14055] [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: 04/27/2021] [Revised: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 01/30/2023]
Affiliation(s)
- Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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26
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Mori Y, Misawa M, Kudo S. Challenges in artificial intelligence for polyp detection. Dig Endosc 2022; 34:870-871. [PMID: 35318734 PMCID: PMC9314935 DOI: 10.1111/den.14279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Yuichi Mori
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway,Section for GastroenterologyDepartment of Transplantation MedicineOslo University HospitalOsloNorway,Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
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27
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Imai K. Reappraisal of a second examination after standard colonoscopy withdrawal in the proximal colon: Retroflex or forward view? Dig Endosc 2022; 34:741-743. [PMID: 35301765 DOI: 10.1111/den.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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28
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Comparison in the development of colorectal cancer after screening colonoscopy between elderly and younger population. Eur J Cancer Prev 2022; 31:505-512. [PMID: 35102072 DOI: 10.1097/cej.0000000000000739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS This study aimed to evaluate and compare the incidence of colorectal cancer (CRC) in elderly participants aged ≥75 years and those <75 years who had previously undergone a colonoscopy. METHODS This retrospective cohort study was conducted at the Center for Preventive Medicine at St. Luke's International Hospital in Japan. All participants who underwent screening colonoscopy between 2005 and 2015 were included and followed up until 2020. Our primary outcome was the identification of CRC as confirmed by pathology after screening colonoscopy. We compared the development of CRC between the two groups using survival analyses. A sub-analysis to evaluate the incidence of CRC among participants with and without neoplastic polyp resection at initial colonoscopy was also performed. RESULTS A total of 8350 participants were enrolled; the median follow-up period was 2982 days (interquartile range:1932-4141), mean age was 52.5 years (SD: 11.5) and 5274 (61.3%) participants were men. The incidence of CRC during the follow-up period was 82 (0.95%) among all participants and 11 (4.31%) among the elderly participants. Elderly participants showed a significantly higher incidence of CRC than the other group [hazard ratio, 2.56; 95% confidence interval (CI), 1.14-5.75]. The sub-analysis showed that out of 2878 participants with a neoplastic polyp at the initial colonoscopy, 52 (1.81%) developed CRC (hazard ratio, 2.85; 95% CI, 1.16-6.98). CONCLUSIONS A repeat colonoscopy might be warranted in people with high activities of daily living and few comorbidities, especially if there is a history of neoplastic polypectomy at the first colonoscopy.
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29
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Yamada M, Shino R, Kondo H, Yamada S, Takamaru H, Sakamoto T, Bhandari P, Imaoka H, Kuchiba A, Shibata T, Saito Y, Hamamoto R. Robust automated prediction of the revised Vienna Classification in colonoscopy using deep learning: development and initial external validation. J Gastroenterol 2022; 57:879-889. [PMID: 35972582 PMCID: PMC9596523 DOI: 10.1007/s00535-022-01908-1] [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: 05/31/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Improved optical diagnostic technology is needed that can be used by also outside expert centers. Hence, we developed an artificial intelligence (AI) system that automatically and robustly predicts the pathological diagnosis based on the revised Vienna Classification using standard colonoscopy images. METHODS We prepared deep learning algorithms and colonoscopy images containing pathologically proven lesions (56,872 images, 6775 lesions). Four classifications were adopted: revised Vienna Classification category 1, 3, and 4/5 and normal images. The best algorithm-ResNet152-in the independent internal validation (14,048 images, 1718 lesions) was used for external validation (255 images, 128 lesions) based on neoplastic and non-neoplastic classification. Diagnostic performance of endoscopists was compared using a computer-assisted interpreting test. RESULTS In the internal validation, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for adenoma (category 3) of 84.6% (95% CI 83.5-85.6%), 99.7% (99.5-99.8%), 90.8% (89.9-91.7%), 89.2% (88.5-99.0%), and 89.8% (89.3-90.4%), respectively. In the external validation, ResNet152's sensitivity, specificity, PPV, NPV, and accuracy for neoplastic lesions were 88.3% (82.6-94.1%), 90.3% (83.0-97.7%), 94.6% (90.5-98.8%), 80.0% (70.6-89.4%), and 89.0% (84.5-93.6%), respectively. This diagnostic performance was superior to that of expert endoscopists. Area under the receiver-operating characteristic curve was 0.903 (0.860-0.946). CONCLUSIONS The developed AI system can help non-expert endoscopists make differential diagnoses of colorectal neoplasia on par with expert endoscopists during colonoscopy. (229/250 words).
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Affiliation(s)
- Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan ,Division of Medical AI Research and Development, National Cancer Center Research Institute, Tokyo, Japan
| | - Ryosaku Shino
- Biometrics Research Laboratories, NEC Corporation, Kawasaki, Kanagawa Japan
| | - Hiroko Kondo
- Division of Medical AI Research and Development, National Cancer Center Research Institute, Tokyo, Japan ,RIKEN Center for Advanced Intelligence Project, Cancer Translational Research Team, Tokyo, Japan
| | - Shigemi Yamada
- Division of Medical AI Research and Development, National Cancer Center Research Institute, Tokyo, Japan ,RIKEN Center for Advanced Intelligence Project, Cancer Translational Research Team, Tokyo, Japan
| | - Hiroyuki Takamaru
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Hitoshi Imaoka
- Biometrics Research Laboratories, NEC Corporation, Kawasaki, Kanagawa Japan
| | - Aya Kuchiba
- Biostatistics Division, National Cancer Center, Tokyo, Japan
| | - Taro Shibata
- Biostatistics Division, National Cancer Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan
| | - Ryuji Hamamoto
- Division of Medical AI Research and Development, National Cancer Center Research Institute, Tokyo, Japan ,RIKEN Center for Advanced Intelligence Project, Cancer Translational Research Team, Tokyo, Japan
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30
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Murakami D, Yamato M, Arai M, Nishino T. Artificial intelligence in colonoscopy. Lancet Gastroenterol Hepatol 2021; 6:984-985. [PMID: 34774156 DOI: 10.1016/s2468-1253(21)00379-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Daisuke Murakami
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, 276-8524, Japan; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan.
| | - Masayuki Yamato
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Makoto Arai
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, 276-8524, Japan
| | - Takayoshi Nishino
- Department of Gastroenterology, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, 276-8524, Japan
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31
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Reducing adenoma miss rate of colonoscopy assisted by artificial intelligence: a multicenter randomized controlled trial. J Gastroenterol 2021; 56:746-757. [PMID: 34218329 DOI: 10.1007/s00535-021-01808-w] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/27/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We have developed the computer-aided detection (CADe) system using an original deep learning algorithm based on a convolutional neural network for assisting endoscopists in detecting colorectal lesions during colonoscopy. The aim of this study was to clarify whether adenoma miss rate (AMR) could be reduced with CADe assistance during screening and surveillance colonoscopy. METHODS This study was a multicenter randomized controlled trial. Patients aged 40 to 80 years who were referred for colorectal screening or surveillance at four sites in Japan were randomly assigned at a 1:1 ratio to either the "standard colonoscopy (SC)-first group" or the "CADe-first group" to undergo a back-to-back tandem procedure. Tandem colonoscopies were performed on the same day for each participant by the same endoscopist in a preassigned order. All polyps detected in each pass were histopathologically diagnosed after biopsy or resection. RESULTS A total of 358 patients were enrolled and 179 patients were assigned to the SC-first group or CADe-first group. The AMR of the CADe-first group was significantly lower than that of the SC-first group (13.8% vs. 36.7%, P < 0.0001). Similar results were observed for the polyp miss rate (14.2% vs. 40.6%, P < 0.0001) and sessile serrated lesion miss rate (13.0% vs. 38.5%, P = 0.03). The adenoma detection rate of CADe-assisted colonoscopy was 64.5%, which was significantly higher than that of standard colonoscopy (53.6%; P = 0.036). CONCLUSION Our study results first showed a reduction in the AMR when assisting with CADe based on deep learning in a multicenter randomized controlled trial.
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32
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Sekiguchi M, Kakugawa Y, Takamaru H, Yamada M, Sakamoto T, Saito Y, Matsuda T. Risk of metachronous neoplastic lesions during post-polypectomy surveillance in individuals with advanced colorectal neoplasia at initial screening colonoscopy. J Gastroenterol Hepatol 2021; 36:2230-2238. [PMID: 33626598 DOI: 10.1111/jgh.15471] [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: 01/14/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM The evidence of associations between some types of advanced colorectal neoplasia (ACN) at baseline and the risk of metachronous neoplasia is inconsistent. This study aimed to elucidate the incidence of metachronous neoplasia during post-polypectomy surveillance in individuals with ACN at baseline and examine the risk factors for its high incidence. METHODS Data from individuals who underwent endoscopic resection for ACN and received surveillance colonoscopy were analyzed. Data from individuals with no neoplastic lesions at baseline were used as reference. The incidence of metachronous ACN and clinically significant neoplasia (ACN and nonadvanced adenomas sized ≥ 5 mm) were evaluated. Risk factors for the higher incidence of these lesions were examined in individuals with ACN at baseline. RESULTS During the median follow-up period of 61.8 months, metachronous ACN and nonadvanced adenomas sized ≥ 5 mm were detected in 9.6% and 32.4% of individuals with ACN at baseline (n = 136), respectively. The cumulative incidence of metachronous ACN and clinically significant neoplasia in individuals with ACN at baseline (3-year incidence: 5.5% and 16.9%, respectively) was higher than that in individuals with no neoplastic lesions at baseline (P < 0.01 for both). The presence of advanced histology at baseline, ≥ 5 neoplastic lesions at baseline, and family history of colorectal cancer were identified as risk factors for the higher incidence of clinically significant neoplasia. CONCLUSIONS The relatively high incidence of metachronous neoplasia in individuals with ACN at baseline was confirmed; careful surveillance is required for these individuals, particularly in those with the risk factors.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuo Kakugawa
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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