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Popescu Crainic I, Djinbachian R, Rex DK, Barkun A, Shaukat A, East J, Hassan C, Mori Y, Pohl H, Rastogi A, Sharma P, Anderson JC, Taghiakbari M, Medawar E, von Renteln D. Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study. Scand J Gastroenterol 2024; 59:608-614. [PMID: 38333956 DOI: 10.1080/00365521.2024.2308519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND AIMS Accurate polyp size estimation during colonoscopy has an impact on clinical decision-making. A laser-based virtual scale endoscope (VSE) is available to allow measuring polyp size using a virtual adaptive scale. This study evaluates video-based polyp size measurement accuracy among expert endoscopists using either VSE or visual assessment (VA) with either snare as reference size or without any reference size information. METHODS A prospective, video-based study was conducted with 10 expert endoscopists. Video sequences from 90 polyps with known reference size (fresh specimen measured using calipers) were distributed on three different slide sets so that each slide set showed the same polyp only once with either VSE, VA or snare-based information. A slide set was randomly assigned to each endoscopist. Endoscopists were asked to provide size estimation based on video review. RESULTS Relative accuracies for VSE, VA, and snare-based estimation were 75.1% (95% CI [71.6-78.5]), 65.0% (95% CI [59.5-70.4]) and 62.0% (95% CI [54.8-69.0]), respectively. VSE yielded significantly higher relative accuracy compared to VA (p = 0.002) and to snare (p = 0.001). A significantly lower percentage of polyps 1-5 mm were misclassified as >5 mm using VSE versus VA and snare (6.52% vs. 19.6% and 17.5%, p = 0.004) and a significantly lower percentage of polyps >5 mm were misclassified as 1-5 mm using VSE versus VA and snare (11.4% vs. 31.9% and 14.9%, p = 0.038). CONCLUSIONS Endoscopists estimate polyp size with the highest accuracy when virtual adaptive scale information is displayed. Using a snare to assist sizing did not improve measurement accuracy compared to displaying visual information alone.
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Affiliation(s)
- Ioana Popescu Crainic
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Roupen Djinbachian
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, IN University Medical Center, Indianapolis, Indiana, USA
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Québec, Canada
| | - Aasma Shaukat
- Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York City, New York, USA
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK
- Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Cesare Hassan
- Division of Gastroenterology, Regina Margherita Hospital, Rome, Italy
| | - Yuichi Mori
- Division of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Heiko Pohl
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Division of Gastroenterology, White River Junction Veteran Affairs Medical Center, White River Junction, Vermont, USA
| | - Amit Rastogi
- Division of Gastroenterology, University of KS School of Medicine, Kansas City, Kansas, USA
| | - Prateek Sharma
- Division of Gastroenterology, University of KS School of Medicine, Kansas City, Kansas, USA
- Division of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Joseph C Anderson
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mahsa Taghiakbari
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Edgard Medawar
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
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Medawar E, Djinbachian R, Taghiakbari M, Khoury T, Zoughlami A, Zarandi-Nowroozi M, Safih W, von Renteln D. Large serrated polyps indicate a greater risk of advanced metachronous colorectal neoplasia than high-grade adenomas. Endosc Int Open 2023; 11:E849-E858. [PMID: 37942445 PMCID: PMC10629496 DOI: 10.1055/a-2124-9788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/04/2023] [Indexed: 11/10/2023] Open
Abstract
Background and study aims The risk of developing total metachronous advanced neoplasia (TMAN) in patients with index serrated lesions (SL) or adenoma with high-grade dysplasia (HGD) is unknown. We evaluated this risk in patients with either HGD, SL < 10 mm or SL ≥ 10 mm at index colonoscopy, who underwent surveillance colonoscopies. Patients and methods This retrospective cohort study evaluated all consecutive patients (n = 2477) diagnosed between 2010 and 2019 with colorectal HGD, SLs < 10 mm or SLs ≥ 10 mm. We excluded patients aged < 45 or > 75 years or those who had inflammatory bowel disease, hereditary colorectal cancer (CRC) syndromes, previous or synchronous CRC, or no follow-up colonoscopy. Descriptive variables were compared using analysis of variance or Pearson chi-squared tests. Multivariate Cox regressions were used to compare the risk of TMAN between the HGD, SL < 10 mm and SL ≥ 10 mm groups. Results Overall, 585 patients (mean age 63 years; 55% male; mean follow-up 3.67 years) were included (226 with SLs < 10 mm, 204 with SLs ≥ 10 mm, 155 with HGD). Compared with SLs < 10 mm, patients with HGD did not have a significantly different rate of TMAN (HR=0.75 [0.39-1.44]) and patients with SLs ≥ 10 mm had a higher rate of TMAN (HR=2.08 [1.38-3.15]). Compared with HGD, patients with SLs ≥ 10 mm had a higher rate of TMAN (HR=1.87 [1.04-3.36]). Conclusions The risk for TMAN was higher for patients with SLs ≥ 10 mm than with HGD or SLs < 10 mm. This risk should be considered when planning surveillance intervals for patients diagnosed with large SLs.
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Affiliation(s)
- Edgard Medawar
- Department of Medicine, University of Ottawa, Ottawa, Canada
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Roupen Djinbachian
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
- Division of Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada
| | - Mahsa Taghiakbari
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Tommy Khoury
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
| | | | - Melissa Zarandi-Nowroozi
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
- Division of Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada
| | - Widad Safih
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Daniel von Renteln
- University of Montreal Hospital Research Centre, University of Montreal, Montreal, Canada
- Division of Gastroenterology, University of Montreal Hospital Centre, Montreal, Canada
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Djinbachian R, Lafontaine ML, Dufault T, Medawar E, Boivin M, Bouin M, von Renteln D. Rates of synchronous advanced neoplasia and colorectal cancer in patients with colonic serrated lesions. Surg Endosc 2023:10.1007/s00464-023-09974-z. [PMID: 36944739 DOI: 10.1007/s00464-023-09974-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS Serrated lesions (SL) have been associated with significant risks of developing colorectal cancer (CRC). Data on synchronous findings after SL detection during colonoscopy is limited. Study aim was to evaluate the rate of synchronous advanced neoplasia (S-AN) and synchronous CRC (S-CRC) in colonoscopies where SLs were detected. METHODS We conducted a retrospective study of screening aged patients 45-74year with colorectal SL (sessile serrated polyp [SSP] or traditional serrated adenoma [TSA]) detected during an elective colonoscopy. Primary outcome was risk of S-AN in patients with SL. Secondary outcomes included risk of S-AN or S-CRC stratified by SL characteristics. RESULTS The study included 1262 patients with 1649 SLs (1214 with SSPs and 48 with TSAs). 47.2% were female and 22.9% of exams were screening colonoscopies, 48.2% surveillance, 28.9% diagnostic. The overall rates of S-AN and S-CRC were 15.1% and 1.3%, respectively. Presence of SSPs ≥ 10 mm was associated with higher rates of S-AN, (18.1 vs. 12.2%, Odds-Ratio [OR] = 1.61 [95% Confidence Interval [CI] 1.17-2.23], p = 0.004). SSP dysplasia was predictive of S-AN, (30.3 vs 14.1%, OR = 2.68 [95%CI 1.24-5.78], p = 0.012) but not S-CRC. SSP number (≥ 3) and location (proximal) were not predictors of S-AN or S-CRC. CONCLUSION Patients with SLs are at high-risk of S-AN and S-CRC. Findings of SSPs ≥ 10 mm and SSP dysplasia are associated with high-risk of S-AN. Endoscopists should exercise heightened vigilance for synchronous findings when SLs are detected, especially SSPs ≥ 10 mm or when bowel preparation is suboptimal. Studies contrasting synchronous risk of other polyp types are needed to confirm these results.
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Affiliation(s)
- Roupen Djinbachian
- Division of Gastroenterology, Department of Medicine, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | | | - Talia Dufault
- Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Edgard Medawar
- Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Michel Boivin
- Division of Gastroenterology, Department of Medicine, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Mickael Bouin
- Division of Gastroenterology, Department of Medicine, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, Department of Medicine, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada.
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Medawar E, Djinbachian R, Popescu Crainic I, Lakatos P, Barkun A, Bernard EJ, von Renteln D. A159 RISK OF TOTAL METACHRONOUS ADVANCED NEOPLASIA IN PATIENTS WITH SERRATED LESIONS AND INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991300 DOI: 10.1093/jcag/gwac036.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background The risk of total metachronous advanced neoplasia (TMAN) in patients with serrated lesions (SL) and IBD is unknown. It is also unclear whether colonic inflammation in IBD contributes to serrated neoplasia. Purpose Study aim was to compare the risk of TMAN at surveillance colonoscopies in patients with SL and IBD to patients with SL without IBD. We also sought to compare IBD severity in patients with IBD and SL in a colonic area involved with IBD (SL-IA) to patients with IBD and SL in an uninvolved area (SL-UA). Method A cohort study was conducted. Through pathology database search, we identified 2428 patients with endoscopically resected SL, defined as sessile serrated lesion (SSL), traditional serrated adenoma (TSA) or IBD and serrated epithelial change (SEC), between 2010 and 2019 at the University of Montreal Hospital Center. We included patients aged 45-75 without polyposis syndromes and excluded patients with a history of CRC, first surveillance <12 months after complete index, sigmoidoscopy at index, or no follow-up. Patient files were reviewed for demographic data, IBD severity, and findings at index and follow-up. Follow-up was continued until TMAN or last colonoscopy within 10 years. Primary outcome was the risk of TMAN (defined as advanced adenoma (AA), advanced serrated lesion (ASL) or CRC) in a surveillance colonoscopy within 10 years from index. Secondary outcomes were the risk of metachronous AA and ASL, and IBD severity in SL-IA and SL-UA. Continuous and categorical variables were compared using the student t, Pearson’s chi-squared, or Mann-Whitney tests. We performed univariate and multivariate Cox regressions, with hazard ratios (HR) and 95% confidence intervals. Result(s) In the metachronous outcomes analysis, 440 patients with SL (mean age 61.8 y., 51.6% male, 424 SSL, 16 TSA) were eligible, and 37 with SL and IBD were eligible (mean age 60.9 y., 54.1% male, 30 SSL, 6 SEC, 1 TSA). Compared to patients without IBD, IBD patients were less likely to have synchronous adenomas (16.2% vs 41.6%, p<0.05), had less SLs ≥10 mm (24.3% vs 46.8%, p<0.05), and had a similar risk of metachronous TMAN (HR=0.92 [0.44–1.90]), AA (HR=0.53 [0.13–2.12]) and ASL (HR=1.03 [0.44–2.41]). In the comparison of SL-UA and SL-IA, 56 patients with IBD were eligible, with 21 having SL-UA (mean age 62.0 y., 42.9% male, 19 SSL, 1 TSA, 1 SEC) and 35 having SL-IA (mean age 60.8 y., 62.9% male, 27 SSL, 1 TSA and 8 SEC). Both groups had similar time intervals between IBD diagnosis and SL diagnosis (p>0.05), and similar maximal therapeutic maintenance steps (p>0.05), as well as Mayo/SES-CD scores, serum C-reactive protein, hemoglobin, and albumin, and fecal calprotectin values at index and last colonoscopy (p>0.05). Conclusion(s) Patients with SL and IBD are not at higher risk of total metachronous advanced neoplasia than patients with SL and no IBD. SLs in IBD should be considered sporadic and undergo endoscopic resection and follow-up similar to non-IBD patients. Please acknowledge all funding agencies by checking the applicable boxes below CIHR, Other Please indicate your source of funding; Fonds de Recherche du Québec en Santé Disclosure of Interest None Declared
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Affiliation(s)
- E Medawar
- Université de Montréal, Montreal,University of Ottawa, Ottawa
| | | | | | | | - A Barkun
- McGill University, Montreal, Canada
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Brecht AK, Medawar E, Thieleking R, Sacher J, Beyer F, Villringer A, Witte AV. Dietary and serum tyrosine, white matter microstructure and inter-individual variability in executive functions in overweight adults: Relation to sex/gender and age. Appetite 2022; 178:106093. [PMID: 35738483 DOI: 10.1016/j.appet.2022.106093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 11/02/2022]
Abstract
Tyrosine (tyr), the precursor of the neurotransmitter dopamine, is known to modulate cognitive functions including executive attention. Tyr supplementation is suggested to influence dopamine-modulated cognitive performance. However, results are inconclusive regarding the presence or strength and also the direction of the association between tyr and cognitive function. This pre-registered cross-sectional analysis investigates whether diet-associated serum tyr relates to executive attention performance, and whether this relationship is moderated by differences in white matter microstructure. 59 healthy, overweight, young to middle-aged adults (20 female, 28.3 ± 6.6 years, BMI: 27.3 ± 1.5 kg/m2) drawn from a longitudinal study reported dietary habits, donated blood and completed diffusion-weighted brain magnetic resonance imaging and the attention network test. Main analyses were performed using linear regressions and non-parametric voxel-wise inference testing. Confirmatory analyses did neither support an association between dietary and serum tyr nor a relationship between relative serum tyr/large neutral amino acids (LNAA) levels or white matter microstructure and executive attention performance. However, exploratory analyses revealed higher tyr intake, higher serum tyr and better executive attention performance in the male sex/gender group. In addition, older age was associated with higher dietary tyr intake and lower fractional anisotropy in a widespread cluster across the brain. Finally, a positive association between relative serum tyr/LNAA and executive attention performance was found in the male sex/gender group when accounting for age effects. Our analysis advances the field of dopamine-modulated cognitive functions by revealing sex/gender and age differences which might be diet-related. Longitudinal or intervention studies and larger sample sizes are needed to provide more reliable evidence for links between tyr and executive attention.
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Affiliation(s)
- A-K Brecht
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - E Medawar
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - R Thieleking
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - J Sacher
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Cognitive Neurology, University Medical Center Leipzig, Germany
| | - F Beyer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Cognitive Neurology, University Medical Center Leipzig, Germany
| | - A Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Cognitive Neurology, University Medical Center Leipzig, Germany
| | - A V Witte
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Cognitive Neurology, University Medical Center Leipzig, Germany.
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Crevier-Sorbo G, Brunette-Clément T, Medawar E, Mathieu F, Morgan BR, Hachem LD, Dewan MC, Fallah A, Weil AG, Ibrahim GM. A needs assessment of pediatric epilepsy surgery in Haiti. J Neurosurg Pediatr 2020; 27:189-195. [PMID: 33254133 DOI: 10.3171/2020.7.peds20256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy disproportionately affects low- and/or middle-income countries (LMICs). Surgical treatments for epilepsy are potentially curative and cost-effective and may improve quality of life and reduce social stigmas. In the current study, the authors estimate the potential need for a surgical epilepsy program in Haiti by applying contemporary epilepsy surgery referral guidelines to a population of children assessed at the Clinique d'Épilepsie de Port-au-Prince (CLIDEP). METHODS The authors reviewed 812 pediatric patient records from the CLIDEP, the only pediatric epilepsy referral center in Haiti. Clinical covariates and seizure outcomes were extracted from digitized charts. Electroencephalography (EEG) and neuroimaging reports were further analyzed to determine the prevalence of focal epilepsy or surgically amenable syndromes and to assess the lesional causes of epilepsy in Haiti. Lastly, the toolsforepilepsy instrument was applied to determine the proportion of patients who met the criteria for epilepsy surgery referral. RESULTS Two-thirds of the patients at CLIDEP (543/812) were determined to have epilepsy based on clinical and diagnostic evaluations. Most of them (82%, 444/543) had been evaluated with interictal EEG, 88% of whom (391/444) had abnormal findings. The most common finding was a unilateral focal abnormality (32%, 125/391). Neuroimaging, a prerequisite for applying the epilepsy surgery referral criteria, had been performed in only 58 patients in the entire CLIDEP cohort, 39 of whom were eventually diagnosed with epilepsy. Two-thirds (26/39) of those patients had abnormal findings on neuroimaging. Most patients (55%, 18/33) assessed with the toolsforepilepsy application met the criteria for epilepsy surgery referral. CONCLUSIONS The authors' findings suggest that many children with epilepsy in Haiti could benefit from being evaluated at a center with the capacity to perform basic brain imaging and neurosurgical treatments.
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Affiliation(s)
| | | | - Edgard Medawar
- 1Faculty of Medicine, McGill University, Montreal, Quebec
| | - Francois Mathieu
- 3Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | | | - Laureen D Hachem
- 3Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario
| | - Michael C Dewan
- 7Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario
| | - Aria Fallah
- 5Department of Neurosurgery, UCLA Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Alexander G Weil
- 2Faculty of Medicine, University of Montreal, Quebec.,6Division of Neurosurgery, Sainte-Justine Hospital, Montreal, Quebec
| | - George M Ibrahim
- 3Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario.,7Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario.,8Institute of Biomaterials and Biomedical Engineering, University of Toronto, Ontario; and.,9Institute of Medical Science, University of Toronto, Ontario, Canada
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