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van der Ende-van Loon M, Korteling D, Willekens H, Schilders M, Curvers W, Bisschops R, Schoon E, Terwee C. Dutch-Flemish translation and validation of the gastrointestinal symptom scales from the patient‑reported outcomes measurement information system (PROMIS) ®. J Patient Rep Outcomes 2023; 7:125. [PMID: 38032401 PMCID: PMC10689627 DOI: 10.1186/s41687-023-00662-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE To translate the eight PROMIS® GastrointestinaI Symptom Scales into Dutch-Flemish and to evaluate their psychometric properties. METHODS This study consisted of two parts: (1) translation according to the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology and (2) evaluation of psychometric properties: structural validity, using confirmatory factor analysis; and construct validity using hypothesis testing. RESULTS In the first part of the study, in 19 out of the 77 items (24.7%) translation was challenging. After discussion between the translators, consensus could be achieved. In the cognitive debriefing interview phase, ten minor changes in the wording of items were made. A universal Dutch-Flemish translation for all 77 items was obtained. In de second part of the study a good fit was found for three DF-PROMIS GI Scales: Bowel Incontinence, Gas and Bloating, and Belly Pain. Four scales (Reflux, Disrupted Swallowing, Diarrhea, and Constipation) did not show sufficient fit and fit for the Nausea and Vomiting scale could not be assessed because of skewed responses. Construct validity was considered sufficient for six out of eight DF-PROMIS GI Scales. Less than 75% of hypothesis for de Constipation and Disrupted Swallowing scales could be confirmed. CONCLUSION The PROMIS GI Symptom Scales were successfully translated into DutchFlemish. The findings suggest a sufficient structural validity for the PROMIS GI Scales. Bowel Incontinence, Gas and Bloating and Belly Pain. Construct validity was sufficient for the Scales Gas and Bloating, Incontinence, Nausea and Vomiting, Reflux, Belly Pain, and Diarrhea.
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Affiliation(s)
- Mirjam van der Ende-van Loon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
- GROW: School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Dorinde Korteling
- Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC Location, Emma Children's Hospital, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Child Development, Amsterdam, The Netherlands
- Amsterdam Public Health, Mental Health and Methodology, Amsterdam, The Netherlands
| | - Hilde Willekens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Monique Schilders
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Wouter Curvers
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- GROW: School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Caroline Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
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Thijssen A, Schreuder RMR, Fonollà R, van der Zander Q, Scheeve T, Winkens B, Subramaniam S, Bhandari P, de With P, Masclee A, van der Sommen F, Schoon E. Automatic textual description of colorectal polyp features: explainable artificial intelligence. Endosc Int Open 2023; 11:E513-E518. [PMID: 37206697 PMCID: PMC10191733 DOI: 10.1055/a-2071-6652] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/06/2023] [Indexed: 05/21/2023] Open
Abstract
Computer-aided diagnosis systems (CADx) can improve colorectal polyp (CRP) optical diagnosis. For integration into clinical practice, better understanding of artificial intelligence (AI) by endoscopists is needed. We aimed to develop an explainable AI CADx capable of automatically generating textual descriptions of CRPs. For training and testing of this CADx, textual descriptions of CRP size and features according to the Blue Light Imaging (BLI) Adenoma Serrated International Classification (BASIC) were used, describing CRP surface, pit pattern, and vessels. CADx was tested using BLI images of 55 CRPs. Reference descriptions with agreement by at least five out of six expert endoscopists were used as gold standard. CADx performance was analyzed by calculating agreement between the CADx generated descriptions and reference descriptions. CADx development for automatic textual description of CRP features succeeded. Gwet's AC1 values comparing the reference and generated descriptions per CRP feature were: size 0.496, surface-mucus 0.930, surface-regularity 0.926, surface-depression 0.940, pits-features 0.921, pits-type 0.957, pits-distribution 0.167, and vessels 0.778. CADx performance differed per CRP feature and was particularly high for surface descriptors while size and pits-distribution description need improvement. Explainable AI can help comprehend reasoning behind CADx diagnoses and therefore facilitate integration into clinical practice and increase trust in AI.
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Affiliation(s)
- Ayla Thijssen
- Maastricht University Medical Center, Division of Gastroenterology and Hepatology, Maastricht, Netherlands
- Maastricht University, GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | | | - Roger Fonollà
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Quirine van der Zander
- Maastricht University Medical Center, Division of Gastroenterology and Hepatology, Maastricht, Netherlands
- Maastricht University, GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | - Thom Scheeve
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Bjorn Winkens
- Maastricht University, Department of Methodology and Statistics, Maastricht, Netherlands
- Maastricht University, CAPHRI, Care and Public Health Research Institute
| | - Sharmila Subramaniam
- Portsmouth Hospitals University NHS Trust, Division of Gastroenterology and Hepatology, Portsmouth, United Kingdom
| | - Pradeep Bhandari
- Portsmouth Hospitals University NHS Trust, Division of Gastroenterology and Hepatology, Portsmouth, United Kingdom
| | - Peter de With
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Ad Masclee
- Maastricht University Medical Center, Division of Gastroenterology and Hepatology, Maastricht, Netherlands
| | - Fons van der Sommen
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Erik Schoon
- Maastricht University, GROW School for Oncology and Reproduction, Maastricht, Netherlands
- Catharina Hospital, Division of Gastroenterology and Hepatology, Eindhoven, Netherlands
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Thijssen A, Schreuder RM, Fonollà R, van der Zander Q, Scheeve T, Winkens B, Subramaniam S, Bhandari P, de With P, Masclee A, van der Sommen F, Schoon E. Erratum: Automatic textual description of colorectal polyp features: explainable artificial intelligence. Endosc Int Open 2023; 11:C3. [PMID: 37303584 PMCID: PMC10256434 DOI: 10.1055/a-2103-9750] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
[This corrects the article DOI: 10.1055/a-2071-6652.].
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Affiliation(s)
- Ayla Thijssen
- Maastricht University Medical Center, Division of Gastroenterology and Hepatology, Maastricht, Netherlands
- Maastricht University, GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | | | - Roger Fonollà
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Quirine van der Zander
- Maastricht University Medical Center, Division of Gastroenterology and Hepatology, Maastricht, Netherlands
- Maastricht University, GROW School for Oncology and Reproduction, Maastricht, Netherlands
| | - Thom Scheeve
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Bjorn Winkens
- Maastricht University, Department of Methodology and Statistics, Maastricht, Netherlands
- Maastricht University, CAPHRI, Care and Public Health Research Institute
| | - Sharmila Subramaniam
- Portsmouth Hospitals University NHS Trust, Division of Gastroenterology and Hepatology, Portsmouth, United Kingdom
| | - Pradeep Bhandari
- Portsmouth Hospitals University NHS Trust, Division of Gastroenterology and Hepatology, Portsmouth, United Kingdom
| | - Peter de With
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Ad Masclee
- Maastricht University Medical Center, Division of Gastroenterology and Hepatology, Maastricht, Netherlands
| | - Fons van der Sommen
- Eindhoven University of Technology, Department of Electrical Engineering, Eindhoven, Netherlands
| | - Erik Schoon
- Maastricht University, GROW School for Oncology and Reproduction, Maastricht, Netherlands
- Catharina Hospital, Division of Gastroenterology and Hepatology, Eindhoven, Netherlands
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van der Ende-van Loon M, Brouwers M, de Munnik S, Nieuwkerk P, Curvers W, Schoon E. Factors influencing health-related quality of life in patients with Barrett's esophagus: a qualitative focus group study. Eur J Gastroenterol Hepatol 2022; 34:161-167. [PMID: 33470701 DOI: 10.1097/meg.0000000000002070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Barrett's esophagus is a premalignant condition in the lower part of the esophagus, caused by gastroesophageal reflux disease. Previous studies found that having a Barrett's esophagus is associated with a significant decrease of health-related quality of life (HRQOL). Over the past decade, a considerable amount of literature has been published on the development of endoscopic treatment for (early) neoplasia in Barrett's esophagus. Though, currently very little is known about the impact of those endoscopic treatments on HRQOL from the perspective of patients. In this study, we aim to assess the factors influencing HRQOL according to Barrett's esophagus patients. METHODS By using a qualitative focus group design, patients with nondysplastic Barrett's esophagus and patients with a history of endoscopic treatment for Barrett's dysplasia were included. Data were analysed following the conventional content analyses approach. RESULTS A total of 34 patients participated in the four focus group sessions. Experiencing symptoms was valued as the most important factor in both groups. Other factors identified as important HRQOL influencers were: use of medication, fear of cancer and trust in physicians and endoscopic procedures. CONCLUSIONS In general, Barrett's esophagus patients experienced a good HRQOL, with a minimal emotional burden from the diagnosis of Barrett's esophagus. Most influencing factor on HRQOL was: experiencing reflux and dyspepsia symptoms. This study underlines the importance of adequate gastroesophageal reflux treatment and providing information to Barrett's esophagus patients, tailored to their personal needs.
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Affiliation(s)
| | | | - Suzanne de Munnik
- Department of Gastroenterology and Hepatology
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Erik Schoon
- Department of Gastroenterology and Hepatology
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Verhaegh P, Flink H, Daniels-Gooszen A, Huysentruyt C, Schoon E. A gastric ulcer: double trouble. Autops Case Rep 2022; 12:e2021376. [PMID: 35496735 PMCID: PMC9037888 DOI: 10.4322/acr.2021.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/31/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Pauline Verhaegh
- Maastricht University Medical Center, Division Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht, The Netherlands
- Catharina Hospital, Catharina Cancer Institute, Department of Gastroenterology and Hepatology, Eindhoven, The Netherlands
| | - Hajo Flink
- Catharina Hospital, Catharina Cancer Institute, Department of Gastroenterology and Hepatology, Eindhoven, The Netherlands
| | - Alette Daniels-Gooszen
- Catharina Hospital, Catharina Cancer Institute, Department of Radiology, Eindhoven, The Netherlands
| | - Clément Huysentruyt
- Catharina Hospital, Stichting PAMM, Laboratory of Pathology, Eindhoven, The Netherlands
| | - Erik Schoon
- Catharina Hospital, Catharina Cancer Institute, Department of Gastroenterology and Hepatology, Eindhoven, The Netherlands
- Maastricht University, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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Boers T, van der Putten J, Struyvenberg M, Fockens K, Jukema J, Schoon E, van der Sommen F, Bergman J, de With P. Improving Temporal Stability and Accuracy for Endoscopic Video Tissue Classification Using Recurrent Neural Networks. Sensors (Basel) 2020; 20:E4133. [PMID: 32722344 PMCID: PMC7436238 DOI: 10.3390/s20154133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/10/2023]
Abstract
Early Barrett's neoplasia are often missed due to subtle visual features and inexperience of the non-expert endoscopist with such lesions. While promising results have been reported on the automated detection of this type of early cancer in still endoscopic images, video-based detection using the temporal domain is still open. The temporally stable nature of video data in endoscopic examinations enables to develop a framework that can diagnose the imaged tissue class over time, thereby yielding a more robust and improved model for spatial predictions. We show that the introduction of Recurrent Neural Network nodes offers a more stable and accurate model for tissue classification, compared to classification on individual images. We have developed a customized Resnet18 feature extractor with four types of classifiers: Fully Connected (FC), Fully Connected with an averaging filter (FC Avg(n = 5)), Long Short Term Memory (LSTM) and a Gated Recurrent Unit (GRU). Experimental results are based on 82 pullback videos of the esophagus with 46 high-grade dysplasia patients. Our results demonstrate that the LSTM classifier outperforms the FC, FC Avg(n = 5) and GRU classifier with an average accuracy of 85.9% compared to 82.2%, 83.0% and 85.6%, respectively. The benefit of our novel implementation for endoscopic tissue classification is the inclusion of spatio-temporal information for improved and robust decision making, and it is the first step towards full temporal learning of esophageal cancer detection in endoscopic video.
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Affiliation(s)
- Tim Boers
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands; (J.v.d.P.); (F.v.d.S.); (P.d.W.)
| | - Joost van der Putten
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands; (J.v.d.P.); (F.v.d.S.); (P.d.W.)
| | - Maarten Struyvenberg
- Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (K.F.); (J.J.); (J.B.)
| | - Kiki Fockens
- Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (K.F.); (J.J.); (J.B.)
| | - Jelmer Jukema
- Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (K.F.); (J.J.); (J.B.)
| | - Erik Schoon
- Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands;
| | - Fons van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands; (J.v.d.P.); (F.v.d.S.); (P.d.W.)
| | - Jacques Bergman
- Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (K.F.); (J.J.); (J.B.)
| | - Peter de With
- Department of Electrical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE Eindhoven, The Netherlands; (J.v.d.P.); (F.v.d.S.); (P.d.W.)
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Subramaniam S, Kandiah K, Schoon E, Aepli P, Hayee B, Pischel A, Stefanovic M, Alkandari A, Coron E, Omae M, Baldaque-Silva F, Maselli R, Bisschops R, Sharma P, Repici A, Bhandari P. Development and validation of the international Blue Light Imaging for Barrett's Neoplasia Classification. Gastrointest Endosc 2020; 91:310-320. [PMID: 31586576 DOI: 10.1016/j.gie.2019.09.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 06/06/2019] [Accepted: 09/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Detecting subtle Barrett's neoplasia during surveillance endoscopy can be challenging. Blue-light imaging (BLI) is a novel advanced endoscopic technology with high-intensity contrast imaging that may improve the identification of Barrett's neoplasia. The aim of this study was to develop and validate the first classification to enable characterization of neoplastic and non-neoplastic Barrett's esophagus using BLI. METHODS In phase 1, descriptors pertaining to neoplastic and non-neoplastic Barrett's esophagus were identified to form the classification, named the Blue Light Imaging for Barrett's Neoplasia Classification (BLINC). Phase 2 involved validation of these component criteria by 10 expert endoscopists assessing 50 BLI images. In phase 3, a web-based training module was developed to enable 15 general (nonexpert) endoscopists to use BLINC. They then validated the classification with an image assessment exercise in phase 4, and their pre- and post-training results were compared. RESULTS In phase 1 the descriptors were grouped into color, pit, and vessel pattern categories to form the classification. In phase 2 the sensitivity of neoplasia identification was 96.0% with a very good level of agreement among the experts (κ = .83). In phase 3, 15 general endoscopists completed the training module. In phase 4 their pretraining sensitivity (85.3%) improved significantly to 95.7% post-training with a good level of agreement (κ = .67). CONCLUSIONS We developed and validated a new classification system (BLINC) for the optical diagnosis of Barrett's neoplasia using BLI. Despite the limitations of this image-based study with a high prevalence of neoplasia, we believe it has the potential to improve the optical diagnosis of Barrett's neoplasia given the high degree of sensitivity (96%) noted. It is also a promising tool for training in Barrett's esophagus optical diagnosis using BLI.
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Affiliation(s)
- Sharmila Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Kesavan Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Erik Schoon
- Department of Gastroenterology, Catharina Hospital, Eindhoven, Netherlands
| | - Patrick Aepli
- Department of Gastroenterology & Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland
| | - Bu' Hayee
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Andreas Pischel
- Department of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Asma Alkandari
- Department of Gastroenterology & Hepatology, Aljahra Hospital, Kuwait
| | - Emmanuel Coron
- Centre Hospitalier Universitaire & Faculté de Médecine de Nantes, Institut des Maladies de l'Appareil Digestif, France
| | - Masami Omae
- Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Roberta Maselli
- Digestive Endoscopy Unit, Humanitas Research Hospital, Milan, Italy
| | - Raf Bisschops
- Department of Gastroenterology & Hepatology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Prateek Sharma
- Department of Gastroenterology & Hepatology, Kansas University Medical Center, Kansas, USA
| | | | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom
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van der Putten J, van der Sommen F, de Groof J, Struyvenberg M, Zinger S, Curvers W, Schoon E, Bergman J, de With PHN. Modeling clinical assessor intervariability using deep hypersphere encoder–decoder networks. Neural Comput Appl 2019. [DOI: 10.1007/s00521-019-04607-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractIn medical imaging, a proper gold-standard ground truth as, e.g., annotated segmentations by assessors or experts is lacking or only scarcely available and suffers from large intervariability in those segmentations. Most state-of-the-art segmentation models do not take inter-observer variability into account and are fully deterministic in nature. In this work, we propose hypersphere encoder–decoder networks in combination with dynamic leaky ReLUs, as a new method to explicitly incorporate inter-observer variability into a segmentation model. With this model, we can then generate multiple proposals based on the inter-observer agreement. As a result, the output segmentations of the proposed model can be tuned to typical margins inherent to the ambiguity in the data. For experimental validation, we provide a proof of concept on a toy data set as well as show improved segmentation results on two medical data sets. The proposed method has several advantages over current state-of-the-art segmentation models such as interpretability in the uncertainty of segmentation borders. Experiments with a medical localization problem show that it offers improved biopsy localizations, which are on average 12% closer to the optimal biopsy location.
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Subramaniam S, Hayee B, Aepli P, Schoon E, Stefanovic M, Kandiah K, Thayalasekaran S, Alkandari A, Bassett P, Coron E, Pech O, Hassan C, Neumann H, Bisschops R, Repici A, Bhandari P. Optical diagnosis of colorectal polyps with Blue Light Imaging using a new international classification. United European Gastroenterol J 2019; 7:316-325. [PMID: 31080616 DOI: 10.1177/2050640618822402] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 10/01/2018] [Accepted: 11/21/2018] [Indexed: 12/27/2022] Open
Abstract
Background Blue Light Imaging (BLI) is a new imaging technology that enhances mucosal surface and vessel patterns. A specific BLI classification was recently developed to enable better characterisation of colorectal polyps (BLI Adenoma Serrated International Classification (BASIC)). The aim of this study was to validate the diagnostic performance of BASIC in predicting polyp histology in experienced and trainee endoscopists. Methods Five experienced and five trainee endoscopists evaluated high-definition white light (HDWL) and BLI images from 45 small polyps to assess baseline accuracy, sensitivity, specificity, and positive and negative predictive values (NPVs) of polyp histology. Each endoscopist was trained with the BLI classification before repeating the exercise. Results were compared pre- and post-training. Results The overall pre-training accuracy improved from 87% to 94%. The sensitivity and NPV of adenoma diagnosis also improved significantly from 79% to 96% and 81% to 95% with BASIC training. This improvement was noted in both groups. The interobserver level of agreement was very good (K = 0.90) in the experienced cohort and good (K = 0.66) in the trainee group post-training. Conclusions BLI is a useful tool for optical diagnosis, and the use of BASIC with adequate training can significantly improve the accuracy, sensitivity and NPV of adenoma diagnosis.
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Affiliation(s)
- Sharmila Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | - Bu Hayee
- Department of Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Aepli
- Department of Gastroenterology, Luzerner Kantonspittal, Lucerne, Switzerland
| | - Erik Schoon
- Department of Gastroenterology, Catharina Hospital, Eindhoven, the Netherlands
| | - Milan Stefanovic
- Department of Gastroenterology, Diagnostični center Bled, Ljubljana, Slovenia
| | - Kesavan Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | | | - Asma Alkandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
| | | | - Emmanuel Coron
- Centre Hospitalier Universitaire and Faculté de Médecine de Nantes, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St John of God Hospital, Regensburg, Bavaria, Germany
| | - Cesare Hassan
- Department of Gastroenterology, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Helmut Neumann
- Department of Medicine, University Hospital Erlangen, Germany
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Universitaire Ziekenhuizen Leuven, Belgium
| | | | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
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Valori R, Cortas G, de Lange T, Balfaqih OS, de Pater M, Eisendrath P, Falt P, Koruk I, Ono A, Rustemović N, Schoon E, Veitch A, Senore C, Bellisario C, Minozzi S, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Spada C, Bisschops R, Rutter M. Performance measures for endoscopy services: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2018; 50:1186-1204. [PMID: 30423593 DOI: 10.1055/a-0755-7515] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 12/13/2022]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.
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Affiliation(s)
- Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - George Cortas
- University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Thomas de Lange
- Department of Transplantation, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Omer Salem Balfaqih
- Thamar University, Medical College, Dhamar; and Hadramout University, Medical College, Mukalla, Yemen
| | - Marjon de Pater
- Department of Gastroenterology Endoscopy, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Pierre Eisendrath
- Hepatogastroenterology department, CHU Saint-Pierre, Université libre de Bruxelles, Brussels, Belgium
| | - Premysl Falt
- University Hospital Olomouc, and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Irfan Koruk
- Department of Gastroenterology, Istanbul Bilim University Medical School, Istanbul, Turkey
| | - Akiko Ono
- Unidad de Endoscopia Digestiva, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Nadan Rustemović
- GI Endoscopy Unit, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cathy Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education and Department of Gastroenterological Oncology; and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center, and Institute of Oncology, Warsaw, Poland; and Department of Health Management and Health Economics, University of Oslo, Norway
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia; and Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology. University Hospital Leuven, Leuven, Belgium
| | - Mathew Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK.,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
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11
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Valori R, Cortas G, de Lange T, Salem Balfaqih O, de Pater M, Eisendrath P, Falt P, Koruk I, Ono A, Rustemović N, Schoon E, Veitch A, Senore C, Bellisario C, Minozzi S, Bennett C, Bretthauer M, Dinis-Ribeiro M, Domagk D, Hassan C, Kaminski MF, Rees CJ, Spada C, Bisschops R, Rutter M. Performance measures for endoscopy services: A European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2018; 7:21-44. [PMID: 30788114 DOI: 10.1177/2050640618810242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 10/02/2018] [Accepted: 10/07/2018] [Indexed: 12/18/2022] Open
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a list of key performance measures for endoscopy services. We recommend that these performance measures be adopted by all endoscopy services across Europe. The measures include those related to the leadership, organization, and delivery of the service, as well as those associated with the patient journey. Each measure includes a recommendation for a minimum and target standard for endoscopy services to achieve. We recommend that all stakeholders in endoscopy take note of these ESGE endoscopy services performance measures to accelerate their adoption and implementation. Stakeholders include patients and their advocacy groups; service leaders; staff, including endoscopists; professional societies; payers; and regulators.
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Affiliation(s)
- Roland Valori
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire, UK
| | - George Cortas
- University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Thomas de Lange
- Department of Transplantation, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Omer Salem Balfaqih
- Thamar University, Medical College, Dhamar; and Hadramout University, Medical College, Mukalla, Yemen
| | - Marjon de Pater
- Dept. of Gastroenterology Endoscopy, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Pierre Eisendrath
- Hepato-Gastroenterology department, CHU Saint-Pierre, Université libre de Bruxelles, Brussels, Belgium
| | - Premysl Falt
- University Hospital Olomouc, and Faculty of Medicine, Palacky University, Olomouc, Czech Republic; and Faculty of Medicine, Charles University, Hradec Kralove, Czech Republic
| | - Irfan Koruk
- Department of Gastroenterology, Istanbul Bilim University Medical School, Istanbul, Turkey
| | - Akiko Ono
- Unidad de Endoscopia Digestiva, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Nadan Rustemović
- GI Endoscopy Unit, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Andrew Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Carlo Senore
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza, Turin, Italy
| | - Cathy Bennett
- Office of Research and Innovation, Royal College of Surgeons in Ireland, Coláiste Ríoga na Máinleá in Éirinn, Dublin, Ireland
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Servicio de Gastroenterologia, Instituto Portugues de Oncologia Francisco Gentil, Porto, Portugal
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education and Department of Gastroenterological Oncology; and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center, and Institute of Oncology, Warsaw, Poland; and Department of Health Management and Health Economics, University of Oslo, Norway
| | - Colin J Rees
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia; and Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Mathew Rutter
- Northern Institute for Cancer Research, Newcastle University, Newcastle, UK.,Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
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12
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Bisschops R, Bessissow T, Dekker E, East JE, Para-Blanco A, Ragunath K, Bhandari P, Rutter M, Schoon E, Wilson A, John JM, Van Steen K, Baert F, Ferrante M. Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis. Gastrointest Endosc 2017; 86:1100-1106.e1. [PMID: 28986266 DOI: 10.1016/j.gie.2017.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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] [Received: 06/01/2017] [Accepted: 09/22/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with longstanding ulcerative colitis (UC) are at increased risk of developing colorectal neoplasia. Chromoendoscopy (CE) increases detection of lesions, and Kudo pit pattern classification I and II have been suggested to be predictive of benign polyps in UC. Little is known on the use of this classification in nonmagnified high-definition (HD) (virtual) CE and narrow-band Imaging (NBI) or on the interobserver agreement. The aim of this pilot study was to assess the diagnostic accuracy and the interobserver agreement of the Kudo pit pattern classification in UC patients undergoing surveillance with methylene blue CE or NBI in a multicenter study. METHODS Fifty images of lesions identified in 27 UC patients (13 neoplastic) either with classical CE (methylene blue .1%; n = 24) or NBI (n = 26) were selected by an independent investigator. Images were selected from a randomized controlled trial to compare CE and NBI. All nonmagnified images were obtained with a processor and mounted in a PowerPoint file in a standardized way (same size; black background). Ten endoscopists with extensive experience in NBI/CE were asked to assess the lesions for the predominant Kudo pit pattern (I, II, IIIL, IIIS, IV, and V) to indicate if they believed the lesion was neoplastic and how confident they were about the diagnosis. Histology was used as the criterion standard. RESULTS Median sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing neoplasia based on the presence of pit pattern other than I or II was 77%, 68%, 88%, and 46%, respectively. Diagnostic accuracy was significantly higher when a diagnosis was made with a high level of confidence (77% vs 21%, P < .001). The overall interobserver agreement for any pit pattern was only fair (κ = .282), with CE being significantly better than NBI (.322 vs .224, P < .001). From a clinical viewpoint the difference between neoplastic and non-neoplastic lesions is important. The agreement for differentiation between non-neoplastic patterns (I, II) and neoplastic patterns (IIIL, IIIS, IV, or V) was moderate (κ = .587) and even significantly better for NBI in comparison with CE (κ = .653 vs .495, P < .001). CONCLUSIONS Differentiation between non-neoplastic and neoplastic pit patterns in UC lesions shows a moderate to substantial agreement among expert endoscopists. The agreement for differentiating neoplastic from non-neoplastic lesions is significantly better for NBI in comparison with HD CE. The assessment of pit pattern I or II with nonmagnified HD CE or NBI has a high negative predictive value to rule out neoplasia. (Clinical trial registration number: NCT01882205.).
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Affiliation(s)
- Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Talat Bessissow
- Division of Gastroenterology, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Adolfo Para-Blanco
- NIHR Nottingham Digestive Diseases Biomedical Research Unit City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Pradeep Bhandari
- Department of Gastroenterology, Spire Portsmouth Hospital, Portsmouth, United Kingdom
| | - Matt Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, United Kingdom, and School of Medicine, Durham University, Durham, United Kingdom
| | - Erik Schoon
- Department of Gastroenterology, Catherina Hospital, Eindhoven, The Netherlands
| | - Ana Wilson
- Wolfson Unit for Endoscopy, St. Mark's Hospital, London, United Kingdom
| | | | - Kristel Van Steen
- Medical Genomics Unit, BIO3, GIGA-R, University of Liège, Liège, Belgium
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
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13
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Schoon E. Eradication of Barrett's neoplasia: endoscopy vs. laparoscopy. Endoscopy 2017; 49:629-630. [PMID: 28658689 DOI: 10.1055/s-0043-109020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Erik Schoon
- Gastroenterology and Hepatology, Catharina Ziekenhuis, Eindhoven, The Netherlands
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14
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Curvers WL, van Vilsteren FG, Baak LC, Böhmer C, Mallant-Hent RC, Naber AH, van Oijen A, Ponsioen CY, Scholten P, Schenk E, Schoon E, Seldenrijk CA, Meijer GA, ten Kate FJ, Bergman JJ. Endoscopic trimodal imaging versus standard video endoscopy for detection of early Barrett's neoplasia: a multicenter, randomized, crossover study in general practice. Gastrointest Endosc 2011; 73:195-203. [PMID: 21168835 DOI: 10.1016/j.gie.2010.10.014] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [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] [Received: 08/31/2010] [Accepted: 10/08/2010] [Indexed: 12/24/2022]
Abstract
BACKGROUND Endoscopic trimodal imaging (ETMI) may improve detection of early neoplasia in Barrett's esophagus (BE). Studies with ETMI so far have been performed in tertiary referral settings only. OBJECTIVE To compare ETMI with standard video endoscopy (SVE) for the detection of neoplasia in BE patients with an intermediate-risk profile. DESIGN Multicenter, randomized, crossover study. SETTING Community practice. PATIENTS AND METHODS BE patients with confirmed low-grade intraepithelial neoplasia (LGIN) underwent both ETMI and SVE in random order (interval 6-16 weeks). During ETMI, BE was inspected with high-resolution endoscopy followed by autofluorescence imaging (AFI). All visible lesions were then inspected with narrow-band imaging. During ETMI and SVE, visible lesions were sampled followed by 4-quadrant random biopsies every 2 cm. MAIN OUTCOME MEASUREMENTS Overall histological yield of ETMI and SVE and targeted histological yield of ETMI and SVE. RESULTS A total of 99 patients (79 men, 63±10 years) underwent both procedures. ETMI had a significantly higher targeted histological yield because of additional detection of 22 lesions with LGIN/high-grade intraepithelial neoplasia (HGIN)/carcinoma (Ca) by AFI. There was no significant difference in the overall histological yield (targeted+random) between ETMI and SVE. HGIN/Ca was diagnosed only by random biopsies in 6 of 24 patients and 7 of 24 patients, with ETMI and SVE, respectively. LIMITATIONS Inspection, with high-resolution endoscopy and AFI, was performed sequentially. CONCLUSION ETMI performed in a community-based setting did not improve the overall detection of dysplasia compared with SVE. The diagnosis of dysplasia is still being made in a significant number of patients by random biopsies. Patients with a confirmed diagnosis of LGIN have a significant risk of HGIN/Ca. ( CLINICAL TRIAL REGISTRATION NUMBER ISRCTN91816824; NTR867.).
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Affiliation(s)
- Wouter L Curvers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
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15
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De Ridder R, Schoon E, Koek G. The effect of bariatric surgery on liver histology. Dig Dis Sci 2007; 52:3532. [PMID: 17417729 PMCID: PMC2071957 DOI: 10.1007/s10620-006-9369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 03/28/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Rogier De Ridder
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, P.O. Box 5800, Maastrict, 6221VA the Netherlands
| | - Erik Schoon
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, P.O. Box 5800, Maastrict, 6221VA the Netherlands
| | - Ger Koek
- Department of Gastroenterology and Hepatology, University Hospital Maastricht, P.O. Box 5800, Maastrict, 6221VA the Netherlands
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16
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Ryan BM, Russel MGVM, Schurgers L, Wichers M, Sijbrandij J, Stockbrugger RW, Schoon E. Effect of antitumour necrosis factor-alpha therapy on bone turnover in patients with active Crohn's disease: a prospective study. Aliment Pharmacol Ther 2004; 20:851-7. [PMID: 15479356 DOI: 10.1111/j.1365-2036.2004.02097.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Patients with Crohn's disease are at increased risk of osteoporosis. Disease activity and circulating proinflammatory cytokines are thought to play a role in this process. Infliximab, a chimaeric antitumour necrosis factor-alpha antibody is effective in the treatment of Crohn's disease. The aim of this study was to investigate the impact of treatment with infliximab on bone turnover in Crohn's disease patients. METHODS This was a prospective trial. Twenty-four patients with active Crohn's disease were treated with infliximab (5 mg/kg). Bone markers were assayed pre- and post-treatment. Bone formation was measured using serum bone-specific alkaline phosphatase and total osteocalcin and bone resorption using serum N-telopeptide cross-linked type 1 collagen. RESULTS Infliximab therapy caused a significant increase in both markers of bone formation in patients with active Crohn's disease. No significant change in the bone resorption marker serum N-telopeptide cross-linked type 1 was found. CONCLUSION Infliximab therapy had a significant beneficial effect on bone metabolism in patients with active Crohn's disease. These findings further support the theory that active ongoing inflammation and high levels of circulating cytokines play a pivotal role in the pathogenesis of bone loss in patients with Crohn's disease.
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Affiliation(s)
- B M Ryan
- Department of Gastroenterology, Manchester Royal Infirmary, Manchester, UK.
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17
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Abstract
Osteoporosis is one of the systemic effects associated with chronic obstructive pulmonary disease (COPD). Potential risk factors of osteoporosis may be due to the lifestyle, genetics, treatment with corticosteroids, endocrine abnormalities or the impairment of the body composition and peripheral skeletal muscles. Evidence for the possible contribution of such factors is reviewed. The occurrence of fractures, as a consequence of osteoporosis, can contribute to the disability and mortality of patients with COPD and add to the economic burden of the disease. The treatment with corticosteroids for the lung disease is associated with increased prevalence of fractures, but other factors may contribute. There is a remarkable paucity of interventional studies targeting the osteoporosis in patients with COPD. The results of studies on the treatment of osteoporosis in chronic lung diseases, some including small numbers of patients with COPD, are reviewed in the paper. Prospective longitudinal studies on the incidence of osteoporosis in chronic obstructive pulmonary disease need to assess patients with various degrees of disease severity and investigate the possible contribution of etiological factors. Randomised placebo-controlled trials are required to assess the effect of intervention, such as bisphosphonates, hormone replacement, calcium supplementation, on the prevention and treatment of osteoporosis and fractures in chronic obstructive pulmonary disease.
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Affiliation(s)
- A A Ionescu
- Section of Respiratory and Communicable Diseases, Dept of Medicine, University of Wales, College of Medicine, Llandough Hospital, Penarth, Wales, UK.
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18
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Leenen LP, Schoon E, Stuifbergen W, van der Werken C. [Surgical treatment of toxic megacolon]. Ned Tijdschr Geneeskd 1991; 135:992-6. [PMID: 2062396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
From 1978 to 1989, 11 patients suffering from toxic megacolon were treated. In eight patients it was based on ulcerative colitis, while Crohns' disease, infectious colitis and pseudomembranous colitis were seen once each. Patients were initially treated with intravenous fluids and corticosteroids. They were closely followed both clinically and radiologically. The plain abdominal X-ray was of great help. Conservative regimen was successful in 3 patients, the remaining had to be operated on in due course. Three patients proved to have a perforation of the bowel at the time of operation. The initial operations performed were one proctocolectomy, four times a subtotal colectomy, twice a partial colectomy and in one instance a diverting colostomy. Two patients had to undergo an additional colon resection. Postoperative complications consisted mainly of intra-abdominal abscesses. Two of the operated patients died. Follow-up is between 2 and 9 years. None of the patients had a recurrence of the toxic megacolon. Four patients had a recurrence of their underlying disease, which however could be resolved in most cases by medical means. In one patient total colectomy is being considered.
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Affiliation(s)
- L P Leenen
- Afd. Heelkunde, Sint Elisabeth Ziekenhuis, Tilburg
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