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Ortiz O, Daca-Alvarez M, Rivero-Sánchez L, Saez De Gordoa K, Moreira R, Cuatrecasas M, Balaguer F, Pellisé M. Linked-color imaging versus high definition white-light endoscopy for evaluation of post-polypectomy scars of nonpedunculated lesions: LCI-Scar study. Endoscopy 2024; 56:283-290. [PMID: 37931908 DOI: 10.1055/a-2204-3236] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Detection and treatment of recurrence after piecemeal endoscopic mucosal resection of nonpedunculated colorectal polyps are crucial for avoidance of post-colonoscopy cancer. Linked-color imaging (LCI) has demonstrated improved polyp detection but has never been assessed for evaluation of post-polypectomy scars. Our aim was to compare sensitivity and negative predictive value (NPV) between LCI and white-light endoscopy (WLE) for detection of post-polypectomy recurrence. METHODS Patients undergoing surveillance colonoscopy after resection of lesions ≥15 mm were included in this prospective, single-center, randomized, crossover study. Each post-polypectomy scar underwent two examinations, one with LCI and the other with WLE, performed by two blinded endoscopists. Blue-light imaging (BLI) was then applied. A diagnosis of recurrence with a level of confidence was made for each modality and histopathology was the gold standard. RESULTS 129 patients with 173 scars were included. Baseline patient, lesion, and procedural characteristics were similar in both arms. Recurrence was detected in 56/173 (32.4%), with 27/56 (48.2%) adenomas and 29/56 (51.8%) serrated lesions. LCI had greater sensitivity (96.4% [95%CI 87.8%-99.5%]) versus WLE (89.3% [95%CI 78.1%-95.9%]) and greater NPV (98.1% [95%CI 93.4%-99.8%] versus 94.6% [95%CI 88.7%-98.0%]). Paired concordance between modalities was 96.0%. In discordant cases, LCI identified four true-positive cases not detected by WLE and reclassified one false-positive of WLE. WLE reclassified two false positives of LCI without any increase in recurrence detection. CONCLUSIONS LCI was highly accurate and had greater ability than WLE to rule out recurrence on post-polypectomy scars after resection of large polyps.
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Affiliation(s)
- Oswaldo Ortiz
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | | | - Rebeca Moreira
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
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Mastrorocco E, Terrin M, Migliorisi G, Masoni B, Farinola V, De Deo D, Ferretti S, Poletti V, Mercurio M, Bartocci B, Galtieri PA, Pellegatta G, Ferrara E, Carrara S, Sethi A, Siddiqui UD, Pellisé M, Facciorusso A, Hassan C, Repici A, Maselli R. Gender authorship in major American and European gastroenterology journals: the gap is still unfilled. Endoscopy 2024. [PMID: 38325395 DOI: 10.1055/a-2252-3958] [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: 02/09/2024]
Abstract
BACKGROUND The gender gap in the authorship of scientific research may affect career advancement. Our aim was to assess the potential gender gap in gastrointestinal (GI) journals. METHODS A systematic review was performed of the GI literature and ongoing research in the period 2020-2022. A total 10 GI journals and ongoing research on clinicaltrials.gov were selected for review. The gender gap in first and senior authorship was evaluated for each article and ongoing research project. Associations between the gender gap and possible predictors were measured and results are presented as odds ratios (ORs) with 95%CI. RESULTS The number of first female authors (FFAs) and senior female authors (SFAs) in published articles were 1408/4207 (33.5%) and 911/4207 (21.7%), respectively. There were 781/2654 (29.4%) female principal investigators (PI)s for the ongoing research. On comparison of non-endoscopic vs. endoscopic topics, the latter were associated with the gender gap (hepatology, OR 2.15 [95%CI 1.83-2.55]; inflammatory bowel disease, OR 2.12 [95%CI 1.60-2.45]; upper and lower GI, OR 1.31 [95%CI 1.18-1.73]); as well as the type of article (original article vs. editorial, OR 1.92 [95%CI 1.58-2.33]). The type of research was also associated with the gender gap (clinical vs. preclinical studies, OR 0.88 [95%CI 0.66-0.91]). CONCLUSION Our results demonstrated a correlation between the gender gap and the design and topic of the research. Future strategies for improving equity in career development in GI endoscopy should focus on closing the gender gap in equity of authorship.
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Affiliation(s)
- Elisabetta Mastrorocco
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Maria Terrin
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giulia Migliorisi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Benedetta Masoni
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valeria Farinola
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Diletta De Deo
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Silvia Ferretti
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Valeria Poletti
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Miriana Mercurio
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Bianca Bartocci
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - P Alessia Galtieri
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
| | - Gaia Pellegatta
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
| | - Elisa Ferrara
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
| | - Silvia Carrara
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
| | - Amrita Sethi
- Gastroenterology and Hepatology, Columbia University Medical Center, New York, United States
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), The University of Chicago Medicine, Chicago, United States
| | - Maria Pellisé
- Gastroenterology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandro Repici
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Roberta Maselli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Humanitas Research Hospital Department of Gastroenterology, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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3
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Khalaf K, Seleq S, Bourke MJ, Alkandari A, Bapaye A, Bechara R, Calo NC, Fedorov ED, Hassan C, Kalauz M, Kandel GP, Matsuda T, May GR, Mönkemüller K, Mosko JD, Ohno A, Pavic T, Pellisé M, Raos Z, Repici A, Rex DK, Saxena P, Schauer C, Sethi A, Sharma P, Shaukat A, Siddiqui UD, Singh R, Smith LA, Tanabe M, Teshima CW, von Renteln D, Gimpaya N, Pawlak KM, Fujiyoshi MRA, Fujiyoshi Y, Lamba M, Li S, Malipatil SB, Grover SC. Establishment of Standards for the Referral of Large Non-Pedunculated Colorectal Polyps: An International Expert Consensus Using a Modified Delphi Process. Gastrointest Endosc 2024:S0016-5107(24)00090-7. [PMID: 38331224 DOI: 10.1016/j.gie.2024.02.001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/10/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND AIMS Resection of colorectal polyps has been shown to decrease the incidence and mortality of colorectal cancer. Large non-pedunculated colorectal polyps are often referred to expert centres for endoscopic resection, which requires relevant information to be conveyed to the therapeutic endoscopist to allow for triage and planning of resection technique. The primary objective of our study was to establish minimum expected standards for the referral of LNPCP for potential ER. METHODS A Delphi methodology was employed to establish consensus on minimum expected standards for the referral of large colorectal polyps among a panel of international endoscopy experts. The expert panel was recruited through purposive sampling, and three rounds of surveys were conducted to achieve consensus, with quantitative and qualitative data analysed for each round. RESULTS A total of 24 international experts from diverse continents participated in the Delphi study, resulting in consensus on 19 statements related to the referral of large colorectal polyps. The identified factors, including patient demographics, relevant medications, lesion factors, photodocumentation and the presence of a tattoo, were deemed important for conveying the necessary information to therapeutic endoscopists. The mean scores for the statements ranged from 7.04 to 9.29 out of 10, with high percentages of experts considering most statements as a very high priority. Subgroup analysis by continent revealed some variations in consensus rates among experts from different regions. CONCLUSION The identified consensus statements can aid in improving the triage and planning of resection techniques for large colorectal polyps, ultimately contributing to the reduction of colorectal cancer incidence and mortality.
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Affiliation(s)
- Kareem Khalaf
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Samir Seleq
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Michael J Bourke
- Westmead Hospital University of Sydney, Sydney, New South Wales, Australia
| | - Asma Alkandari
- Thanyan Alghanim Center for Gastroenterology and Hepatology, Alamiri Hospital, Kuwait, Kuwait
| | - Amol Bapaye
- Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Robert Bechara
- Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Natalia C Calo
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Evgeniy D Fedorov
- Pirogov Russia National Research Medical University, Moscow, Russian Federation
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Mirjana Kalauz
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Gabor P Kandel
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Takahisa Matsuda
- Division of Gastroenterology and Hepatology, Toho University Omori Medical Center, Tokyo, Japan
| | - Gary R May
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Klaus Mönkemüller
- Department of Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Jeffrey D Mosko
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Akiko Ohno
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Tajana Pavic
- Department of Gastroenterology and Hepatology, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Maria Pellisé
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Zoe Raos
- Department of Gastroenterology, Te Whatu Ora - Waitemata. Faculty of Medicine, The University of Auckland, Auckland, New Zealand
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indiana, USA
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Cameron Schauer
- Department of Gastroenterology, Te Whatu Ora - Waitemata. Faculty of Medicine, The University of Auckland, Auckland, New Zealand
| | - Amrita Sethi
- Division of Digestive and Liver Disease, Irving Medical Center, Columbia University, New York, New York, USA
| | - Prateek Sharma
- University of Kansas School of Medicine, VA Medical Center, Kansas City, Kansas, USA
| | - Aasma Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, New York City, New York, USA
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics (CERT), University of Chicago, Chicago, Illinois, USA
| | - Rajvinder Singh
- Lyell McEwin Hospital, NALHN & the University of Adelaide, Adelaide, Australia
| | - Lesley-Ann Smith
- Department of Gastroenterology, Te Whatu Ora - Te TokaTumai, Auckland, New Zealand
| | - Mayo Tanabe
- Showa University Koto Toyosu Hospital, Digestive Diseases Center, Tokyo, Japan
| | - Christopher W Teshima
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Daniel von Renteln
- Centre Hospitalier de l'Universite de Montreal (CHUM), Universite de Montreal, Montreal, Canada
| | - Nikko Gimpaya
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Katarzyna M Pawlak
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Mary Raina Angeli Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Yusuke Fujiyoshi
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Mehul Lamba
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Suqing Li
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharan B Malipatil
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada
| | - Samir C Grover
- Division of Gastroenterology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Endoscopy Research Network (CanENDO), Canada.
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Antonelli G, Voiosu AM, Pawlak KM, Gonçalves TC, Le N, Bronswijk M, Hollenbach M, Elshaarawy O, Beilenhoff U, Mascagni P, Voiosu T, Pellisé M, Dinis-Ribeiro M, Triantafyllou K, Arvanitakis M, Bisschops R, Hassan C, Messmann H, Gralnek IM. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2024; 56:131-150. [PMID: 38040025 DOI: 10.1055/a-2205-2613] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
This ESGE Position Statement provides structured and evidence-based guidance on the essential requirements and processes involved in training in basic gastrointestinal (GI) endoscopic procedures. The document outlines definitions; competencies required, and means to their assessment and maintenance; the structure and requirements of training programs; patient safety and medicolegal issues. 1: ESGE and ESGENA define basic endoscopic procedures as those procedures that are commonly indicated, generally accessible, and expected to be mastered (technically and cognitively) by the end of any core training program in gastrointestinal endoscopy. 2: ESGE and ESGENA consider the following as basic endoscopic procedures: diagnostic upper and lower GI endoscopy, as well as a limited range of interventions such as: tissue acquisition via cold biopsy forceps, polypectomy for lesions ≤ 10 mm, hemostasis techniques, enteral feeding tube placement, foreign body retrieval, dilation of simple esophageal strictures, and India ink tattooing of lesion location. 3: ESGE and ESGENA recommend that training in GI endoscopy should be subject to stringent formal requirements that ensure all ESGE key performance indicators (KPIs) are met. 4: Training in basic endoscopic procedures is a complex process and includes the development and acquisition of cognitive, technical/motor, and integrative skills. Therefore, ESGE and ESGENA recommend the use of validated tools to track the development of skills and assess competence. 5: ESGE and ESGENA recommend incorporating a multimodal approach to evaluating competence in basic GI endoscopic procedures, including procedural thresholds and the measurement and documentation of established ESGE KPIs. 7: ESGE and ESGENA recommend the continuous monitoring of ESGE KPIs during GI endoscopy training to ensure the trainee's maintenance of competence. 9: ESGE and ESGENA recommend that GI endoscopy training units fulfil the ESGE KPIs for endoscopy units and, furthermore, be capable of providing the dedicated personnel, infrastructure, and sufficient case volume required for successful training within a structured training program. 10: ESGE and ESGENA recommend that trainers in basic GI endoscopic procedures should be endoscopists with formal educational training in the teaching of endoscopy, which allows them to successfully and safely teach trainees.
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Affiliation(s)
- Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Andrei M Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Katarzyna M Pawlak
- Endoscopy Unit, Gastroenterology Department, Hospital of the Ministry of Interior and Administration, Szczecin, Poland
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Nha Le
- Gastroenterology Division, Internal Medicine and Hematology Department, Semmelweis University, Budapest, Hungary
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda General Hospital, Bonheiden, Belgium
| | - Marcus Hollenbach
- Division of Gastroenterology, Medical Department II, University of Leipzig Medical Center, Leipzig, Germany
| | - Omar Elshaarawy
- Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Pietro Mascagni
- IHU Strasbourg, Strasbourg, France
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Theodor Voiosu
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Marianna Arvanitakis
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
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5
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Uchima HI, Muñoz-González R, Calm A, Pellisé M. Reply to Bowen et al. Endoscopy 2024; 56:160-161. [PMID: 38290509 DOI: 10.1055/a-2192-2606] [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: 02/01/2024]
Affiliation(s)
- Hugo I Uchima
- Gastrointestinal Endoscopy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Endoscopy Unit, Centro Medico Teknon, Barcelona, Spain
| | - Raquel Muñoz-González
- Gastrointestinal Endoscopy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Endoscopy Unit, Centro Medico Teknon, Barcelona, Spain
| | - Anna Calm
- Gastrointestinal Endoscopy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Maria Pellisé
- Hospital Clínic de Barcelona, Centro de Investigación Biomédiaca en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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Saez de Gordoa K, Rodrigo-Calvo MT, Archilla I, Lopez-Prades S, Diaz A, Tarragona J, Machado I, Ruiz Martín J, Zaffalon D, Daca-Alvarez M, Pellisé M, Camps J, Cuatrecasas M. Lymph Node Molecular Analysis with OSNA Enables the Identification of pT1 CRC Patients at Risk of Recurrence: A Multicentre Study. Cancers (Basel) 2023; 15:5481. [PMID: 38001742 PMCID: PMC10670609 DOI: 10.3390/cancers15225481] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Early-stage colorectal carcinoma (CRC)-pT1-is a therapeutic challenge and presents some histological features related to lymph node metastasis (LNM). A significant proportion of pT1 CRCs are treated surgically, resulting in a non-negligible surgical-associated mortality rate of 1.5-2%. Among these cases, approximately 6-16% exhibit LNM, but the impact on survival is unclear. Therefore, there is an unmet need to establish an objective and reliable lymph node (LN) staging method to optimise the therapeutic management of pT1 CRC patients and to avoid overtreating or undertreating them. In this multicentre study, 89 patients with pT1 CRC were included. All histological features associated with LNM were evaluated. LNs were assessed using two methods, One-Step Nucleic Acid Amplification (OSNA) and the conventional FFPE plus haematoxylin and eosin (H&E) staining. OSNA is an RT-PCR-based method for amplifying CK19 mRNA. Our aim was to assess the performance of OSNA and H&E in evaluating LNs to identify patients at risk of recurrence and to optimise their clinical management. We observed an 80.9% concordance in LN assessment using the two methods. In 9% of cases, LNs were found to be positive using H&E, and in 24.7% of cases, LNs were found to be positive using OSNA. The OSNA results are provided as the total tumour load (TTL), defined as the total tumour burden present in all the LNs of a surgical specimen. In CRC, a TTL ≥ 6000 CK19 m-RNA copies/µL is associated with poor prognosis. Three patients had TTL > 6000 copies/μL, which was associated with higher tumour budding. The discrepancies observed between the OSNA and H&E results were mostly attributed to tumour allocation bias. We concluded that LN assessment with OSNA enables the identification of pT1 CRC patients at some risk of recurrence and helps to optimise their clinical management.
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Affiliation(s)
- Karmele Saez de Gordoa
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Maria Teresa Rodrigo-Calvo
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Ivan Archilla
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Sandra Lopez-Prades
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
| | - Alba Diaz
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Clinical Foundations, University of Barcelona (UB), 08036 Barcelona, Spain
| | - Jordi Tarragona
- Pathology Department, Hospital Arnau de Vilanova, 25198 Lleida, Spain;
| | - Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Hospital Quirón-Salud Valencia, University of Valencia, 46010 Valencia, Spain;
- Centro de Investigación Biomédica en Red en Cancer (CIBERONC), 28029 Madrid, Spain
| | - Juan Ruiz Martín
- Pathology Department, Virgen de la Salud Hospital, 45071 Toledo, Spain;
| | - Diana Zaffalon
- Gastroenterology Department, Consorci Sanitari de Terrassa, 08227 Terrassa, Spain;
| | - Maria Daca-Alvarez
- Gastroenterology Department, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Maria Pellisé
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Gastroenterology Department, Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Jordi Camps
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Cell Biology and Medical Genetics Unit, Department of Cell Biology, Physiology and Immunology, Faculty of Medicine, Autonomous University of Barcelona (UAB), 08193 Bellaterra, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Centre of Biomedical Diagnosis (CDB), Hospital Clinic, 08036 Barcelona, Spain; (K.S.d.G.); (M.T.R.-C.); (I.A.); (S.L.-P.); (A.D.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain; (M.P.); (J.C.)
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029 Madrid, Spain
- Department of Clinical Foundations, University of Barcelona (UB), 08036 Barcelona, Spain
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7
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Uchima H, Calm A, Muñoz-González R, Caballero N, Rosinach M, Marín I, Colán-Hernández J, Iborra I, Castillo-Regalado E, Temiño R, Mata A, Turró R, Espinós J, Moreno De Vega V, Pellisé M. Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions. Endoscopy 2023; 55:1045-1050. [PMID: 37348544 DOI: 10.1055/a-2115-7797] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND We aimed to evaluate the safety and technical success of an easy-to-use technique that applies underwater cap suction pseudopolyp formation to facilitate the resection of flat lesions or those at the appendiceal orifice or ileocecal valve. METHODS We retrospectively analyzed a register of consecutive cap suction underwater endoscopic mucosal resection (CAP-UEMR) procedures performed at two centers between September 2020 and December 2021. Procedures were performed using a cone-shaped cap, extending 7 mm from the endoscope tip, to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary end point was technical success, defined as macroscopic complete resection. RESULTS We treated 83 lesions (median size 20 mm; interquartile range [IQR] 15-30 mm) with CAP-UEMR: 64 depressed or flat lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, and 8 from the ileocecal valve. Technical success was 100 %. There were seven intraprocedural bleedings and two delayed bleedings, all managed endoscopically. No perforations or other complications occurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected, which was treated endoscopically. CONCLUSIONS CAP-UEMR was a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.
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Affiliation(s)
- Hugo Uchima
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Anna Calm
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Raquel Muñoz-González
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Noemí Caballero
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | | | - Ingrid Marín
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Juan Colán-Hernández
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Ignacio Iborra
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Edgar Castillo-Regalado
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Rocío Temiño
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Alfredo Mata
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Román Turró
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Jorge Espinós
- Endoscopy Unit, Teknon Medical Center, Barcelona, Spain
| | - Vicente Moreno De Vega
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Maria Pellisé
- Gastroenterology, Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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8
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Aelvoet AS, Karstensen JG, Bastiaansen BA, van Leerdam ME, Balaguer F, Kaminski M, Hompes R, Bossuyt PM, Ricciardiello L, Latchford A, Jover R, Daca-Alvarez M, Pellisé M, Dekker E. Cold snare polypectomy for duodenal adenomas in familial adenomatous polyposis: a prospective international cohort study. Endosc Int Open 2023; 11:E1056-E1062. [PMID: 37954110 PMCID: PMC10637860 DOI: 10.1055/a-2165-7436] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims In patients with familial adenomatous polyposis (FAP), endoscopic resection of duodenal adenomas is commonly performed to prevent cancer and prevent or defer duodenal surgery. However, based on studies using different resection techniques, adverse events (AEs) of polypectomy in the duodenum can be significant. We hypothesized that cold snare polypectomy (CSP) is a safe technique for duodenal adenomas in FAP and evaluated its outcomes in our centers. Patients and methods We performed a prospective international cohort study including FAP patients who underwent CSP for one or more superficial non-ampullary duodenal adenomas of any size between 2020 and 2022. At that time, this technique was common practice in our centers for superficial duodenal adenomas. The primary outcome was the occurrence of intraprocedural and post-procedural AEs. Results In total, 133 CSPs were performed in 39 patients with FAP (1-18 per session). Median adenoma size was 10 mm (interquartile range 8-15 mm), ranging from 5 to 40 mm; 27 adenomas were ≥20 mm (20%). Of the 133 polypectomies, 109 (82%) were performed after submucosal injection. Sixty-one adenomas (46%) were resected en bloc and 72 (54%) piecemeal. Macroscopic radical resection was achieved for 129 polypectomies (97%). Deep mural injury type II occurred in three polyps (2%) with no delayed perforation after prophylactic clipping. There were no clinically significant bleeds, perforations or other post-procedural AEs. Histopathology showed low-grade dysplasia in all 133 adenomas. Conclusions CSP for (multiple) superficial non-ampullary duodenal adenomas in FAP seems feasible and safe. Long-term prospective research is needed to evaluate whether protocolized duodenal polypectomies prevent cancer and surgery.
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Affiliation(s)
- Arthur S. Aelvoet
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - John G. Karstensen
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Danish Polyposis Registry, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Barbara A.J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Monique E. van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Francesc Balaguer
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Michal Kaminski
- Department of Oncological Gastroenterology and Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Roel Hompes
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M.M. Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Luigi Ricciardiello
- Policlinico di Sant'Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrew Latchford
- Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rodrigo Jover
- Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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9
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Brunori A, Daca-Alvarez M, Pellisé M. pT1 colorectal cancer: A treatment dilemma. Best Pract Res Clin Gastroenterol 2023; 66:101854. [PMID: 37852711 DOI: 10.1016/j.bpg.2023.101854] [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: 05/17/2023] [Revised: 07/04/2023] [Accepted: 07/30/2023] [Indexed: 10/20/2023]
Abstract
The implementation of population screening programs for colorectal cancer (CRC) has led to a considerable increase in the prevalence pT1-CRC originating on polyps amenable by local treatments. However, a high proportion of patients are referred for unnecessary oncological surgeries without a clear benefit in terms of survival. Selecting the appropriate endoscopic resection technique in the moment of diagnosis becomes crucial to provide the best treatment alternative to each individual polyp and patient. For this, it is imperative to increase the optical diagnostic skill for differentiating pT1-CRCs and decide the appropriate initial therapy. En bloc resection is crucial to obtain an adequate histological specimen that might allow organ preserving therapeutic management. In this review, we address key challenges in T1 CRC management, explore the efficacy and safety of the available diagnostic and therapeutic approaches, and shed light on upcoming advances in the field.
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Affiliation(s)
- Angelo Brunori
- Gastroenterology and Digestive Endoscopy, Università degli Studi di Perugia, Italy
| | - Maria Daca-Alvarez
- Department of Gastroenterology Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de EnfermedadesHepáticas y Digestivas (CIBERehd), Spain
| | - Maria Pellisé
- Department of Gastroenterology Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Centro de InvestigaciónBiomé, dica en Red de EnfermedadesHepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Barcelona, Spain.
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10
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Everett SM, Triantafyllou K, Hassan C, Mergener K, Tham TC, Almeida N, Antonelli G, Axon A, Bisschops R, Bretthauer M, Costil V, Foroutan F, Gauci J, Hritz I, Messmann H, Pellisé M, Roelandt P, Seicean A, Tziatzios G, Voiosu A, Gralnek IM. Informed consent for endoscopic procedures: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023; 55:952-966. [PMID: 37557899 DOI: 10.1055/a-2133-3365] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
All endoscopic procedures are invasive and carry risk. Accordingly, all endoscopists should involve the patient in the decision-making process about the most appropriate endoscopic procedure for that individual, in keeping with a patient's right to self-determination and autonomy. Recognition of this has led to detailed guidelines on informed consent for endoscopy in some countries, but in many no such guidance exists; this may lead to variations in care and exposure to risk of litigation. In this document, the European Society of Gastrointestinal Endoscopy (ESGE) sets out a series of statements that cover best practice in informed consent for endoscopy. These statements should be seen as a minimum standard of practice, but practitioners must be aware of and adhere to the law in their own country. 1: Patients should give informed consent for all gastrointestinal endoscopic procedures for which they have capacity to do so. 2: The healthcare professional seeking consent for an endoscopic procedure should ensure that the patient has the capacity to consent to that procedure. 3: For patients who lack capacity, healthcare personnel should at all times try to engage with people close to the patient, such as family, friends, or caregivers, to achieve consensus on the appropriateness of performing the procedure. 4: Where a patient lacks capacity to provide informed consent, the best interest decision should be clearly documented in the medical record. This should include information about the capacity assessment, reason(s) that the decision cannot be delayed for capacity recovery (or if recovery is not expected), who has been consulted, and where relevant the form of authority for the decision. 5: There should be a systematic and transparent disclosure of the expected benefits and harms that may reasonably affect patient choice on whether or not to undergo any diagnostic or interventional endoscopic procedure. Information about possible alternatives, as well as the consequences of doing nothing, should also be provided when relevant. 6: The information provided on the benefit and harms of an endoscopic procedure should be adapted to the procedure and patient-specific risk factors, and the preferences of the patient should be central to the consent process. 7: The consent discussion should be undertaken by an individual who is familiar with the procedure and its risks, and is able to discuss these in the context of the individual patient. 8: Patients should confirm consent to an endoscopic procedure in a private, unrushed, and non-coercive environment. 9: If a patient requests that an endoscopic procedure be discontinued, the procedure should be paused and the patient's capacity for decision making assessed. If a competent patient continues to object to the procedure, or if a conclusive determination of capacity is not feasible, the examination should be terminated as soon as it is safe to do so. 10: Informed consent should be sufficiently detailed to cover all findings that can be reasonably anticipated during an endoscopic examination. The scope of this consent should not be expanded, nor a patient's implicit consent for additional interventions assumed, unless failure to proceed with such interventions would result in immediate and predictable harm to the patient.
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Affiliation(s)
- Simon M Everett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Nuno Almeida
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Michael Bretthauer
- Clinical Effectiveness Group, Department of Transplantation Medicine, Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation
| | - James Gauci
- Department of Gastroenterology, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Istvan Hritz
- Department of Surgery, Transplantation and Gastroenterology, Center for Therapeutic Endoscopy, Semmelweis University, Budapest, Hungary
| | - Helmut Messmann
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Philip Roelandt
- Department of Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
- Translational Research in Gastrointestinal Diseases (TARGID), Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania
- University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania
| | - Georgios Tziatzios
- Department of Gastroenterology, "Konstantopoulio-Patision" General Hospital, Athens, Greece
| | - Andrei Voiosu
- Gastroenterology and Hepatology Department, Colentina Clinical Hospital and Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Ian M Gralnek
- Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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11
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Nass KJ, van Doorn SC, Fockens P, Rees CJ, Pellisé M, van der Vlugt M, Dekker E. High quality colonoscopy: using textbook process as a composite quality measure. Endoscopy 2023; 55:812-819. [PMID: 37019154 PMCID: PMC10465239 DOI: 10.1055/a-2069-6588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 04/04/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND : High quality colonoscopy is fundamental to good patient outcomes. "Textbook outcome" has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish the "textbook process" (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists. METHODS : To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. The achievement of TP was then applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 1 January 2018 and 1 August 2021 were analyzed. RESULTS : The Delphi consensus process was completed by 20 of 27 invited experts (74.1 %). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication; successful cecal intubation; adequate bowel preparation; adequate withdrawal time; acceptable patient comfort score; provision of post-polypectomy surveillance recommendations in line with guidelines; and the absence of the use of reversal agents, early adverse events, readmission, and mortality. In the two endoscopy services studied, TP was achieved in 5962/8227 colonoscopies (72.5 %). Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging per endoscopist from 41.0 % to 89.1 %. CONCLUSION : This study proposes a new composite measure for colonoscopy, namely "textbook process." TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as a measure in future quality assessment programs.
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Affiliation(s)
- Karlijn J. Nass
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sascha C. van Doorn
- Department of Gastroenterology and Hepatology, Flevo Hospital, Almere, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
| | - Colin J. Rees
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maria Pellisé
- Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Research Institute Amsterdam Gastroenterology and Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Bergman Clinics, Amsterdam, The Netherlands
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12
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Bonjoch L, Soares de Lima Y, Díaz-Gay M, Dotti I, Muñoz J, Moreira L, Carballal S, Ocaña T, Cuatrecasas M, Ortiz O, Castells A, Pellisé M, Balaguer F, Salas A, Alexandrov LB, Castellví-Bel S. Unraveling the impact of a germline heterozygous POLD1 frameshift variant in serrated polyposis syndrome. Front Mol Biosci 2023; 10:1119900. [PMID: 36756361 PMCID: PMC9900627 DOI: 10.3389/fmolb.2023.1119900] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/10/2023] [Indexed: 01/24/2023] Open
Abstract
Serrated polyposis syndrome (SPS) is one of the most frequent polyposis syndromes characterized by an increased risk for developing colorectal cancer (CRC). Although SPS etiology has been mainly associated with environmental factors, germline predisposition to SPS could also be relevant for cases with familial aggregation or a family history of SPS/CRC. After whole-exome sequencing of 39 SPS patients from 16 families, we identified a heterozygous germline frameshift variant in the POLD1 gene (c.1941delG, p.(Lys648fs*46)) in a patient with SPS and CRC. Tumor presented an ultra-hypermutated phenotype and microsatellite instability. The POLD1 germline variant segregated in three additional SPS-affected family members. We attempted to create yeast and cellular models for this variant but were no viable. Alternatively, we generated patient-derived organoids (PDOs) from healthy rectal tissue of the index case, as well as from a control donor. Then, we challenged PDOs with a DNA-damaging agent to induce replication stress. No significant differences were observed in the DNA damage response between control and POLD1-Lys648fs PDOs, nor specific mutational signatures were observed. Our results do not support the pathogenicity of the analyzed POLD1 frameshift variant. One possible explanation is that haplosufficiency of the wild-type allele may be compensating for the absence of expression of the frameshift allele. Overall, future work is required to elucidate if functional consequences could be derived from POLD1 alterations different from missense variants in their proofreading domain. To our knowledge, our study presents the first organoid model for germline POLD1 variants and establishes the basis for its use as a model for disease in SPS, CRC and other malignancies.
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Affiliation(s)
- Laia Bonjoch
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Yasmin Soares de Lima
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Marcos Díaz-Gay
- Department of Cellular and Molecular Medicine and Department of Bioengineering and Moores Cancer Center, UC San Diego, La Jolla, CA, United States
| | - Isabella Dotti
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Jenifer Muñoz
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Sabela Carballal
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Teresa Ocaña
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd) and Tumor Bank-Biobank, Hospital Clínic, Barcelona, Spain
| | - Oswaldo Ortiz
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Azucena Salas
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
| | - Ludmil B. Alexandrov
- Department of Cellular and Molecular Medicine and Department of Bioengineering and Moores Cancer Center, UC San Diego, La Jolla, CA, United States
| | - Sergi Castellví-Bel
- Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Hospital Clínic, Barcelona, Spain
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13
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Houwen BBSL, Hartendorp F, Giotis I, Hazewinkel Y, Fockens P, Walstra TR, Dekker E, van Boeckel P, Boparai K, Borg FT, Carballal S, Cazemier M, Daca M, van Eijk B, Jansen J, Koussoulas V, Kuipers T, van Lelyveld N, Ordas I, Marsman W, Moreira L, Muños FR, Noach L, Pellisé M, Ramsoekh D, Schröder R, van Soest E, van Noorden JT, Tytgat K, van Oosterwijk P, van Putten P, Vehmeijer A, Vries RD, van der Vlugt M, Voogd F, van der Zanden E. Computer-aided classification of colorectal segments during colonoscopy: a deep learning approach based on images of a magnetic endoscopic positioning device. Scand J Gastroenterol 2022; 58:649-655. [PMID: 36458659 DOI: 10.1080/00365521.2022.2151320] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Assessment of the anatomical colorectal segment of polyps during colonoscopy is important for treatment and follow-up strategies, but is largely operator dependent. This feasibility study aimed to assess whether, using images of a magnetic endoscope imaging (MEI) positioning device, a deep learning approach can be useful to objectively divide the colorectum into anatomical segments. METHODS Models based on the VGG-16 based convolutional neural network architecture were developed to classify the colorectum into anatomical segments. These models were pre-trained on ImageNet data and further trained using prospectively collected data of the POLAR study in which endoscopists were using MEI (3930 still images and 90,151 video frames). Five-fold cross validation with multiple runs was used to evaluate the overall diagnostic accuracies of the models for colorectal segment classification (divided into a 5-class and 2-class colorectal segment division). The colorectal segment assignment by endoscopists was used as the reference standard. RESULTS For the 5-class colorectal segment division, the best performing model correctly classified the colorectal segment in 753 of the 1196 polyps, corresponding to an overall accuracy of 63%, sensitivity of 63%, specificity of 89% and kappa of 0.47. For the 2-class colorectal segment division, 1112 of the 1196 polyps were correctly classified, corresponding to an accuracy of 93%, sensitivity of 93%, specificity of 90% and kappa of 0.82. CONCLUSION The diagnostic performance of a deep learning approach for colorectal segment classification based on images of a MEI device is yet suboptimal (clinicaltrials.gov: NCT03822390).
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Affiliation(s)
- Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Fons Hartendorp
- Department of Computer Science, University of Amsterdam, Amsterdam, the Netherlands
| | - Ioanis Giotis
- ZiuZ Visual Intelligence, Gorredijk, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco R Walstra
- Department of Computer Science, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Bergman Clinics Maag & Darm Amsterdam, Amsterdam, The Netherlands
| | | | | | - P. van Boeckel
- Department of Gastroenterology and Hepatology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - K. Boparai
- Department of Gastroenterology and Hepatology, Amstelland Hospital, Amstelveen, the Netherlands
| | - F. ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - S. Carballal
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - M. Cazemier
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d‘Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - M. Daca
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - B. van Eijk
- Department of Gastroenterology and Hepatology, Spaarne Ziekenhuis, Hoofddorp, the Netherlands
| | - J.M Jansen
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d‘Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - V. Koussoulas
- Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - T. Kuipers
- Department of Gastroenterology and Hepatology, Amstelland Hospital, Amstelveen, the Netherlands
| | - N. van Lelyveld
- Department of Gastroenterology and Hepatology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - I. Ordas
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - W. Marsman
- Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - L. Moreira
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - F.J Rando Muños
- Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - L. Noach
- Department of Gastroenterology and Hepatology, Amstelland Hospital, Amstelveen, the Netherlands
| | - M. Pellisé
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - D. Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Bergman Clinics Maag & Darm Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Amstelland Hospital, Amstelveen, the Netherlands
| | - R. Schröder
- Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - E.J van Soest
- Department of Gastroenterology and Hepatology, Spaarne Ziekenhuis, Hoofddorp, the Netherlands
| | - J. Tenthof van Noorden
- Department of Gastroenterology and Hepatology, Sint Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - K.M.A.J Tytgat
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Bergman Clinics Maag & Darm Amsterdam, Amsterdam, The Netherlands
| | - P. van Oosterwijk
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - P. van Putten
- Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - A. Vehmeijer
- Department of Gastroenterology and Hepatology, Spaarne Ziekenhuis, Hoofddorp, the Netherlands
| | - R. de Vries
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - M. van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Bergman Clinics Maag & Darm Amsterdam, Amsterdam, The Netherlands
| | - F. Voogd
- Department of Gastroenterology and Hepatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - E. van der Zanden
- Department of Gastroenterology and Hepatology, Amstelland Hospital, Amstelveen, the Netherlands
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14
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Daca-Alvarez M, Martí M, Spinelli A, de Miranda NFFC, Palles C, Vivas A, Lachtford A, Monahan K, Szczepkowski M, Tarnowski W, Makkai-Popa ST, Vidal R, López I, Hurtado E, Jiménez F, Jiménez-Toscano M, Álvaro E, Sanz G, Ballestero A, Melone S, Brandáriz L, Prieto I, García-Olmo D, Ocaña T, Moreira R, Moreno L, Carballal S, Moreira L, Pellisé M, González-Sarmiento R, Holowatyj AN, Perea J, Balaguer F. Familial component of early-onset colorectal cancer: opportunity for prevention. Br J Surg 2022; 109:1319-1325. [PMID: 36108087 PMCID: PMC11004945 DOI: 10.1093/bjs/znac322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/17/2022] [Accepted: 08/21/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Individuals with a non-syndromic family history of colorectal cancer are known to have an increased risk. There is an opportunity to prevent early-onset colorectal cancer (age less than 50 years) (EOCRC) in this population. The aim was to explore the proportion of EOCRC that is preventable due to family history of colorectal cancer. METHODS This was a retrospective multicentre European study of patients with non-hereditary EOCRC. The impact of the European Society of Gastrointestinal Endoscopy (ESGE), U.S. Multi-Society Task Force (USMSTF), and National Comprehensive Cancer Network (NCCN) guidelines on prevention and early diagnosis was compared. Colorectal cancer was defined as potentially preventable if surveillance colonoscopy would have been performed at least 5 years before the age of diagnosis of colorectal cancer, and diagnosed early if colonoscopy was undertaken between 1 and 4 years before the diagnosis. RESULTS Some 903 patients with EOCRC were included. Criteria for familial colorectal cancer risk in ESGE, USMSTF, and NCCN guidelines were met in 6.3, 9.4, and 30.4 per cent of patients respectively. Based on ESGE, USMSTF, and NCCN guidelines, colorectal cancer could potentially have been prevented in 41, 55, and 30.3 per cent of patients, and diagnosed earlier in 11, 14, and 21.1 per cent respectively. In ESGE guidelines, if surveillance had started 10 years before the youngest relative, there would be a significant increase in prevention (41 versus 55 per cent; P = 0.010). CONCLUSION ESGE, USMSTF, and NCCN criteria for familial colorectal cancer were met in 6.3, 9.4, and 30.4 per cent of patients with EOCRC respectively. In these patients, early detection and/or prevention could be achieved in 52, 70, and 51.4 per cent respectively. Early and accurate identification of familial colorectal cancer risk and increase in the uptake of early colonoscopy are key to decreasing familial EOCRC.
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Affiliation(s)
- Maria Daca-Alvarez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Marc Martí
- Department of Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Research Hospital, Humanitas University, Rozzano, Italy
| | | | - Claire Palles
- Gastrointestinal Cancer Genetics Laboratory, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Alfredo Vivas
- Department of Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Andrew Lachtford
- Polyposis Registry and Family Cancer Clinic, St Mark’s Hospital, London, UK
| | - Kevin Monahan
- Polyposis Registry and Family Cancer Clinic, St Mark’s Hospital, London, UK
- Department of Gastroenterology, West Middlesex University Hospital, London, UK
| | - Marek Szczepkowski
- Clinical Department of Colorectal, General and Oncological Surgery, Centre of Postgraduate Medical Education, Bielanski Hospital, Warsaw, Poland
| | - Wieslaw Tarnowski
- Department of Surgery, Centre of Postgraduate Medical Education, Orlowski Hospital, Warsaw, Poland
| | | | - Rosario Vidal
- Medical Oncology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Irene López
- Department of Surgery, Hospital MD Anderson, Madrid, Spain
| | - Elena Hurtado
- Department of Surgery, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Fernando Jiménez
- Department of Surgery, Hospital Galdakao-Usansolo, Vizcaya, Spain
| | | | - Edurne Álvaro
- Department of Surgery, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Gonzalo Sanz
- Department of Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - Araceli Ballestero
- Department of Surgery, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Sirio Melone
- Department of Surgery, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Lorena Brandáriz
- Department of Surgery, Hospital Universitario General de Villalba, Madrid, Spain
| | - Isabel Prieto
- Department of Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Damián García-Olmo
- Department of Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Rebeca Moreira
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Sabela Carballal
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Rogelio González-Sarmiento
- Molecular Medicine Unit, Department of Medicine, Biomedical Research Institute of Salamanca (IBSAL), Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-SACYL-CSIC, Salamanca, Spain
| | - Andreana N Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - José Perea
- Molecular Medicine Unit, Department of Medicine, Biomedical Research Institute of Salamanca (IBSAL), Institute of Molecular and Cellular Biology of Cancer (IBMCC), University of Salamanca-SACYL-CSIC, Salamanca, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
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15
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García-Rodríguez A, Tudela Y, Córdova H, Carballal S, Ordás I, Moreira L, Vaquero E, Ortiz O, Rivero L, Sánchez FJ, Cuatrecasas M, Pellisé M, Bernal J, Fernández-Esparrach G. In vivo computer-aided diagnosis of colorectal polyps using white light endoscopy. Endosc Int Open 2022; 10:E1201-E1207. [PMID: 36118638 PMCID: PMC9473851 DOI: 10.1055/a-1881-3178] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/01/2021] [Accepted: 06/10/2022] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Artificial intelligence is currently able to accurately predict the histology of colorectal polyps. However, systems developed to date use complex optical technologies and have not been tested in vivo. The objective of this study was to evaluate the efficacy of a new deep learning-based optical diagnosis system, ATENEA, in a real clinical setting using only high-definition white light endoscopy (WLE) and to compare its performance with endoscopists. Methods ATENEA was prospectively tested in real life on consecutive polyps detected in colorectal cancer screening colonoscopies at Hospital Clínic. No images were discarded, and only WLE was used. The in vivo ATENEA's prediction (adenoma vs non-adenoma) was compared with the prediction of four staff endoscopists without specific training in optical diagnosis for the study purposes. Endoscopists were blind to the ATENEA output. Histology was the gold standard. Results Ninety polyps (median size: 5 mm, range: 2-25) from 31 patients were included of which 69 (76.7 %) were adenomas. ATENEA correctly predicted the histology in 63 of 69 (91.3 %, 95 % CI: 82 %-97 %) adenomas and 12 of 21 (57.1 %, 95 % CI: 34 %-78 %) non-adenomas while endoscopists made correct predictions in 52 of 69 (75.4 %, 95 % CI: 60 %-85 %) and 20 of 21 (95.2 %, 95 % CI: 76 %-100 %), respectively. The global accuracy was 83.3 % (95 % CI: 74%-90 %) and 80 % (95 % CI: 70 %-88 %) for ATENEA and endoscopists, respectively. Conclusion ATENEA can accurately be used for in vivo characterization of colorectal polyps, enabling the endoscopist to make direct decisions. ATENEA showed a global accuracy similar to that of endoscopists despite an unsatisfactory performance for non-adenomatous lesions.
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Affiliation(s)
- Ana García-Rodríguez
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain
| | - Yael Tudela
- Computer Science Department. Autonomous University of Barcelona and Computer Vision Center, Barcelona, Catalonia, Spain
| | - Henry Córdova
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Sabela Carballal
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Ingrid Ordás
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Leticia Moreira
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Eva Vaquero
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Oswaldo Ortiz
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain
| | - Liseth Rivero
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - F. Javier Sánchez
- Computer Science Department. Autonomous University of Barcelona and Computer Vision Center, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain,Pathology Department. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
| | - Jorge Bernal
- Computer Science Department. Autonomous University of Barcelona and Computer Vision Center, Barcelona, Catalonia, Spain
| | - Glòria Fernández-Esparrach
- Endoscopy Unit. Gastroenterology Department. ICMDiM. Hospital Clínic of Barcelona. University of Barcelona, Barcelona, Catalonia, Spain,IDIBAPS, Barcelona, Catalonia, Spain,CIBEREHD, Spain
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16
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Dekker E, Nass KJ, Iacucci M, Murino A, Sabino J, Bugajski M, Carretero C, Cortas G, Despott EJ, East JE, Kaminski MF, Karstensen JG, Keuchel M, Löwenberg M, Monged A, Nardone OM, Neumann H, Omar MM, Pellisé M, Peyrin-Biroulet L, Rutter MD, Bisschops R. Performance measures for colonoscopy in inflammatory bowel disease patients: European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2022; 54:904-915. [PMID: 35913069 DOI: 10.1055/a-1874-0946] [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: 12/10/2022]
Abstract
The European Society of Gastrointestinal Endoscopy (ESGE) presents a short list of performance measures for colonoscopy in inflammatory bowel disease (IBD) patients. Current performance measures for colonoscopy mainly focus on detecting (pre)malignant lesions. However, these performance measures are not relevant for all colonoscopy indications in IBD patients. Therefore, our aim was to provide endoscopy services across Europe and other interested countries with a tool for quality monitoring and improvement in IBD colonoscopy. Eight key performance measures and one minor performance measure were recommended for measurement and evaluation in daily endoscopy practice.
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Affiliation(s)
- Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Karlijn J Nass
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, NIHR Birmingham Biomedical Research Centre, University Hospitals NHS Foundation Trust, University of Birmingham, Birmingham, UK
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospital Leuven, TARGID, KU Leuven, Leuven, Belgium
| | - Marek Bugajski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Cristina Carretero
- Department of Gastroenterology, University of Navarre Clinic, Healthcare Research Institute of Navarre, Pamplona, Spain
| | - George Cortas
- University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Edward J Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital and University College London Institute for Liver and Digestive Health, London, UK
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - John Gásdal Karstensen
- Gastroenterology Unit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Ashraf Monged
- Endoscopy Unit, Royal College of Surgeons of Ireland Hospitals Group, Dublin, Ireland
| | - Olga M Nardone
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Mahmoud M Omar
- Department of Internal Medicine, Digestive Diseases and Endoscopy, New Mowasat Hospital, Salmiya, Kuwait
| | - Maria Pellisé
- Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
| | | | - Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton-on-Tees, Cleveland, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, TARGID, KU Leuven, Leuven, Belgium
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17
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Rodríguez de Santiago E, Dinis-Ribeiro M, Pohl H, Agrawal D, Arvanitakis M, Baddeley R, Bak E, Bhandari P, Bretthauer M, Burga P, Donnelly L, Eickhoff A, Hayee B, Kaminski MF, Karlović K, Lorenzo-Zúñiga V, Pellisé M, Pioche M, Siau K, Siersema PD, Stableforth W, Tham TC, Triantafyllou K, Tringali A, Veitch A, Voiosu AM, Webster GJ, Vienne A, Beilenhoff U, Bisschops R, Hassan C, Gralnek IM, Messmann H. Reducing the environmental footprint of gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy 2022; 54:797-826. [PMID: 35803275 DOI: 10.1055/a-1859-3726] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [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] [Indexed: 02/07/2023]
Abstract
Climate change and the destruction of ecosystems by human activities are among the greatest challenges of the 21st century and require urgent action. Health care activities significantly contribute to the emission of greenhouse gases and waste production, with gastrointestinal (GI) endoscopy being one of the largest contributors. This Position Statement aims to raise awareness of the ecological footprint of GI endoscopy and provides guidance to reduce its environmental impact. The European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) outline suggestions and recommendations for health care providers, patients, governments, and industry. MAIN STATEMENTS 1: GI endoscopy is a resource-intensive activity with a significant yet poorly assessed environmental impact. 2: ESGE-ESGENA recommend adopting immediate actions to reduce the environmental impact of GI endoscopy. 3: ESGE-ESGENA recommend adherence to guidelines and implementation of audit strategies on the appropriateness of GI endoscopy to avoid the environmental impact of unnecessary procedures. 4: ESGE-ESGENA recommend the embedding of reduce, reuse, and recycle programs in the GI endoscopy unit. 5: ESGE-ESGENA suggest that there is an urgent need to reassess and reduce the environmental and economic impact of single-use GI endoscopic devices. 6: ESGE-ESGENA suggest against routine use of single-use GI endoscopes. However, their use could be considered in highly selected patients on a case-by-case basis. 7: ESGE-ESGENA recommend inclusion of sustainability in the training curricula of GI endoscopy and as a quality domain. 8: ESGE-ESGENA recommend conducting high quality research to quantify and minimize the environmental impact of GI endoscopy. 9: ESGE-ESGENA recommend that GI endoscopy companies assess, disclose, and audit the environmental impact of their value chain. 10: ESGE-ESGENA recommend that GI endoscopy should become a net-zero greenhouse gas emissions practice by 2050.
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Affiliation(s)
- Enrique Rodríguez de Santiago
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center (Porto.CCC), and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, and Section of Gastroenterology and Hepatology, VA White River Junction, Vermont, USA
| | - Deepak Agrawal
- Division of Gastroenterology and Hepatology, Dell Medical School, University of Texas Austin, Texas, USA
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Robin Baddeley
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital, and Wolfson Unit for Endoscopy, St Mark's Hospital, London, United Kingdom
| | - Elzbieta Bak
- Department of Gastroenterology and Internal Medicine, Clinical Hospital of Medical University of Warsaw, Warsaw, Poland
| | | | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, and Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Patricia Burga
- Endoscopy Department, University Hospital of Padua, Italy
| | - Leigh Donnelly
- Endoscopy Department, Northumbria Healthcare NHS Trust, Northumberland, United Kingdom
| | - Axel Eickhoff
- Klinik für Gastroenterologie, Diabetologie, Infektiologie, Klinikum Hanau, Hanau, Germany
| | - Bu'Hussain Hayee
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | - Michal F Kaminski
- Department of Cancer Prevention and Department of Oncological Gastroenterology, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Katarina Karlović
- Clinical Hospital Center Rijeka , Department of Gastroenterology, Endoscopy Unit, Rijeka, Croatia
| | - Vicente Lorenzo-Zúñiga
- Department of Gastroenterology, University and Polytechnic La Fe Hospital/IIS La Fe, Valencia, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), and Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Mathieu Pioche
- Endoscopy Unit, Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France
| | - Keith Siau
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - William Stableforth
- Department of Gastroenterology, Dudley Group Hospitals NHS Foundation Trust, Dudley, United Kingdom
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Alberto Tringali
- Digestive Endoscopy Unit, ULSS 2 Marca Trevigiana, Conegliano Hospital, Conegliano, Italy
| | - Andrew Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Andrei M Voiosu
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucharest, Romania
| | - George J Webster
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | | | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, and Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Helmut Messmann
- III Medizinische Klinik Universitätsklinikum Augsburg, Augsburg, Germany
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18
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Quintanilla I, Jung G, Jimeno M, Lozano JJ, Sidorova J, Camps J, Carballal S, Bujanda L, Vera MI, Quintero E, Carrillo-Palau M, Cuatrecasas M, Castells A, Panés J, Ricart E, Moreira L, Balaguer F, Pellisé M. Differentially Deregulated MicroRNAs as Novel Biomarkers for Neoplastic Progression in Ulcerative Colitis. Clin Transl Gastroenterol 2022; 13:e00489. [PMID: 35404333 PMCID: PMC10476842 DOI: 10.14309/ctg.0000000000000489] [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] [Received: 11/18/2021] [Accepted: 03/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) is a potentially life-threatening complication of long-standing ulcerative colitis (UC). MicroRNAs (miRNA) are epigenetic regulators that have been involved in the development of UC-associated CRC. However, their role as potential mucosal biomarkers of neoplastic progression has not been adequately studied. METHODS In this study, we analyzed the expression of 96 preselected miRNAs in human formalin-fixed and paraffin-embedded tissue of 52 case biopsies (20 normal mucosa, 20 dysplasia, and 12 UC-associated CRCs) and 50 control biopsies (10 normal mucosa, 21 sporadic adenomas, and 19 sporadic CRCs) by using Custom TaqMan Array Cards. For validation of deregulated miRNAs, we performed individual quantitative real-time polymerase chain reaction in an independent cohort of 50 cases (13 normal mucosa, 25 dysplasia, and 12 UC-associated CRCs) and 46 controls (7 normal mucosa, 19 sporadic adenomas, and 20 sporadic CRCs). RESULTS Sixty-four miRNAs were found to be differentially deregulated in the UC-associated CRC sequence. Eight of these miRNAs were chosen for further validation. We confirmed miR-31, -106a, and -135b to be significantly deregulated between normal mucosa and dysplasia, as well as across the UC-associated CRC sequence (all P < 0.01). Notably, these miRNAs also confirmed to have a significant differential expression compared with sporadic CRC (all P < 0.05). DISCUSSION UC-associated and sporadic CRCs have distinct miRNA expression patterns, and some miRNAs indicate early neoplastic progression.
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Affiliation(s)
- Isabel Quintanilla
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Gerhard Jung
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Mireya Jimeno
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Departament of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan José Lozano
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - Julia Sidorova
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - Jordi Camps
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Sabela Carballal
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Luis Bujanda
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Biodonostia Health Research Institute, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Maria Isabel Vera
- Department of Gastroenterology, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Enrique Quintero
- Department of Gastroenterology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Miriam Cuatrecasas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Pathology, Hospital Clinic, Barcelona, Spain
| | - Antoni Castells
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Julià Panés
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Elena Ricart
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Leticia Moreira
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
- Department of Gastroenterology, Hospital Clinic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
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19
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Jung G, Hernández-Illán E, Lozano JJ, Sidorova J, Muñoz J, Okada Y, Quintero E, Hernandez G, Jover R, Carballal S, Cuatrecasas M, Moreno L, Diaz M, Ocaña T, Sánchez A, Rivero L, Ortiz O, Llach J, Castells A, Pellisé M, Goel A, Batlle E, Balaguer F. Epigenome-Wide DNA Methylation Profiling of Normal Mucosa Reveals HLA-F Hypermethylation as a Biomarker Candidate for Serrated Polyposis Syndrome. J Mol Diagn 2022; 24:674-686. [PMID: 35447336 DOI: 10.1016/j.jmoldx.2022.03.010] [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] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/08/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Serrated polyposis syndrome (SPS) is associated with a high risk for colorectal cancer. Intense promoter hypermethylation is a frequent molecular finding in the serrated pathway and may be present in normal mucosa, predisposing to the formation of serrated lesions. To identify novel biomarkers for SPS, fresh-frozen samples of normal mucosa from 50 patients with SPS and 19 healthy individuals were analyzed by using the 850K BeadChip Technology (Infinium). Aberrant methylation levels were correlated with gene expression using a next-generation transcriptome profiling tool. Two validation steps were performed on independent cohorts: first, on formalin-fixed, paraffin-embedded tissue of the normal mucosa; and second, on 24 serrated lesions. The most frequently hypermethylated genes were HLA-F, SLFN12, HLA-DMA, and RARRES3; and the most frequently hypomethylated genes were PIWIL1 and ANK3 (Δβ = 10%; P < 0.05). Expression levels of HLA-F, SLFN12, and HLA-DMA were significantly different between SPS patients and healthy individuals and correlated well with the methylation status of the corresponding differentially methylated region (fold change, >20%; r > 0.55; P < 0.001). Significant hypermethylation of CpGs in the gene body of HLA-F was also found in serrated lesions (Δβ = 23%; false discovery rate = 0.01). Epigenome-wide methylation profiling has revealed numerous differentially methylated CpGs in normal mucosa from SPS patients. Significant hypermethylation of HLA-F is a novel biomarker candidate for SPS.
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Affiliation(s)
- Gerhard Jung
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Juan J Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - Julia Sidorova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - Jenifer Muñoz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Yasuyuki Okada
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute, Biomedical Research Center, Monrovia, California; Department of Gastroenterology and Oncology, Tokushima University Graduate School, Tokushima, Japan
| | - Enrique Quintero
- Department of Gastroenterology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Goretti Hernandez
- Department of Gastroenterology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Sabela Carballal
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain; Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Mireia Diaz
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Teresa Ocaña
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ariadna Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Oswaldo Ortiz
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Joan Llach
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ajay Goel
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute, Biomedical Research Center, Monrovia, California; City of Hope Comprehensive Cancer Center, Duarte, California
| | - Eduard Batlle
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain.
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20
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Llach J, Pellisé M, Monahan K. Lynch syndrome; towards more personalized management? Best Pract Res Clin Gastroenterol 2022; 58-59:101790. [PMID: 35988964 DOI: 10.1016/j.bpg.2022.101790] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Abstract
Lynch syndrome is the most common inherited cause of colorectal (lifetime risk up to 70%) and endometrial cancer. The diagnosis of Lynch syndrome facilitates preventive measures aimed at reducing the incidence and mortality of cancer. Colonoscopic surveillance for colorectal cancer, aspirin, and prophylactic hysterectomy and bilateral salpo-oopherectomy for endometrial and/or ovarian cancer have demonstrated to effectively reduce cancer mortality in this population. However, the lifetime risk of each cancer in people with Lynch syndrome is gene-specific and may be modified by environmental factors. Furthermore, the benefits of surveillance strategies need to be balanced against the risk of over-diagnosis and be supported by evidence of improved outcomes from cancer diagnosis in surveillance. Therefore, people with Lynch syndrome may benefit from a personalized management approach.
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Affiliation(s)
- Joan Llach
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain.
| | - Kevin Monahan
- Imperial College London & The St Mark's Centre for Familial Intestinal Cancer, Lynch Syndrome & Family Cancer Clinic & Polyposis Registry, St Mark's Hospital, Harrow, HA1 3UJ, London, United Kingdom.
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21
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Houwen BB, Vleugels JL, Pellisé M, Rivero-Sánchez L, Balaguer F, Bisschops R, Tejpar S, Repici A, Ramsoekh D, Jacobs MA, Schreuder RM, Kamiński MF, Rupińska M, Bhandari P, van Oijen MG, Koens L, Bastiaansen BA, Tytgat KM, Fockens P, Dekker E, Hazewinkel Y. Real-time diagnostic accuracy of blue light imaging, linked color imaging and white-light endoscopy for colorectal polyp characterization. Endosc Int Open 2022; 10:E9-E18. [PMID: 35047330 PMCID: PMC8759942 DOI: 10.1055/a-1594-1693] [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: 04/17/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background and study aims Fujifilm has developed a novel ELUXEO 7000 endoscope system that employs light-emitting diodes (LEDs) at four different wavelengths as light sources that enable blue light imaging (BLI), linked color imaging (LCI), and high-definition white-light endoscopy (HD-WLE). The aim of this study was to address the diagnostic accuracy of real-time polyp characterization using BLI, LCI and HD-WLE (ELUXEO 7000 endoscopy system). Patients methods This is a prespecified post-hoc analysis of a prospective study in which 22 experienced endoscopists (> 2,000 colonoscopies) from eight international centers participated. Using a combination of BLI, LCI, and HD-WLE, lesions were endoscopically characterized including a high- or low-confidence statement. Per protocol, digital images were created from all three imaging modalities. Histopathology was the reference standard. Endoscopists were familiar with polyp characterization, but did not take dedicated training for purposes of this study. Results Overall, 341 lesions were detected in 332 patients. Of the lesions, 269 histologically confirmed polyps with an optical diagnosis were included for analysis (165 adenomas, 27 sessile serrated lesions, and 77 hyperplastic polyps). Overall, polyp characterization was performed with high confidence in 82.9 %. The overall accuracy for polyp characterization was 75.1 % (95 % confidence interval [CI] 69.5-80.1 %), compared with an accuracy of 78.0 % (95 % CI 72.0-83.2 %) for high confidence assignments. The accuracy for endoscopic characterization for diminutive polyps was 74.7 % (95 %CI 68.4-80.3 %), compared with an accuracy of 78.2 % (95 % CI 71.4-84.0 %) for high-confidence assignments. Conclusions The diagnostic accuracy of BLI, LCI, and HD-WLE by experienced endoscopist for real-time polyp characterization seems limited (NCT03344289).
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Affiliation(s)
- Britt B.S.L. Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Jasper L.A. Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut dʼInvestigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut dʼInvestigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clinic of Barcelona, Barcelona, Spain,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut dʼInvestigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Sabine Tejpar
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy,Department of Gastroenterology, Humanitas Clinical and Research Center – IRCCS, Rozzano, Italy
| | - D. Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU University Medical Centre, VU University Amsterdam, Amsterdam, the Netherlands
| | - M. A.J.M Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU University Medical Centre, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ramon-Michel Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Michal F. Kamiński
- Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Maria Rupińska
- Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - M. G.H. van Oijen
- Department of Medical Oncology, Amsterdam University Medical Center, location Academic Medical Centre, University of Amsterdam, the Netherlands
| | - L. Koens
- Department of Pathology, Amsterdam University Medical Center, location Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Barbara A.J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - K. M.A.J. Tytgat
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location Academic Medical Center, University of Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Radboud University of Nijmegen, Nijmegen, The Netherlands
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22
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Houwen BBSL, Hassan C, Coupé VMH, Greuter MJE, Hazewinkel Y, Vleugels JLA, Antonelli G, Bustamante-Balén M, Coron E, Cortas GA, Dinis-Ribeiro M, Dobru DE, East JE, Iacucci M, Jover R, Kuvaev R, Neumann H, Pellisé M, Puig I, Rutter MD, Saunders B, Tate DJ, Mori Y, Longcroft-Wheaton G, Bisschops R, Dekker E. Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2022; 54:88-99. [PMID: 34872120 DOI: 10.1055/a-1689-5130] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 12/12/2022]
Abstract
BACKGROUND : The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 - 5 mm). METHODS : A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. RECOMMENDATION 1: In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. RECOMMENDATION 2: In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. CONCLUSION : The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.
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Affiliation(s)
- Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Marjolein J E Greuter
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Jasper L A Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy.,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Marco Bustamante-Balén
- Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - George A Cortas
- Division of Gastroenterology, University of Balamand, Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal.,RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Daniela E Dobru
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London
| | - Marietta Iacucci
- Institute of Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation.,Department of Gastroenterology, Faculty of Additional Professional Education, N.A. Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany.,GastroZentrum, Lippe, Germany
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Ignasi Puig
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.,Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
| | - Matthew D Rutter
- Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.,University Hospital of North Tees , Stockton-on-Tees, UK
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - David J Tate
- Department of Gastroenterology and Hepatology, University of Ghent, Ghent, Belgium.,University Hospital Ghent, Ghent, Belgium
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven, (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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23
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Ortiz O, Rex DK, Grimm IS, Moyer MT, Hasan MK, Pleskow D, Elmunzer BJ, Khashab MA, Sanaei O, Al-Kawas FH, Gordon SR, Mathew A, Levenick JM, Aslanian HR, Antaki F, von Renteln D, Crockett SD, Rastogi A, Gill JA, Law R, Wallace MB, Elias PA, MacKenzie TA, Pohl H, Pellisé M. Factors associated with complete clip closure after endoscopic mucosal resection of large colorectal polyps. Endoscopy 2021; 53:1150-1159. [PMID: 33291159 DOI: 10.1055/a-1332-6727] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIM : Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of nonpedunculated polyps larger than 20 mm reduces the incidence of severe delayed bleeding, especially in proximal polyps. This study aimed to evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. METHODS : This is a post hoc analysis of the CLIP study (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when no remaining mucosal defect was visible and clips were less than 1 cm apart. Factors associated with complete closure were evaluated in multivariable analysis. RESULTS : In total, 458 patients (age 65, 58 % men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4 %); closure was not complete for 156 (31.6 %). Factors associated with complete closure in adjusted analysis were smaller polyp size (odds ratio 1.06 for every millimeter decrease [95 % confidence interval 1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). CONCLUSIONS : Complete clip closure was not achieved for almost one in three resected large nonpedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable. This highlights the need for alternative closure options and measures to prevent bleeding.
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Affiliation(s)
- Oswaldo Ortiz
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Douglas K Rex
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ian S Grimm
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Matthew T Moyer
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Douglas Pleskow
- Division of Gastroenterology Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - B Joseph Elmunzer
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Omid Sanaei
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Firas H Al-Kawas
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Sibley Memorial Hospital, Washington, DC, USA
| | - Stuart R Gordon
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA.,Department of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Abraham Mathew
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - John M Levenick
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Harry R Aslanian
- Section of Digestive Diseases, Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Fadi Antaki
- Division of Gastroenterology, John D. Dingell Veterans Affairs Medical Center and Wayne State University, Detroit, Michigan, USA
| | - Daniel von Renteln
- Division of Gastroenterology, University of Montreal Medical Center (CHUM) and Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Seth D Crockett
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology, and Motility, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey A Gill
- Division of Gastroenterology, James A. Haley VA, University of South Florida, Tampa, Florida, USA
| | - Ryan Law
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael B Wallace
- Department of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | - Pooja A Elias
- Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Todd A MacKenzie
- The Dartmouth Institute, Department for Biomedical Data Science, Lebanon, New Hampshire, USA
| | - Heiko Pohl
- Department of Gastroenterology and Hepatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Section of Gastroenterology and Hepatology, VA White River Junction, Vermont, USA
| | - Maria Pellisé
- Department of Gastroenterology, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Barcelona, Spain
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24
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Bayó C, Castellano G, Ocaña T, Moreira L, Carballal S, Sánchez A, Moreira R, Ortiz O, Castells A, Pellisé M, Juan-Otero M, Benitez-Ribas D, Balaguer F. SO-26 In-silico Lynch syndrome-related neoantigens prediction for a dendritic cell-based cancer prevention vaccine. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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25
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Keys MT, Serra-Burriel M, Martínez-Lizaga N, Pellisé M, Balaguer F, Sánchez A, Bernal-Delgado E, Castells A. Population-based organized screening by faecal immunochemical testing and colorectal cancer mortality: a natural experiment. Int J Epidemiol 2021; 50:143-155. [PMID: 33211822 DOI: 10.1093/ije/dyaa166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Population-based organized screening programmes for colorectal cancer (CRC) are underway worldwide, with many based on the faecal immunochemical test (FIT). No clinical trials assessing FIT compared with no screening are planned, and few studies have assessed the population impact of such programmes. METHODS Before 2010, 11 out of 50 Spanish provinces initiated population-based organized screening programmes with FIT for an average-risk population aged 50-69 years. We used a quasi-experimental design across Spanish provinces between 1999 and 2016 to evaluate their impact on population age-standardized mortality and incidence rates due to CRC. Difference-in-differences and synthetic control analyses were performed to test for validation of statistical assumptions and to assess the dynamics of screening-associated changes in outcomes over time. RESULTS No differences in outcome trends between exposed (n = 11) and control (n = 36) provinces were observed for up to 7 years preceding the implementation of screening. Relative to controls, exposed provinces experienced a mean increase in age-standardized incidence of 10.08% [95% confidence interval (CI) (5.09, 15.07)] 2 years after implementation, followed by a reduction in age-standardized mortality rates due to CRC of 8.82% [95% CI (3.77, 13.86)] after 7 years. Results were similar for both women and men. No associated changes were observed in adjacent age bands not targeted by screening, nor for 10 other major causes of death in the exposed provinces. CONCLUSIONS FIT-based organized screening in Spain was associated with reductions in population colorectal cancer mortality. Further research is warranted in order to assess the replicability and external validity of our findings, and on gender-specific use of FIT in organized screening.
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Affiliation(s)
- Matthew T Keys
- Department of Public Health, Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.,Department of Economics, Center for Research in Health and Economics (CRES), Pompeu Fabra University, Barcelona, Spain
| | - Miquel Serra-Burriel
- Department of Economics, Center for Research in Health and Economics (CRES), Pompeu Fabra University, Barcelona, Spain
| | - Natalia Martínez-Lizaga
- Data Science in Health Services and Policy Research, Institute for Health Sciences in Aragón (IACS), Zaragoza, Spain.,Spanish Health Services Research Network on Chronic Diseases (REDISSEC), Zaragoza, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd, University of Barcelona, Barcelona, Spain
| | - Ariadna Sánchez
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd, University of Barcelona, Barcelona, Spain
| | - Enrique Bernal-Delgado
- Data Science in Health Services and Policy Research, Institute for Health Sciences in Aragón (IACS), Zaragoza, Spain.,Spanish Health Services Research Network on Chronic Diseases (REDISSEC), Zaragoza, Spain
| | - Antoni Castells
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERehd, University of Barcelona, Barcelona, Spain
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26
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Medina-Prado L, Hassan C, Dekker E, Bisschops R, Alfieri S, Bhandari P, Bourke MJ, Bravo R, Bustamante-Balen M, Dominitz J, Ferlitsch M, Fockens P, van Leerdam M, Lieberman D, Herráiz M, Kahi C, Kaminski M, Matsuda T, Moss A, Pellisé M, Pohl H, Rees C, Rex DK, Romero-Simó M, Rutter MD, Sharma P, Shaukat A, Thomas-Gibson S, Valori R, Jover R. When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement. Clin Gastroenterol Hepatol 2021; 19:1038-1050. [PMID: 33493699 DOI: 10.1016/j.cgh.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/19/2020] [Revised: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. METHODS The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. RESULTS A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). CONCLUSIONS This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.
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Affiliation(s)
- Lucía Medina-Prado
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Sergio Alfieri
- Surgery Department, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital. Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Raquel Bravo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
| | - Marco Bustamante-Balen
- Gastrointestinal Endoscopy Unit, Gastrointestinal Endoscopy Research Group, Health Research Institute (Instituto de Investigación Sanitaria La Fe. NHS: National Health Service), Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jason Dominitz
- Gastroenterology Department, VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | - Monika Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Monique van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - Maite Herráiz
- Departamento de Digestivo, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Charles Kahi
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michal Kaminski
- Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
| | - Maria Pellisé
- Gastroenterology Department, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia Spain
| | - Heiko Pohl
- Department of Gastroenterology and Hepatology, VA Medical Center, White River Junction, Vermont; Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Colin Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, United Kingdom
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Manuel Romero-Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Matthew D Rutter
- University Hospital of North Tees, Stockton on Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, VA Medical Center, University of Kansas School of Medicine, Kansas City, Kansas
| | - Aasma Shaukat
- Section of Gastroenterology, Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, and Imperial College, London, United Kingdom
| | - Roland Valori
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
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Hernández-Tejero M, Rodríguez de Santiago E, Pellisé M. Reply. Clin Gastroenterol Hepatol 2021; 19:852-853. [PMID: 33248081 DOI: 10.1016/j.cgh.2020.06.003] [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] [Received: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- María Hernández-Tejero
- Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Universitat de Barcelona, Barcelona, Spain
| | - Enrique Rodríguez de Santiago
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi i Sunyer
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Duran-Sanchon S, Moreno L, Gómez-Matas J, Augé JM, Serra-Burriel M, Cuatrecasas M, Moreira L, Serradesanferm A, Pozo À, Grau J, Pellisé M, Gironella M, Castells A. Fecal MicroRNA-Based Algorithm Increases Effectiveness of Fecal Immunochemical Test-Based Screening for Colorectal Cancer. Clin Gastroenterol Hepatol 2021; 19:323-330.e1. [PMID: 32113893 DOI: 10.1016/j.cgh.2020.02.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 10/16/2019] [Revised: 02/07/2020] [Accepted: 02/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS An algorithm based on fecal levels of 2 microRNAs (miR-421 and miR-27a-3p), fecal hemoglobin concentration, and patient age and sex can identify patients with advanced colorectal neoplasia. We investigated whether this algorithm, called miRFec, could increase effectiveness and efficiency of fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening programs. METHODS We obtained data and fecal samples from 767 persons with a positive result from the FIT who then underwent colonoscopy examination while participating a population-based CRC screening program, from March 2011 through May 2017 in Barcelona, Spain. Fecal miRNAs were isolated from the buffer contained in the original FIT collection device and analyzed by quantitative reverse transcription PCR. Aims were to evaluate the usefulness of the miRFec algorithm in identifying persons at greatest risk for CRC who should be prioritized for colonoscopy examination and individuals at low risk for whom colonoscopy could be avoided. RESULTS Of the 767 study subjects, 414 (54.0%) were found by colonoscopy to have advanced colorectal neoplasia (67 with CRC and 347 with advanced adenomas) and 353 (46.0%) were found to have either non-advanced adenomas (n = 136) or a normal examination (n = 217). MiRFec algorithm scores (1-4) were independently associated with the presence of advanced colorectal neoplasia (P < .001). The miRFec algorithm differentiated patients with CRC from those with non-advanced adenomas or normal colonoscopy with an area under the receiver operating characteristic curve of 90% (95% CI, 86-94). Subjects with miRFec scores in the 4th quartile (above 3.09, high-risk group) were 8-fold more likely to have advanced colorectal neoplasia than subjects with miRFec scores in the 1st quartile (below 2.14, low-risk group). Subjects in the low-risk group had a positive predictive value below 30% for detection of advanced colorectal neoplasia. When we used a 50% specificity cut-off value, the miRFec algorithm identified 97% of patients with CRC and would allow 264 subjects (34.4%) to avoid colonoscopy examination. CONCLUSIONS An algorithm based on fecal levels of 2 miRNAs and hemoglobin, patient age and sex (miRFec) differentiated patients with CRC from those with non-advanced adenomas or normal colonoscopy with an area under the receiver operating characteristic curve value of 90% and avoided 34% of colonoscopies. Inclusion of this algorithm in FIT-based CRC screening programs could increase their effectiveness and efficiency.
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Affiliation(s)
- Saray Duran-Sanchon
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Javier Gómez-Matas
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Josep M Augé
- Biochemistry and Molecular Genetics Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Míriam Cuatrecasas
- Pathology Department and Tumour Bank-Biobank, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Àngels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Meritxell Gironella
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Barcelona, Spain.
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Ginès À, Fernández-Esparrach G, Pellisé M, Sendino O, Balaguer F, Llach J, González-Suárez B, Saló S. Critical importance of early introduction of prevention measures for SARS-CoV-2 infection in endoscopy units. Gastrointest Endosc 2020; 92:936-937. [PMID: 32553570 PMCID: PMC7831867 DOI: 10.1016/j.gie.2020.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Àngels Ginès
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Glòria Fernández-Esparrach
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Oriol Sendino
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Begoña González-Suárez
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Swagotika Saló
- Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), University of Barcelona, Barcelona, Spain
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30
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Pellisé M. The COVID-19 pandemic and colorectal cancer prevention: God tempers the wind to the shorn lamb. Endoscopy 2020; 52:877-878. [PMID: 32967017 PMCID: PMC7516359 DOI: 10.1055/a-1243-1372] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
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31
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Gralnek IM, Hassan C, Beilenhoff U, Antonelli G, Ebigbo A, Pellisé M, Arvanitakis M, Bhandari P, Bisschops R, Van Hooft JE, Kaminski MF, Triantafyllou K, Webster G, Voiosu AM, Pohl H, Dunkley I, Fehrke B, Gazic M, Gjergek T, Maasen S, Waagenes W, de Pater M, Ponchon T, Siersema PD, Messmann H, Dinis-Ribeiro M. ESGE and ESGENA Position Statement on gastrointestinal endoscopy and COVID-19: An update on guidance during the post-lockdown phase and selected results from a membership survey. Endoscopy 2020; 52:891-898. [PMID: 32643767 PMCID: PMC7520543 DOI: 10.1055/a-1213-5761] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ian M. Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, and Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | | | | | | | - Alanna Ebigbo
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clinic de Barcelona. Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd). Universitat de Barcelona, Barcelona, Spain
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Pradeep Bhandari
- Gastroenterology, Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospitals Leuven, Leuven, Belgium
| | - Jeanin E. Van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michal F. Kaminski
- Department of Cancer Prevention and Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Department of Internal Medicine – Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - George Webster
- Department of Gastroenterology, University College London Hospitals, London, United Kingdom
| | - Andrei M. Voiosu
- Department of Gastroenterology and Hepatology, Colentina Clinical Hospital, Bucharest, Romania
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover New Hampshire, VA Medical Center, Section of Gastroenterology, White River Junction, Vermont, USA
| | - Irene Dunkley
- North West Anglia NHS Foundation Trust, Hinchingbrooke, United Kingdom
| | | | | | | | | | | | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Mario Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Portugal
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González-Suárez B, Pagés M, Araujo IK, Romero C, Rodríguez de Miguel C, Ayuso JR, Pozo À, Vila-Casadesús M, Serradesanferm A, Ginès À, Fernández-Esparrach G, Pellisé M, López-Cerón M, Flores D, Córdova H, Sendino O, Grau J, Llach J, Serra-Burriel M, Cárdenas A, Balaguer F, Castells A. Colon capsule endoscopy versus CT colonography in FIT-positive colorectal cancer screening subjects: a prospective randomised trial-the VICOCA study. BMC Med 2020; 18:255. [PMID: 32943059 PMCID: PMC7500543 DOI: 10.1186/s12916-020-01717-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/18/2019] [Accepted: 07/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Colon capsule endoscopy (CCE) and CT colonography (CTC) are minimally invasive techniques for colorectal cancer (CRC) screening. Our objective is to compare CCE and CTC for the identification of patients with colorectal neoplasia among participants in a CRC screening programme with positive faecal immunochemical test (FIT). Primary outcome was to compare the performance of CCE and CTC in detecting patients with neoplastic lesions. METHODS The VICOCA study is a prospective, single-centre, randomised trial conducted from March 2014 to May 2016; 662 individuals were invited and 349 were randomised to CCE or CTC before colonoscopy. Endoscopists were blinded to the results of CCE and CTC. RESULTS Three hundred forty-nine individuals were included: 173 in the CCE group and 176 in the CTC group. Two hundred ninety individuals agreed to participate: 147 in the CCE group and 143 in the CTC group. In the intention-to-screen analysis, sensitivity, specificity and positive and negative predictive values for the identification of individuals with colorectal neoplasia were 98.1%, 76.6%, 93.7% and 92.0% in the CCE group and 64.9%, 95.7%, 96.8% and 57.7% in the CTC group. In terms of detecting significant neoplastic lesions, the sensitivity of CCE and CTC was 96.1% and 79.3%, respectively. Detection rate for advanced colorectal neoplasm was higher in the CCE group than in the CTC group (100% and 93.1%, respectively; RR = 1.07; p = 0.08). Both CCE and CTC identified all patients with cancer. CCE detected more patients with any lesion than CTC (98.6% and 81.0%, respectively; RR = 1.22; p = 0.002). CONCLUSION Although both techniques seem to be similar in detecting patients with advanced colorectal neoplasms, CCE is more sensitive for the detection of any neoplastic lesion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02081742 . Registered: September 16, 2013.
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Affiliation(s)
- Begoña González-Suárez
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
| | - Mario Pagés
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Isis Karina Araujo
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Romero
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Juan Ramón Ayuso
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Àngels Pozo
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Maria Vila-Casadesús
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Anna Serradesanferm
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Àngels Ginès
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Glòria Fernández-Esparrach
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - María López-Cerón
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Flores
- Radiology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Henry Córdova
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Oriol Sendino
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jaume Grau
- Department of Preventive Medicine and Epidemiology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Llach
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economic, Pompeu Fabra University, Barcelona, Spain
| | - Andrés Cárdenas
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Catalonia, Spain
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33
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Llach J, Moreno L, Sánchez A, Herrera-Pariente C, Ocaña T, Cuatrecasas M, Rivero-Sánchez L, Moreira R, Díaz M, Jung G, Pellisé M, Castells A, Balaguer F, Carballal S, Moreira L. Genetic Counseling for Hereditary Gastric and Pancreatic Cancer in High-Risk Gastrointestinal Cancer Clinics: An Effective Strategy. Cancers (Basel) 2020; 12:cancers12092386. [PMID: 32842532 PMCID: PMC7564434 DOI: 10.3390/cancers12092386] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The identification of high-risk groups of gastric (GC) and pancreatic adenocarcinoma (PC) due to a hereditary basis could imply a benefit in the affected families by establishing personalized preventive strategies. We aimed at assessing the diagnostic yield of GC/PC hereditary syndromes in individuals evaluated based on specific clinical criteria. In total, 77 unrelated individuals (45 from GC group/32 from PC group) were recruited: 51 (66.2%) cancer diagnosis ≤60 years, 3 (4%) with personal history of GC/PC and other cancer and 23 (29.8%) due to family history. Immunohistochemical analysis of DNA mismatch repair proteins was performed in 38 (49.3%) available tumors, being pathological in one (2%) GC. A genetic analysis was performed if clinical criteria of hereditary syndrome were fulfilled, identifying a mutation in 10/22 (45.5%) families [7/16 (43.7%) with GC and 3/6 (50%) with PC] and 19 (24.7%) fulfilled criteria of familial cancer. Diagnosis of cancer <40 years and personal history of other cancers were independent risk factors of a hereditary syndrome [OR:11.3 (95%IC 1.9–67); p = 0.007 and OR:17.4 (95% IC 2.5–119.9); p = 0.004; respectively]. The selection of patients based on clinical criteria leads to high diagnostic yield, detecting a causative germline mutation in almost half of the cases; therefore, both meticulous genetic counseling and use of multi-gen panels is crucial.
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Affiliation(s)
- Joan Llach
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Ariadna Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Cristina Herrera-Pariente
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Teresa Ocaña
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Miriam Cuatrecasas
- Pathology Department, Centre for Biomedical Diagnosis, Hospital Clínic, 08036 Barcelona, Spain;
| | - Liseth Rivero-Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Rebeca Moreira
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Mireia Díaz
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Gerhard Jung
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Sabela Carballal
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
- Correspondence: ; Tel.: +34-93-227-5739; Fax: +34-93-227-5589
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Spadaccini M, Frazzoni L, Vanella G, East J, Radaelli F, Spada C, Fuccio L, Benamouzig R, Bisschops R, Bretthauer M, Dekker E, Dinis-Ribeiro M, Ferlitsch M, Gralnek I, Jover R, Kaminski MF, Pellisé M, Triantafyllou K, Van Hooft JE, Dumonceau JM, Marmo C, Alfieri S, Chandrasekar VT, Sharma P, Rex DK, Repici A, Hassan C. Efficacy and Tolerability of High- vs Low-Volume Split-Dose Bowel Cleansing Regimens for Colonoscopy: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:1454-1465.e14. [PMID: 31683057 DOI: 10.1016/j.cgh.2019.10.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 07/09/2019] [Revised: 10/17/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Efficacy of bowel preparation is an important determinant of outcomes of colonoscopy. It is not clear whether approved low-volume polyethylene glycol (PEG) and non-PEG regimens are as effective as high-volume PEG regimens when taken in a split dose. METHODS In a systematic review of multiple electronic databases through January 31, 2019 with a registered protocol (PROSPERO: CRD42019128067), we identified randomized controlled trials that compared low- vs high-volume bowel cleansing regimens, administered in a split dose, for colonoscopy. The primary efficacy outcome was rate of adequate bowel cleansing, and the secondary efficacy outcome was adenoma detection rate. Primary tolerability outcomes were compliance, tolerability, and willingness to repeat. We calculated relative risk (RR) and 95% CI values and assessed heterogeneity among studies by using the I2 statistic. The overall quality of evidence was assessed using the GRADE framework. RESULTS In an analysis of data from 17 randomized controlled trials, comprising 7528 patients, we found no significant differences in adequacy of bowel cleansing between the low- vs high-volume split-dose regimens (86.1% vs 87.4%; RR, 1.00; 95% CI, 0.98-1.02) and there was minimal heterogeneity (I2 = 17%). There was no significant difference in adenoma detection rate (RR, 0.96; 95% CI, 0.87-1.08) among 4 randomized controlled trials. Compared with high-volume, split-dose regimens, low-volume split-dose regimens had higher odds for compliance or completion (RR, 1.06; 95% CI, 1.02-1.10), tolerability (RR, 1.39; 95% CI, 1.12-1.74), and willingness to repeat bowel preparation (RR, 1.41; 95% CI, 1.20-1.66). The overall quality of evidence was moderate. CONCLUSIONS Based on a systematic review of 17 randomized controlled trials, low-volume, split-dose regimens appear to be as effective as high-volume, split-dose regimens in bowel cleansing and are better tolerated, with superior compliance.
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Affiliation(s)
| | - Leonardo Frazzoni
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Vanella
- Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom
| | | | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Michael Bretthauer
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium; Institute of Health and Society, University of Oslo Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Austria
| | - Ian Gralnek
- Institute of Gastroenterology and Hepatology Emek Medical Center, Afula, Israel
| | - Rodrigo Jover
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Maria Pellisé
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Konstantinos Triantafyllou
- Ηepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Athens University, Athens, Greece
| | - Jeanin E Van Hooft
- Department of Gastroenterology and Hepatology Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Clelia Marmo
- Division of Surgical Digestive System, University Hospital Second University of Naples, Naples, Italy
| | - Sergio Alfieri
- Fondazione Policlinico A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Prateek Sharma
- Kansas City Veterans Affairs Hospital, Kansas City, Missouri
| | - Doug K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
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35
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Duran-Sanchon S, Moreno L, Augé JM, Serra-Burriel M, Cuatrecasas M, Moreira L, Martín A, Serradesanferm A, Pozo À, Costa R, Lacy A, Pellisé M, Lozano JJ, Gironella M, Castells A. Identification and Validation of MicroRNA Profiles in Fecal Samples for Detection of Colorectal Cancer. Gastroenterology 2020; 158:947-957.e4. [PMID: 31622624 DOI: 10.1053/j.gastro.2019.10.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [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: 06/25/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Screening for colorectal cancer (CRC) is effective in the population at average risk. The most extended strategy in organized programs involves the fecal immunochemical test, which is limited by low sensitivity for the detection of advanced adenomas (AAs). We aimed to identify microRNA (miRNA) signatures in fecal samples that identify patients with AAs or CRC and might be used in noninvasive screening. METHODS Our study comprised 4 stages. In the discovery phase, we performed genome-wide miRNA expression profiling of 124 fresh, paired colorectal tumor and nontumor samples (30 CRC; 32 AAs) from patients in Spain. In the technical validation stage, miRNAs with altered expression levels in tumor vs nontumor tissues were quantified by reverse-transcription polymerase chain reaction in fecal samples from a subset of patients included in the discovery phase (n = 39) and individuals without colorectal neoplasms (controls, n = 39). In the clinical validation stage, the miRNAs found to be most significantly up-regulated by quantitative reverse transcription polymerase chain reaction analysis were measured in an independent set of fecal samples (n = 767) from patients with positive results from fecal immunochemical tests in a CRC screening program. Finally, we developed a model to identify patients with advanced neoplasms (CRCs or AAs) based on their miRNA profiles, using findings from colonoscopy as the reference standard. RESULTS Among 200 and 324 miRNAs significantly deregulated in CRC and AA tissues, respectively, 7 and 5 of these miRNAs were also found to be deregulated in feces (technical validation). Of them, MIR421, MIR130b-3p, and MIR27a-3p were confirmed to be upregulated in fecal samples from patients with advanced neoplasms. In our model, the combination of fecal level of MIR421, MIR27a-3p, and hemoglobin identified patients with CRC with an area under the curve (AUC) of 0.93, compared with an AUC of 0.67 for fecal hemoglobin concentration alone. CONCLUSIONS We found that increased levels of 2 miRNAs and hemoglobin in feces can identify patients with AAs or CRC more accurately than fecal hemoglobin concentration alone. Assays for these miRNAs might be added to fecal tests for the detection of CRC or AAs.
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Affiliation(s)
- Saray Duran-Sanchon
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Josep M Augé
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Catalonia, Spain
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Míriam Cuatrecasas
- Pathology Department and Tumour Bank-Biobank, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Agatha Martín
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Àngels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Rosa Costa
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Antonio Lacy
- Gastrointestinal Surgery Department, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Juan José Lozano
- Bioinformatics Platform, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Meritxell Gironella
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Catalonia, Spain.
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36
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Bisschops R, East JE, Hassan C, Hazewinkel Y, Kamiński MF, Neumann H, Pellisé M, Antonelli G, Bustamante Balen M, Coron E, Cortas G, Iacucci M, Yuichi M, Longcroft-Wheaton G, Mouzyka S, Pilonis N, Puig I, van Hooft JE, Dekker E. Correction: Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy 2019; 51:C6. [PMID: 31853914 DOI: 10.1055/a-1074-5788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 12/13/2022]
Affiliation(s)
- Raf Bisschops
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, TARGID, KU Leuven, Belgium
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michał F Kamiński
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maria Pellisé
- Department of Gastroenterology. Institut Clinic de Malalties Digestives I Metabòliques, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Giulio Antonelli
- Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Marco Bustamante Balen
- Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Emmanuel Coron
- CHU Nantes, Université Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Nantes, France
| | - Georges Cortas
- Division of Gastroenterology, University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Marietta Iacucci
- Institute of Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, UK
| | - Mori Yuichi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Serguei Mouzyka
- National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Nastazja Pilonis
- Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Ignasi Puig
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.,Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
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37
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Bisschops R, East JE, Hassan C, Hazewinkel Y, Kamiński MF, Neumann H, Pellisé M, Antonelli G, Bustamante Balen M, Coron E, Cortas G, Iacucci M, Yuichi M, Longcroft-Wheaton G, Mouzyka S, Pilonis N, Puig I, van Hooft JE, Dekker E. Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy 2019; 51:1155-1179. [PMID: 31711241 DOI: 10.1055/a-1031-7657] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [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] [Indexed: 02/07/2023]
Abstract
1: ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist's adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2: ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3: ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4: ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5: ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6: ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7: ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.
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Affiliation(s)
- Raf Bisschops
- University Hospitals Leuven, Department of Gastroenterology and Hepatology, TARGID, KU Leuven, Belgium
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Oxford National Institute for Health Research Biomedical Research Centre, Oxford, UK
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michał F Kamiński
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maria Pellisé
- Department of Gastroenterology. Institut Clinic de Malalties Digestives I Metabòliques, Hospital Clinic of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Giulio Antonelli
- Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Marco Bustamante Balen
- Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Emmanuel Coron
- CHU Nantes, Université Nantes, Institut des Maladies de l'Appareil Digestif (IMAD), Nantes, France
| | - Georges Cortas
- Division of Gastroenterology, University of Balamand Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Marietta Iacucci
- Institute of Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals, Birmingham NHS Foundation Trust, UK
| | - Mori Yuichi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Serguei Mouzyka
- National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Nastazja Pilonis
- Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Ignasi Puig
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.,Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, The Netherlands
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38
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van Leerdam ME, Roos VH, van Hooft JE, Balaguer F, Dekker E, Kaminski MF, Latchford A, Neumann H, Ricciardiello L, Rupińska M, Saurin JC, Tanis PJ, Wagner A, Jover R, Pellisé M. Endoscopic management of Lynch syndrome and of familial risk of colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51:1082-1093. [PMID: 31597170 DOI: 10.1055/a-1016-4977] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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
ESGE recommends that individuals with Lynch syndrome should be followed in dedicated units that practice monitoring of compliance and endoscopic performance measures.Strong recommendation, low quality evidence, level of agreement 100 %.ESGE recommends starting colonoscopy surveillance at the age of 25 years for MLH1 and MSH2 mutation carriers and at the age of 35 years for MSH6 and PMS2 mutation carriers.Strong recommendation, moderate quality evidence, level of agreement 100 %. ESGE recommends the routine use of high-definition endoscopy systems in individuals with Lynch syndrome. Strong recommendation, high quality evidence, level of agreement 100 %. ESGE suggests the use of chromoendoscopy may be of benefit in individuals with Lynch syndrome undergoing colonoscopy; however routine use must be balanced against costs, training, and practical considerations.Weak recommendation, moderate quality evidence, level of agreement 89 %.ESGE recommends definition of familial risk of colorectal cancer as the presence of at least two first-degree relatives with colorectal cancer or at least one first-degree relative with colorectal cancer before the age of 50 years.Strong recommendation, moderate quality evidence, level of agreement 92 %.ESGE recommends colonoscopy surveillance in first-degree relatives of colorectal cancer patients in families that fulfill the definition of familial risk of colorectal cancer.Strong recommendation, moderate quality evidence, level of agreement 100 %.
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Affiliation(s)
- Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands, Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands
| | - Victorine H Roos
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Michal F Kaminski
- Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Andrew Latchford
- Polyposis Registry, St. Mark's Hospital, Harrow, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Rupińska
- Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, , Amsterdam, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus University Medical Center, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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van Leerdam ME, Roos VH, van Hooft JE, Dekker E, Jover R, Kaminski MF, Latchford A, Neumann H, Pellisé M, Saurin JC, Tanis PJ, Wagner A, Balaguer F, Ricciardiello L. Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2019; 51:877-895. [PMID: 31342472 DOI: 10.1055/a-0965-0605] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [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] [Indexed: 12/14/2022]
Abstract
ESGE recommends that individuals with hereditary gastrointestinal polyposis syndromes should be surveilled in dedicated units that provide monitoring of compliance and endoscopic performance measures. Strong recommendation, moderate quality of evidence, level of agreement 90 %.ESGE recommends performing esophagogastroduodenoscopy, small-bowel examination, and/or colonoscopy earlier than the planned surveillance procedure if a patient is symptomatic. Strong recommendation, low quality of evidence, level of agreement 100 %.
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Affiliation(s)
- Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center and Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands
| | - Victorine H Roos
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Michal F Kaminski
- Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Andrew Latchford
- Polyposis Registry, St. Mark's Hospital, Harrow, United Kingdom.,Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Jean-Christophe Saurin
- Gastroenterology and Endoscopy Unit, Hospices Civils de Lyon, Hôpital E. Herriot, Lyon, France
| | - Pieter J Tanis
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Anja Wagner
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Luigi Ricciardiello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Hassan C, East J, Radaelli F, Spada C, Benamouzig R, Bisschops R, Bretthauer M, Dekker E, Dinis-Ribeiro M, Ferlitsch M, Fuccio L, Awadie H, Gralnek I, Jover R, Kaminski MF, Pellisé M, Triantafyllou K, Vanella G, Mangas-Sanjuan C, Frazzoni L, Van Hooft JE, Dumonceau JM. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy 2019; 51:775-794. [PMID: 31295746 DOI: 10.1055/a-0959-0505] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [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: 12/12/2022]
Abstract
ESGE recommends a low fiber diet on the day preceding colonoscopy.Strong recommendation, moderate quality evidence.ESGE recommends the use of enhanced instructions for bowel preparation.Strong recommendation, moderate quality evidence.ESGE suggests adding oral simethicone to bowel preparation.Weak recommendation, moderate quality evidence.ESGE recommends split-dose bowel preparation for elective colonoscopy.Strong recommendation, high quality evidence.ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing.Strong recommendation, high quality evidence.ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure.Strong recommendation, moderate quality evidence.ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.Strong recommendation, moderate quality evidence.
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Affiliation(s)
- Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, United Kingdom
| | | | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Raf Bisschops
- University Hospitals Leuven, KU Leuven, Department of Gastroenterology and Hepatology
| | - Michael Bretthauer
- Institute of Health and Society, University of Oslo Department of Transplantation Medicine, Oslo University Hospital, Norway
| | - E Dekker
- Department of Gastroenterology and Hepatology Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology & Hepatology, Medical University of Vienna, Austria; Austrian Society of Gastroenterology and Hepatology (OEGGH): Quality Assurance Working Group, Austria
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Halim Awadie
- Institute of Gastroenterology and Hepatology Emek Medical Center Afula, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Israel
| | - Ian Gralnek
- Institute of Gastroenterology and Hepatology Emek Medical Center Afula, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Israel
| | - Rodrigo Jover
- Servicio de Medicina Digestiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Center for Postgraduate Medical Education, Warsaw, Poland
| | - Maria Pellisé
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Konstantinos Triantafyllou
- Ηepatogastroenterology Unit, Second Department of Internal Medicine and Research Institute, Athens University, Athens Greece
| | - Giuseppe Vanella
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Carolina Mangas-Sanjuan
- Servicio de Medicina Digestiva. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Leonardo Frazzoni
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Jeanin E Van Hooft
- Department of Gastroenterology and Hepatology Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Pellisé M, Balaguer F. Serrated polyposis syndrome: time to rethink endoscopic treatment and surveillance. Gastrointest Endosc 2019; 90:101-104. [PMID: 31228973 DOI: 10.1016/j.gie.2019.04.224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023]
Affiliation(s)
- Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
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Reyes R, Ayuso J, Pagés M, Conill C, Darnell A, Pineda E, Gines A, Fernández-Esparrach M, Cuatrecasas M, Moreno R, Lacy A, Pellisé M, Maurel J. Do we need adjuvant therapy in patients with rectal cancer and pathologic complete response, after conventional preoperative chemoradiation and laparoscopic (LapTME) or Transanal total mesorectal excision (TaTME)? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Quintanilla I, López-Cerón M, Jimeno M, Cuatrecasas M, Zabalza M, Moreira L, Alonso V, Rodríguez de Miguel C, Muñoz J, Castellvi-Bel S, Llach J, Castells A, Balaguer F, Camps J, Pellisé M. Rectal Aberrant Crypt Foci in Humans Are Not Surrogate Markers for Colorectal Cancer Risk. Clin Transl Gastroenterol 2019; 10:e00047. [PMID: 31136360 PMCID: PMC6613864 DOI: 10.14309/ctg.0000000000000047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 02/22/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Over the past 20 years, aberrant crypt foci (ACF) have emerged as potential precursors and biomarkers for colorectal cancer (CRC). However, data regarding their molecular pathogenesis, as well as their endoscopic and histological identification, remain inconsistent. METHODS A wide cohort of ACF from 100 control subjects and 100 case patients, including patients with adenoma and CRC, were characterized for endoscopic, morphologic, and molecular features. RESULTS We observed that among all the endoscopic features evaluated, only the number of large ACF correlated with CRC risk (P = 0.003), whereas the histological classification, as assessed by 2 different pathologists, was inconsistent and did not differ between control and case patients. Moreover, only a few APC and BRAF mutations and no microsatellite instability were detected in our samples. KRAS mutations were detected in 16.3% of ACF samples, which also exhibited increased MGMT hypermethylation. However, none of those events were found to be predictive of CRC risk. DISCUSSION Although ACF might be preneoplastic lesions of the colon, they are not suitable biomarkers for assessing CRC progression.
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Affiliation(s)
- Isabel Quintanilla
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - María López-Cerón
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Mireya Jimeno
- Pathology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Centre de Diagnòstic Biomèdic, Hospital Clínic and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
| | - Michel Zabalza
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Leticia Moreira
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Virginia Alonso
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Cristina Rodríguez de Miguel
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Jennifer Muñoz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sergi Castellvi-Bel
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Josep Llach
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Antoni Castells
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Francesc Balaguer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Jordi Camps
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, (IDIBAPS), University of Barcelona, Barcelona, Spain
- Gastroenterology Department, Institut de Malalties Digestives i Metabòliques, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
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Buron A, Román M, Augé JM, Macià F, Grau J, Sala M, Louro J, Martinez-Alonso M, Alvarez-Urturi C, Andreu M, Bessa X, Zaffalon D, Castells A, Pellisé M, Aldea M, Rivero L, Hernández C, Torá-Rocamora I, Castells X. Changes in FIT values below the threshold of positivity and short-term risk of advanced colorectal neoplasia: Results from a population-based cancer screening program. Eur J Cancer 2019; 107:53-59. [DOI: 10.1016/j.ejca.2018.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/28/2018] [Accepted: 11/01/2018] [Indexed: 12/24/2022]
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Rivero-Sánchez L, Grau J, Augé JM, Moreno L, Pozo A, Serradesanferm A, Díaz M, Carballal S, Sánchez A, Moreira L, Balaguer F, Pellisé M, Castells A. Colorectal cancer after negative colonoscopy in fecal immunochemical test-positive participants from a colorectal cancer screening program. Endosc Int Open 2018; 6:E1140-E1148. [PMID: 30211305 PMCID: PMC6133669 DOI: 10.1055/a-0650-4296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/27/2018] [Accepted: 05/14/2018] [Indexed: 12/18/2022] Open
Abstract
Background and study aims Colorectal cancer (CRC) risk after a positive fecal immunochemical test (FIT) and negative colonoscopy is unknown. We aimed to ascertain the cumulative incidence of post-colonoscopy colorectal cancer (PCCRC) and the manifestation of other lesions that could explain the test positivity in individuals with a negative colonoscopy in a population screening program. Patients and method Observational study in participants from the first round of a CRC screening program (2010 - 2012) with positive-FIT (≥ 20 μg/g of feces) and negative colonoscopy (without neoplasia). A 42- to 76-month follow-up was performed searching in the National Health Service database and by a brief structured telephonic interview. Results Of 2659 FIT-positive individuals who underwent colonoscopy, 811 (30.5 %) had a negative colonoscopy. Three PCCRC (0.4 %) were detected within 11 - 28 months and accelerated carcinogenesis was ruled out. Among those with normal colonoscopy, 32 (5 %) relevant lesions were detected at follow-up. One-third of them (11/32) were significant neoplasias: a gastric cancer, a small-bowel lymphoma, six advanced colorectal adenomas, and the three PCCRC. The 21 remaining lesions were inflammatory, vascular disorders, or non-advanced colorectal adenomas. Conclusions The vast majority (95 %) of individuals did not present any subsequent lesion that could explain the FIT positivity. The very low incidence (0.4 %) and characteristics of PCCRC observed in our cohort reinforce the concept that, although a positive FIT preselects high risk individuals, a high quality colonoscopy is the paramount factor in preventing PCCRC. Improving quality standards of colonoscopy are required to strengthen the current CRC screening strategies.
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Affiliation(s)
- Liseth Rivero-Sánchez
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Jaume Grau
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Josep María Augé
- Biochemistry Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
| | - Angels Pozo
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Anna Serradesanferm
- Preventive Medicine and Hospital Epidemiology Department, Hospital Clínic, Barcelona, Spain
| | - Mireia Díaz
- Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
| | - Sabela Carballal
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Ariadna Sánchez
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Corresponding author Dr María Pellisé Department of GastroenterologyHospital ClínicVillarroel 17008036 BarcelonaCataloniaSpain+34-93-2275589
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universitat de Barcelona, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Burón A, Macià F, Andreu M, Pellisé M, Castells X, Grau J. Population-based colorectal cancer screening: Interval cancers and relationship with the quantitative faecal immunological for hemoglobin. Med Clin (Barc) 2018; 152:303-306. [PMID: 30146355 DOI: 10.1016/j.medcli.2018.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/27/2018] [Revised: 06/27/2018] [Accepted: 06/28/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVE The sensitivity of colorectal cancer screening programmes determines their effectiveness and is directly related to the interval cancer (IC). This study describes the frequency and characteristics of the IC of the Programme of Barcelona, Spain, and analyses its relationship with the quantitative value of the screening test (FIT). MATERIAL AND METHODS ICs after negative FIT of the first two rounds of the Programme (2010-2013) were included, observation period until July 2017. The information source of the ICs was their notification by professionals and patients, hospital databases and CMBD (Spanish Minimum Basic Data Set). RESULTS The sensitivity of the Programme is 82%. ICs are diagnosed more in proximal and rectal colon and in advanced stages than screening cancers, and have higher FIT values than overall people with negative FIT. CONCLUSIONS The sensitivity is acceptable and comparable to that of other programmes. The quantitative value of FIT in people with negative test should be included in the personalisation strategies of screening to reduce the risk of IC.
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Affiliation(s)
- Andrea Burón
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; REDISSEC (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas), Madrid, España.
| | - Francesc Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; REDISSEC (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas), Madrid, España
| | - Montserrat Andreu
- IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; Servicio de Gastroenterología, Hospital del Mar, Barcelona, España
| | - Maria Pellisé
- Servicio de Gastroenterología, Hospital Clínic, Barcelona, IDIBAPS, Barcelona, España; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, España; Universidad de Barcelona, Barcelona, España
| | - Xavier Castells
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, España; REDISSEC (Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas), Madrid, España
| | - Jaume Grau
- Universidad de Barcelona, Barcelona, España; Servicio de Preventiva y Epidemiología, ICMID, Hospital Clínic, Barcelona, España
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Zapata L, Quintanilla I, Asensio E, Pellisé M, Cuatrecasas M, Ossowski S, Graham T, Castells A, Sottoriva A, Camps J. PO-334 Distribution of copy number alterations defines clonal populations involved in the evolutionary transition from adenoma-to-carcinoma in colorectal cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Quintanilla I, Asensio E, Pellisé M, Castells A, Cuatrecasas M, Camps J. Abstract 2925: Distribution of copy number alterations defines clonal populations involved in colorectal cancer evolution. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2925] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Colorectal cancer progresses in a multi-step manner with adenoma being the most well-known precursor lesion. Malignant polyp, an adenoma that contains a focus of adenocarcinoma, is a suitable model to study the colorectal tumor evolution. Although the mutations that lead adenoma to evolve into carcinoma have been previously described, the copy number changes involved in this malignant transformation have not been fully explored. To understand how these genomic alterations contribute to carcinogenesis, we used sequential fluorescence in situ hybridization using probes for the oncogenes EGFR, MYC, CDX2, and ZNF217 and the tumor suppressor genes SMAD7 and APC in order to analyze the copy number changes in 23 cases of malignant polyps and 10 cases of low grade dysplasia (LGD) adenomas based on single cell analyses. We found the levels of genomic heterogeneity increased from LGD adenomas to malignant polyps, with the adenoma component having a lower degree of chromosomal instability than the adenocarcinoma component. Despite the intercellular heterogeneity, we observed different patterns of evolution. The gain of ZNF217 was the earliest event as it was found to be in some cases of the LGD adenoma, and was also important in the neoplastic transformation of malignant polyps. Other notable genomic imbalances we observed during the malignant transformation were the gain of CDX2 and the loss of SMAD7. Interestingly, in a significant proportion of cases we observed the gain of all loci analyzed to be the decisive step in the transition from adenoma to carcinoma, suggesting a whole genome duplication event. Lastly, in half of the malignant polyps studied the main clone in the carcinoma component was already present in the adjacent adenoma component, although in some cases at a low frequency only detected by single cell analysis. Our data suggest that copy number changes are early events in colorectal carcinogenesis that can determine the evolution from adenoma to carcinoma.
Citation Format: Isabel Quintanilla, Elena Asensio, Maria Pellisé, Antoni Castells, Miriam Cuatrecasas, Jordi Camps. Distribution of copy number alterations defines clonal populations involved in colorectal cancer evolution [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2925. doi:10.1158/1538-7445.AM2017-2925
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Córdova H, Sánchez-Montes C, Delgado-Guillena PG, Morales VJ, Sendino O, González-Suárez B, Cárdenas A, Pellisé M, Araujo IK, Ginés À, Llach J, Fernández-Esparrach G. Quality indicators for esophagogastroduodenoscopy: A comparative study of outcomes after an improvement programme in a tertiary hospital. Gastroenterol Hepatol 2017. [PMID: 28648767 DOI: 10.1016/j.gastrohep.2017.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There is an opportunity for improvement in the recording and measuring of quality indicators. However, no previous experiences exist in our field in terms of their compliance in esophagogastroduodenoscopy (EGD). OBJECTIVE To analyse compliance with EGD quality criteria and evaluate improvement after conducting a training programme. PATIENTS AND METHODS Comparative study of 2 cohorts: one retrospective (control group) and one prospective (intervention group), before and after a training programme consisting of an information session and the report writing improvement programme. The quality indicators proposed by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology were used. RESULTS A total of 1,200 EGDs were included in a sequential manner (600 in each group). Following the training programme, a significant improvement was observed in the following indicators: documented indication (93 vs. 99.8%; P<0.01), documented full examinations (94.7 vs. 97.3%; P<0.01), correct performance (63.7 vs. 87.9%; P<0.01), appropriate biopsies according to protocols (57.9 vs. 83.8%; P<0.01), photo-documentation of described lesions (84.1 vs. 94.9%; P<0.01), photo-documentation per segment (52.9 vs. 70.5%; P<0.01) and correct overall assessment (56,9 vs. 90.5%; P<0.01). Biopsies for coeliac disease, documented indication, full examination and correct performance, if it went ahead, exceeded the recommended standard. CONCLUSION A very simple training programme improves EGD quality indicators, with the majority reaching the standards recommended by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology.
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Affiliation(s)
- Henry Córdova
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Cristina Sánchez-Montes
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Pedro G Delgado-Guillena
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España; Servicio de Gastroenterología, Hospital General de Granollers, Granollers, Barcelona, España
| | - Victor J Morales
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España; Servicio de Gastroenterología, Hospital General de Granollers, Granollers, Barcelona, España
| | - Oriol Sendino
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Begoña González-Suárez
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Andrés Cárdenas
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Maria Pellisé
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Isis K Araujo
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Àngels Ginés
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Josep Llach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Gloria Fernández-Esparrach
- Unidad de Endoscopia, Servicio de Gastroenterología, Institut Clínic de Malalties Digestives i Metabòliques (ICMDiM), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic, Universitat de Barcelona, Barcelona, España.
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Jover R, Bretthauer M, Dekker E, Holme Ø, Kaminski M, Løberg M, Zauber A, Hernán M, Lansdorp-Vogelaar I, Sunde A, McFadden E, Castells A, Regula J, Quintero E, Pellisé M, Senore C, Kalager M, Dinis-Ribeiro M, Emilsson L, Ransohoff D, Hoff G, Adami HO. Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy 2016; 48:571-8. [PMID: 27042931 PMCID: PMC5412707 DOI: 10.1055/s-0042-104116] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Current guidelines recommend surveillance colonoscopies after polyp removal depending on the number and characteristics of polyps, but there is a lack of evidence supporting the recommendations. This report outlines the rationale and design of two randomized trials and one observational study investigating evidence-based surveillance strategies following polyp removal. Study design and endpoints: The EPoS studies started to recruit patients in April 2015. EPoS study I randomizes 13 746 patients with low-risk adenomas (1 - 2 tubular adenomas size < 10 mm, low-grade dysplasia) to surveillance after 5 and 10 years, or 10 years only. EPoS study II randomizes 13 704 patients with high-risk adenomas (3 - 10 adenomas or adenoma ≥ 10 mm in diameter, or adenoma with high-grade dysplasia, or > 25 % villous features) to surveillance after 3, 5, and 10 years, or 5 and 10 years only. EPoS study III offers surveillance after 5 and 10 years to patients with serrated polyps ≥ 10 mm in diameter at any location, or serrated polyps ≥ 5 mm in diameter proximal to the splenic flexure. All polyps are removed before patients enter the trials. The primary end point is colorectal cancer incidence after 10 years. We assume a colorectal cancer risk of 1 % for patients in EPoS I, and 2 % for patients in EPoS II. Using a noninferiority hypothesis with an equivalence interval of 0.5 % for EPoS I and 0.7 % for EPoS II, the trials are 90 % powered to uncover differences larger than the equivalence intervals. For EPoS III, no power analyses have been performed. CONCLUSIONS The present trials aim to develop evidence-based strategies for polyp surveillance, thereby maximizing effectiveness and minimizing resources. TRIAL REGISTRATION ClinicalTrials.gov (NCT02319928).
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Affiliation(s)
- Rodrigo Jover
- Unidad de Gastroenterología. Hospital General Universitario de Alicante, Alicante, Spain
| | - Michael Bretthauer
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Evelien Dekker
- Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Øyvind Holme
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Michal Kaminski
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Magnus Løberg
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Ann Zauber
- Department of Epidemiology and Biostatistics, Sloan Kettering Memorial Cancer Center, New York, New York, United States
| | - Miguel Hernán
- Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, and Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, United States
| | | | - Annike Sunde
- Frontier Science (Scotland) Ltd., Kingussie, United Kingdom
| | | | - Antoni Castells
- Gastroenterology, University Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain
| | - Jaroslaw Regula
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, and Medical Center for Postgraduate Education, Warsaw, Poland
| | - Enrique Quintero
- Gastroenterology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Maria Pellisé
- Gastroenterology, University Barcelona, CIBERehd, IDIBAPS, Barcelona, Spain
| | - Carlo Senore
- AOU Città della Salute e della Scienza – CPO Piemonte, Turin , Italy
| | - Mette Kalager
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Mario Dinis-Ribeiro
- Instituto Português de Oncologia do Porto, and CINTESIS/Faculty of Medicine, University of Porto, Porto, Portugal
| | - Louise Emilsson
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - David Ransohoff
- Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Geir Hoff
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Hans-Olov Adami
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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