1
|
Chandrapalan S, Hee SW, Widlak MM, Farrugia A, Alam MT, Smith S, Arasaradnam RP. Performance of the faecal immunochemical test for the detection of colorectal neoplasms and the role of proton pump inhibitors in their diagnostic accuracy. Colorectal Dis 2021; 23:1649-1657. [PMID: 33991166 DOI: 10.1111/codi.15735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/19/2020] [Revised: 04/19/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
AIM The faecal immunochemical test (FIT) is currently utilized in both symptomatic and screening populations, but little is known about factors that affect its performance. For example, proton pump inhibitor (PPI) therapy has been purported to increase false negative rates. This has significant implications given the extent of PPI prescriptions. The aim of this work was to evaluate the performance of the FIT for the detection of colorectal neoplasms and the impact of PPI therapy on its diagnostic accuracy. METHOD Symptomatic patients referred on the suspected cancer pathway and those on polyp surveillance between 2015 and 2019 were approached to participate. Estimates of the accuracy of FIT at different cut-off levels in diagnosing colorectal neoplasms were made. Logistic regression was used to assess the effect of PPIs on the FIT results. RESULTS A total of 667 participants were eligible for the final analysis. At a cut-off of 10 μg/g faeces, the overall sensitivity and specificity of FIT for the detection of colorectal cancer (CRC) was 0.85 (95% CI 0.71-0.94) and 0.81 (95% CI 0.78-0.84), respectively. For the detection of advanced neoplasia, the sensitivity was 0.70 (95% CI 0.58-0.79) and the specificity was 0.83 (95% CI 0.80-0.86). At higher thresholds, the sensitivity steadily declined whilst specificity increased. PPI therapy did not have a significant effect on performance of the FIT. CONCLUSION FIT is a good rule-out test for the detection of CRC and advanced neoplasia at lower thresholds. PPI therapy does not appear to have an effect on its diagnostic performance.
Collapse
Affiliation(s)
- Subashini Chandrapalan
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospital of Coventry and Warwickshire, Coventry, UK
| | - Siew Wan Hee
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Monika M Widlak
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospital of Coventry and Warwickshire, Coventry, UK
| | - Alexia Farrugia
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospital of Coventry and Warwickshire, Coventry, UK
| | - Mohammed T Alam
- Department of Biology, College of Science, United Arab Emirates University, Al-Ain, UAE
| | - Steve Smith
- Midlands and North West Bowel Cancer Screening Hub, University Hospital of Coventry and Warwickshire, Coventry, UK
| | - Ramesh P Arasaradnam
- Warwick Medical School, University of Warwick, Coventry, UK.,University Hospital of Coventry and Warwickshire, Coventry, UK.,Health, Biological and Experimental Sciences, University of Coventry, Coventry, UK.,School of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Farrugia A, Widlak MM, Smith S, Waugh N, Arasaradnam RP. Letter: faecal immunochemical testing for adults with symptoms of colorectal cancer-ready for prime time? Aliment Pharmacol Ther 2020; 52:1419. [PMID: 33105978 DOI: 10.1111/apt.16068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Alexia Farrugia
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust and University of Warwick, Coventry, UK
| | - Monika M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust and University of Warwick, Coventry, UK
| | - Stephen Smith
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust and University of Warwick, Coventry, UK
| | - Norman Waugh
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust and University of Warwick, Coventry, UK
| | - Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust and University of Warwick, Coventry, UK
| |
Collapse
|
3
|
Smith SCL, Saltzman J, Shivaji UN, Lethebe BC, Cannatelli R, Ghosh S, Iacucci M, Bannaga A, Fowler H, Geh D, Gupta T, Harvey PR, Khan S, Kumar A, Lim P, McCulloch A, O'Rourke J, Polewiczowska B, Qurashi M, Tahir F, Widlak MM. Randomized controlled study of the prediction of diminutive/small colorectal polyp histology using didactic versus computer-based self-learning module in gastroenterology trainees. Dig Endosc 2019; 31:535-543. [PMID: 30844114 DOI: 10.1111/den.13389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM The aim of this randomized trial was to evaluate the performance of self-training versus didactic training in order to increase the diagnostic accuracy of diminutive/small colonic polyp histological prediction by trainees. METHODS Sixteen trainees reviewed 78 videos (48 iSCAN-OE and 30 NBI) of diminutive/small polyps in a pretraining assessment. Trainees were randomized to receive computer-based self-learning (n = 8) or didactic training (n = 8) using identical teaching materials and videos. The same 78 videos, in a different randomized order, were assessed. The NICE (NBI International Colorectal Endoscopic) and SIMPLE (Simplified Identification Method for Polyp Labeling during Endoscopy) classification systems were used to classify diminutive/small polyps. RESULTS A higher proportion of high-confidence predictions of polyps was made by the self-training group versus the didactic group using both the SIMPLE classification (77.1% [95% CI 73.4-80.3] vs 69.9% [95% CI 66.1-73.5%] [P = 0.005]) and the NICE classification (77% [95% CI 73.2-80.4%] vs 69.8% [95% CI 66-73.4%] [P = 0.006]). When using NICE, sensitivity of the self-training group compared with the didactic group was 72% versus 83% (P = 0.0005), and the accuracy was 66.1% versus 69.1%. The training improved the confidence of participants and SIMPLE was preferred over NICE. CONCLUSION Self-learning for the prediction of diminutive/small polyp histology is a method of training that can achieve results similar to didactic training. Availability of adequate self-learning teaching modules could enable widespread implementation of optical diagnosis in clinical practice.
Collapse
Affiliation(s)
- Samuel C L Smith
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - John Saltzman
- Department of Gastroenterology, Brigham and Women Hospital, Harvard Medical School, Boston, USA
| | - Uday N Shivaji
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Brendan C Lethebe
- University of Calgary, Calgary, Canada.,Clinical Research Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rosanna Cannatelli
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | | | - Subrata Ghosh
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
| | - Marietta Iacucci
- Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK.,University of Calgary, Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Mozdiak E, Weldeselassie Y, McFarlane M, Tabuso M, Widlak MM, Dunlop A, Tsertsvadze A, Arasaradnam RP. Systematic review with meta-analysis of over 90 000 patients. Does fast-track review diagnose colorectal cancer earlier? Aliment Pharmacol Ther 2019; 50:348-372. [PMID: 31286552 DOI: 10.1111/apt.15378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/25/2019] [Revised: 03/13/2019] [Accepted: 05/27/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND National UK data on colorectal cancer (CRC) stage at diagnosis is incomplete. Site-specific fast-track (2-week wait) cancer data are not collected directly by NHS England. Policy making based on these data alone can lead to inaccuracy. AIMS To review available data on key outcomes (cancer conversion rate and stage at diagnosis) for the UK's lower gastrointestinal 2-week wait pathway. METHODS A comprehensive literature search was conducted between 2000 and 2017. Primary outcomes were cancer conversion rate and cancer stage at diagnosis. Results were expressed as proportions with 95% CIs. A random effects model was used for meta-analysis; heterogeneity was assessed by I2 . RESULTS Of 95 papers reviewed, 49 were included in analysis with a total study population of 93,655. Cancer conversion rate was 7.7% (95% CI: 6.9-8.5). The proportion presenting at Dukes A = 11.2% (95% CI 7.4-15.6), B = 36.7% (95% CI 30.8-42.8), C = 35.7% (95% CI: 30.8-40.8) and D = 11.1% (95% CI 7.3-15.5). No colonic pathology was diagnosed in 54.6% (95% CI: 46.2-62.8). CONCLUSIONS Only 7.7% of patients referred by the 2-week wait pathway were found to have CRC. No beneficial effect on stage at diagnosis was found compared to non-2-week wait referral pathways. Over half of patients had no colonic pathology and detection of adenomas was very low. These results should prompt a reconsideration of the benefits of the 2-week wait pathway in CRC diagnosis and outcomes, with more focus on strategies to improve patient selection.
Collapse
Affiliation(s)
- Ella Mozdiak
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | | | - Maria Tabuso
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Monika M Widlak
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Amber Dunlop
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Alexander Tsertsvadze
- The University of Warwick, Coventry, UK.,Faculty of Health and Life Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Ramesh P Arasaradnam
- University Hospitals Coventry and Warwickshire, Coventry, UK.,The University of Warwick, Coventry, UK.,Centre for Applied Biological Sciences, Coventry University, Coventry, UK
| |
Collapse
|
5
|
Widlak MM, Siau K. Young Gi angle: How to set up a successful gastroenterology trainee research network - tips for trainees. United European Gastroenterol J 2019; 7:982-984. [PMID: 31428423 DOI: 10.1177/2050640619864877] [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] [Indexed: 01/10/2023] Open
Affiliation(s)
- Monika M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Medical School, University of Warwick, Coventry, UK.,West Midlands Research in Gastroenterology Group (WMRIG), West Midlands, UK
| | - Keith Siau
- West Midlands Research in Gastroenterology Group (WMRIG), West Midlands, UK.,Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| |
Collapse
|
6
|
Maurice J, Widlak MM, Emmanuel AV. Twitter debate: controversies in functional gastrointestinal disorders. Frontline Gastroenterol 2019; 11:249-251. [PMID: 32419917 PMCID: PMC7223289 DOI: 10.1136/flgastro-2019-101246] [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] [Received: 04/10/2019] [Revised: 05/24/2019] [Accepted: 06/03/2019] [Indexed: 02/04/2023] Open
Abstract
The new 'Controversies In…' series for the Frontline Gastroenterology Twitter debates addressed the difficult area of functional gastrointestinal disorders, facilitated by the former editor-in-chief Anton Emmanuel. Key topics discussed included distinguishing functional dyspepsia from genuine gastroparesis, when we should investigate for bile acid malabsorption, the current treatments for constipation-predominant irritable bowel syndrome and, importantly, how to manage consultations with complex patients presenting with functional bowel disease. The debate generated over a million impressions on twitter and this article aims to summarise the key educational points from the event.
Collapse
Affiliation(s)
- James Maurice
- Deparment of Hepatology, Imperial College, London, UK
| | - Monika M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Anton V Emmanuel
- Department of Physiology Unit, University College Hospital, London, UK
| |
Collapse
|
7
|
Widlak MM, Neal M, Arasaradnam RP. Letter: improving detection of colorectal cancer using two-stage investigation process-faecal immunochemical test and urinary volatile organic compounds. Aliment Pharmacol Ther 2019; 49:1459-1460. [PMID: 31074900 DOI: 10.1111/apt.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Monika M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Matthew Neal
- Department of Statistics, University of Warwick, Coventry, UK
| | - Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Warwick Medical School, University of Warwick, Coventry, UK.,Faculty of Health and Life Sciences, University of Coventry, Coventry, UK.,Medical and Life Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
8
|
Bannaga AS, Widlak MM, Tehami N, Vinnamala S, Sagar N, Mozdiak E, O’Connell N, Burns L, Elmusharaf K, Arasaradnam RP. Probiotics’ effects on perception of health and bowel frequency: a double-blind, randomised, placebo-controlled clinical trial. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-2-s64] [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: 11/27/2022]
|
9
|
Widlak MM, Neal M, Daulton E, Thomas CL, Tomkins C, Singh B, Harmston C, Wicaksono A, Evans C, Smith S, Savage RS, Covington JA, Arasaradnam RP. Risk stratification of symptomatic patients suspected of colorectal cancer using faecal and urinary markers. Colorectal Dis 2018; 20:O335-O342. [PMID: 30248228 DOI: 10.1111/codi.14431] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 06/20/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022]
Abstract
AIM Faecal markers, such as the faecal immunochemical test for haemoglobin (FIT) and faecal calprotectin (FCP), have been increasingly used to exclude colorectal cancer (CRC) and colonic inflammation. However, in those with lower gastrointestinal symptoms there are considerable numbers who have cancer but have a negative FIT test (i.e. false negative), which has impeded its use in clinical practice. We undertook a study of diagnostic accuracy CRC using FIT, FCP and urinary volatile organic compounds (VOCs) in patients with lower gastrointestinal symptoms. METHOD One thousand and sixteen symptomatic patients with suspected CRC referred by family physicians were recruited prospectively in accordance with national referring protocol. A total of 562 patients who completed colonic investigations, in addition to providing stool for FIT and FCP as well as urine samples for urinary VOC measurements, were included in the final outcome measures. RESULTS The sensitivity and specificity for CRC using FIT was 0.80 [95% confidence interval (CI) 0.66-0.93] and 0.93 (CI 0.91-0.95), respectively. For urinary VOCs, the sensitivity and specificity for CRC was 0.63 (CI 0.46-0.79) and 0.63 (CI 0.59-0.67), respectively. However, for those who were FIT-negative CRC (i.e. false negatives), the addition of urinary VOCs resulted in a sensitivity of 0.97 (CI 0.90-1.0) and specificity of 0.72 (CI 0.68-0.76). CONCLUSIONS When applied to the FIT-negative group, urinary VOCs improve CRC detection (sensitivity rises from 0.80 to 0.97), thus showing promise as a second-stage test to complement FIT in the detection of CRC.
Collapse
Affiliation(s)
- M M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Medical School, University of Warwick, Coventry, UK
| | - M Neal
- Department of Statistics, University of Warwick, Coventry, UK
| | - E Daulton
- School of Engineering, University of Warwick, Coventry, UK
| | - C L Thomas
- Department of Biochemistry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - C Tomkins
- Department of Biochemistry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - B Singh
- Department of Colorectal Surgery, Leicester General Hospital, Leicester, UK
| | - C Harmston
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Wicaksono
- School of Engineering, University of Warwick, Coventry, UK
| | - C Evans
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - S Smith
- Department of Biochemistry, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Midlands and North West Bowel Cancer Screening Hub, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - R S Savage
- Department of Statistics, University of Warwick, Coventry, UK
| | - J A Covington
- School of Engineering, University of Warwick, Coventry, UK
| | - R P Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.,Medical School, University of Warwick, Coventry, UK.,Applied Biological and Experimental Sciences, University of Coventry, Coventry, UK
| |
Collapse
|
10
|
Siau K, Hodson J, Ingram R, Baxter A, Widlak MM, Sharratt C, Baker GM, Troth T, Hicken B, Tahir F, Magrabi M, Yousaf N, Grant C, Poon D, Khalil H, Lee HL, White JR, Tan H, Samani S, Hooper P, Ahmed S, Amin M, Mahgoub S, Asghar K, Leet F, Harborne MJ, Polewiczowska B, Khan S, Anjum MR, McFarlane M, Mozdiak E, O'Flynn LD, Blee IC, Molyneux RM, Kurian A, Abbas SN, Abbasi A, Karim A, Yasin A, Khattak F, White J, Ahmed R, Morgan JA, Alleyne L, Alam MA, Palaniyappan N, Rodger VJ, Sawhney P, Aslam N, Okeke T, Lawson A, Cheung D, Reid JP, Awasthi A, Anderson MR, Timothy JR, Pattni S, Ahmad S, Townson G, Shearman J, Giljaca V, Brookes MJ, Disney BR, Guha N, Thomas T, Norman A, Wurm P, Shah A, Fisher NC, Ishaq S, Major G. Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit. United European Gastroenterol J 2018; 7:199-209. [PMID: 31080604 DOI: 10.1177/2050640618811491] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/15/2018] [Indexed: 12/24/2022] Open
Abstract
Background Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p = 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p = 0.004), but not 30-d mortality (p = 0.344). Conclusions The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.
Collapse
Affiliation(s)
- Keith Siau
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospital Birmingham, Birmingham, UK
| | - Richard Ingram
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Andrew Baxter
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Monika M Widlak
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Caroline Sharratt
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Graham M Baker
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Tom Troth
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ben Hicken
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Faraz Tahir
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Malik Magrabi
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Nouman Yousaf
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Claire Grant
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Dennis Poon
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Hesham Khalil
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Hui Lin Lee
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Jonathan R White
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Huey Tan
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Syazeddy Samani
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Patricia Hooper
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Saeed Ahmed
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Muhammad Amin
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Sara Mahgoub
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Khayal Asghar
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Farique Leet
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Matthew J Harborne
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Beata Polewiczowska
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Sheeba Khan
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Muhammad R Anjum
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Michael McFarlane
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ella Mozdiak
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Lauren D O'Flynn
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ilona C Blee
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Rachel M Molyneux
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ashok Kurian
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Syed N Abbas
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Abdullah Abbasi
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Aadil Karim
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Asif Yasin
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Fawad Khattak
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Josephine White
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ruhina Ahmed
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - James A Morgan
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Lance Alleyne
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Mohamed A Alam
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Naaventhan Palaniyappan
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Victoria J Rodger
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Paramvir Sawhney
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Nasar Aslam
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Theodore Okeke
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Adam Lawson
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Danny Cheung
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Jeremy P Reid
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ashish Awasthi
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Mark R Anderson
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Joe R Timothy
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Sanjeev Pattni
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Saqib Ahmad
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Gillian Townson
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Jeremy Shearman
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Vanja Giljaca
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Matthew J Brookes
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ben R Disney
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Neil Guha
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Titus Thomas
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Anthony Norman
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Peter Wurm
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Ashit Shah
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Neil C Fisher
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Sauid Ishaq
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Giles Major
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| |
Collapse
|
11
|
Trivedi PJ, Kiesslich R, Hodson J, Bhala N, Boulton RA, Cooney R, Gui X, Iqbal T, Li KK, Mumtaz S, Pathmakanthan S, Quraishi MN, Sagar VM, Shah A, Sharma N, Siau K, Smith S, Ward S, Widlak MM, Bisschops R, Ghosh S, Iacucci M. The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training: a multicenter study across academic and community practice (with video). Gastrointest Endosc 2018; 88:95-106.e2. [PMID: 29548940 DOI: 10.1016/j.gie.2018.02.044] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 10/21/2017] [Accepted: 02/28/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC), even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined. METHODS Fifteen participants across 5 centers reviewed a computerized training module outlining high-definition and EVC (iScan) colonoscopy modes. Interobserver agreement was then tested (Mayo score, Ulcerative Colitis Endoscopic Index of Severity [UCEIS], and the Paddington International Virtual Chromoendoscopy Score [PICaSSO] for UC), using a colonoscopy video library (30 cases reviewed pretraining and 30 post-training). Knowledge sustainability was retested in a second round (42 cases; 9/15 participants), 6 months after training provision. RESULTS Pretraining intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC, .775), UCEIS scoring erosions/ulcers (ICC, .770), and UCEIS overall (ICC, .786) and for mucosal (ICC, .754) and vascular components of PICaSSO (ICC, .622). For the vascular components of UCEIS, agreement was only moderate (ICC, .429) and did not enhance post-training (ICC, .417); conversely, use of PICaSSO improved post-training (mucosal ICC, .848; vascular, .746). Histologic correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman's ρ for mucosal: .925; vascular, .873; P < .001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histologic strata was strongest for PICaSSO (area under the receiver operating characteristic curve [AUROC] for mucosal, .781; vascular, .715) compared with Mayo (AUROC, .708) and UCEIS (AUROC for UCEIS overall, .705; vascular, .562; bleeding, .645; erosions/ulcers, .696). Inter-rater reliability for PICaSSO was sustained by round 2 participants (round 1 and 2 ICC for mucosal, .873 and .869, respectively; vascular, .715 and .783, respectively), together with histologic correlation (ρ mucosal, .934; vascular, .938; P < .001 for both). CONCLUSIONS PICaSSO demonstrates good interobserver agreement across all levels of experience, providing excellent correlation with histology. Given the ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.
Collapse
Affiliation(s)
- Palak J Trivedi
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom
| | - Ralf Kiesslich
- Department of Medicine, Division of Gastroenterology, HSK Hospital, Wiesbaden, Germany
| | - James Hodson
- Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Ralph A Boulton
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Rachel Cooney
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Xianyong Gui
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Tariq Iqbal
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Ka-Kit Li
- Department of Gastroenterology and Hepatology, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Saqib Mumtaz
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Shri Pathmakanthan
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Mohammed Nabil Quraishi
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Vandana M Sagar
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Ashit Shah
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Naveen Sharma
- Department of Gastroenterology, University Hospitals Birmingham Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Keith Siau
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom
| | - Samuel Smith
- Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom
| | - Stephen Ward
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Monika M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Warwick, United Kingdom
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Subrata Ghosh
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom; Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Marietta Iacucci
- National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom; Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
12
|
Widlak MM, Thomas CL, Thomas MG, Tomkins C, Smith S, O'Connell N, Wurie S, Burns L, Harmston C, Evans C, Nwokolo CU, Singh B, Arasaradnam RP. Diagnostic accuracy of faecal biomarkers in detecting colorectal cancer and adenoma in symptomatic patients. Aliment Pharmacol Ther 2017; 45:354-363. [PMID: 27910113 DOI: 10.1111/apt.13865] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/15/2016] [Accepted: 10/26/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND The diagnosis of colorectal cancer (CRC) can be difficult as symptoms are variable with poor specificity. Thus, there is a quest for simple, non-invasive testing that can help streamline those with significant colonic pathology. AIM To assess using faecal immunochemical test for haemoglobin (FIT) or faecal calprotectin (FCP) to detect CRC and adenoma in symptomatic patients referred from primary care. METHODS A total of 799 referred for urgent lower gastrointestinal investigations were prospectively recruited. Of these, 430 completed colonic investigations and returned stool samples, and were included in the final statistical analysis. Faecal immunochemical test for haemoglobin was performed on HM-JACKarc analyser (Kyowa Medex, Tokyo, Japan), and FCP by the EliA Calprotectin immunoassay (Thermo Fisher Scientific, Waltham, United States). RESULTS The negative predictive value (NPV) using FIT alone or both markers (FIT and FCP) in combination was similar at 99% for CRC, with a sensitivity and specificity of 84% and 93%, respectively. FIT measurements were significantly higher in left-sided colonic lesions compared with the right side; 713 vs. 94; P = 0.0203). For adenoma, the NPV using FIT alone, or both markers (FIT and FCP) in combination, was similar at 94% with a sensitivity and specificity of 69% and 56%, respectively. CONCLUSIONS Undetectable faecal immunochemical test for haemoglobin is sufficiently sensitive to exclude colorectal cancer, with higher values in left-sided lesions. FCP in combination does not appear to provide additional diagnostic information. Further studies to determine the health economic benefits of implementing faecal immunochemical test for haemoglobin in primary care are required.
Collapse
Affiliation(s)
- M M Widlak
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK.,Medical School, University of Warwick, Coventry, UK
| | - C L Thomas
- Department of Biochemistry, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - M G Thomas
- Medical School, University of Oxford, Oxford, UK
| | - C Tomkins
- Department of Biochemistry, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Smith
- Midlands and North West Bowel Cancer Screening Hub, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - N O'Connell
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - S Wurie
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - L Burns
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - C Harmston
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - C Evans
- Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - C U Nwokolo
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - B Singh
- Department of Colorectal Surgery, University Hospitals of Leicester, Leicester, UK
| | - R P Arasaradnam
- Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, UK.,Medical School, University of Warwick, Coventry, UK.,Applied Biological and Experimental Sciences, University of Coventry, Coventry, UK
| |
Collapse
|