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Stack R, Doherty J, O'Moráin N, Nolan B, Sheridan J, Cullen G, Mulcahy H, Buckley M, Horgan G, Hamed M, McDermott E, Doherty G. Implementation of BSG/ACPGBI/PHE polypectomy surveillance guidelines safely reduces the burden of surveillance in a screening cohort: a virtual model study. BMJ Open Gastroenterol 2023; 10:e001160. [PMID: 37699732 PMCID: PMC10503359 DOI: 10.1136/bmjgast-2023-001160] [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: 04/13/2023] [Accepted: 07/10/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE To evaluate the impact of British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland/Public Health England (BSG/ACPGBI/PHE) 2019 polypectomy surveillance guidelines within a national faecal immunochemical test-based bowel cancer screening (BS) cohort on surveillance activity and detection of pathology by retrospective virtual application. DESIGN A retrospective review of BS colonoscopies performed in 2015-2016 with 5 years prospective follow-up in single institution. Index colonoscopies were selected. Incomplete colonoscopies were excluded. Histology of all resected polyps was reviewed. Surveillance intervals were calculated according to BSG/ACPGBI/PHE 2019 guidelines and compared with pre-existing 'European Guidelines for Quality Assurance in Colorectal Cancer Screening and Diagnosis' (EUQA 2013). Total number of colonoscopies deferred by virtual implementation of BSG/ACPGBI/PHE 2019 guidelines were calculated. Pathology identified on procedures that would have been deferred was reviewed. RESULTS Total number of index BS colonoscopies performed in 2015-2016 inclusive was 890. 115 were excluded (22 no caecal intubation, 51 inadequate bowel preparation, 56 incomplete polyp clearance). N=509 colonoscopies were scheduled within a 5-year interval following index colonoscopy surveillance rounds based on EUQA guidelines. Overall, volume of surveillance was significantly reduced with retrospective application of BSG/ACPGBI/PHE 2019 guidelines (n=221, p<0.0001). No cancers were detected within the 'potentially deferred' procedures who attended for follow-up (n=330) with high-risk findings found in<10% (n=30) of colonoscopies within the BSG/ACPGBI/PHE cohort. CONCLUSION BSG/ACPGBI/PHE 2019 guidelines safely reduce the burden of colonoscopy demand with acceptable pathology findings on deferred colonoscopies.
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Affiliation(s)
- Roisin Stack
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Jayne Doherty
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Neil O'Moráin
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Blathnaid Nolan
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Juliette Sheridan
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Garret Cullen
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Hugh Mulcahy
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Maire Buckley
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Gareth Horgan
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Mohamed Hamed
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Edel McDermott
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Glen Doherty
- Centre of Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Cudmore J, Kumar L, O'Moráin N, Cullen G, Horgan G, Aird J, Sheahan K, Winter DC, Kennelly R, Leyden J. Rates and outcomes of testing for lynch syndrome in a national colorectal cancer screening programme. Cancer Epidemiol 2023; 82:102314. [PMID: 36608496 DOI: 10.1016/j.canep.2022.102314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Lynch Syndrome (LS), the most common cause of hereditary colorectal cancer (CRC), is characterised by pathogenic variants in mismatch repair (MMR) genes. Universal testing of all CRCs for LS can increase detection. Rates and outcomes of testing in Ireland's national CRC screening programme have not been examined previously. METHODS CRCs diagnosed at two screening sites between 2015 and 2020 were identified. Patient records were used to determine if CRCs had been tested for MMR deficiency and if detected, what downstream testing to rule out LS or genetic testing to confirm LS was undertaken. RESULTS Over five years, 206 CRCs were diagnosed. Testing for LS was carried out for 100% of CRCs at site A and 69% of CRCs at site B. Of CRCs tested for LS, 14 (8%) were MMR deficient. After downstream testing for BRAF mutation or hypermethylation of MLH1, three CRCs were identified as potentially LS-related. Of these two individuals declined genetic testing and one was lost to follow-up. CONCLUSIONS By 2020 both sites had implemented universal testing of all CRCs for LS. A small number of individuals were identified as being eligible for genetic testing for LS, however those offered declined testing and one individual was lost to follow up. This highlights the importance of universal testing and the need for referral pathways to ensure all appropriate individuals are referred onwards to genetic services.
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Affiliation(s)
- Jane Cudmore
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland.
| | - Lakshman Kumar
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Neil O'Moráin
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Garrett Cullen
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Gareth Horgan
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - John Aird
- Department of Pathology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kieran Sheahan
- School of Medicine, University College Dublin, Ireland; Department of Pathology, St Vincent's University Hospital, Dublin, Ireland
| | - Desmond C Winter
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Rory Kennelly
- Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin, Ireland; School of Medicine, University College Dublin, Ireland
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O'Moráin N, Stack R, Doherty J, Tosetto M, Garcia Leon A, Mallon P, Doherty G. Faecal calprotectin as a potential biomarker of disease severity in SARS-CoV-2 infection. J Infect 2022; 85:436-480. [PMID: 35768051 PMCID: PMC9233623 DOI: 10.1016/j.jinf.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/05/2022]
Affiliation(s)
- N O'Moráin
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland.
| | - R Stack
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - J Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland
| | - M Tosetto
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Garcia Leon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, 4, Ireland
| | - P Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, 4, Ireland; Department of Infectious Disease, St. Vincent's University Hospital, Dublin, 4, Ireland
| | - G Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland; School of Medicine, University College Dublin, Dublin, 4, Ireland
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O'Moráin N, Doherty J, Stack R, Doherty GA. Mucosal Healing in Crohn's Disease: Bull's Eye or Bust? "The Pro Position". Inflamm Intest Dis 2022; 7:36-41. [PMID: 35224016 PMCID: PMC8820165 DOI: 10.1159/000519521] [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: 08/25/2021] [Accepted: 09/06/2021] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory disorder affecting the gastrointestinal tract with disease behaviour based on the depth and severity of mucosal injury. Cumulative injury can result in complications including stricture formation and penetrating complications which often require surgical resection of diseased segments of the intestine resulting in significant morbidity. Accurate assessment of disease activity and appropriate treatment is essential in preventing complications. SUMMARY Treatment targets in the management of CD have evolved with the advent of more potent immunosuppressive therapy. Targeting the resolution of sub-clinical inflammation and achieving mucosal healing is associated with the prevention of stricturing and penetrating complications. Identifying non-invasive modalities to assess mucosal healing remains a challenge. KEY MESSAGES Mucosal healing minimizes the risk of developing disease complications, prolongs steroid-free survival, and reduces hospitalization and the need for surgical intervention.
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Affiliation(s)
| | - Jayne Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital & School of Medicine, University College Dublin, Dublin, Ireland
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