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Fukase H, Honda M, Miyamoto H, Nakashima M, Gushima R, Naoe H, Yamada R, Komohara Y, Tanaka Y. Narrow-band imaging with magnification for the diagnosis of colorectal adenoma in a patient with Cronkhite-Canada syndrome. DEN Open 2024; 4:e257. [PMID: 37333979 PMCID: PMC10272907 DOI: 10.1002/deo2.257] [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] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
Cronkhite-Canada syndrome (CCS) is a rare disease characterized by gastrointestinal polyposis, skin pigmentation, alopecia, and abnormal nailfolds. Although colorectal cancer has been reported in patients with CCS, reports are limited regarding the effectiveness of the usage of image-enhanced endoscopy in CCS lesions. Here, we report a case of CCS in which narrow-band imaging (NBI) magnifying endoscopy was applied to detect an adenomatous component in multiple hamartomatous polyps. A 79-year-old female complained of taste disorder, anorexia, and weight loss over several months. Endoscopic examination revealed multiple reddened polyps in the stomach and colon, leading to a diagnosis of CCS. Narrow-band imaging magnification showed sparse and dilated round pits on the CCS polyps. Furthermore, 12 out of the numerous colorectal CCS polyps had a coexisting light reddish elevated component with a regular distribution of microvessels and a regular reticular pattern. This pattern satisfied the criteria for Type 2A of the Japan Narrow-band-imaging Expert Team classification, indicating adenoma. After resection, these twelve polyps were subject to pathological analysis, which confirmed they were all hamartomatous polyps with low-grade adenoma on the superficial layer. Immunohistochemical analysis revealed a significant increase in the Ki-67 index and p53 staining only in the adenomatous lesions. We conclude that narrow-band imaging magnifying endoscopy would be useful in differentiating adenoma from CCS-related polyps, which thereby facilitates early detection and treatment of precancerous lesions.
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Affiliation(s)
- Hitoshi Fukase
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
| | - Munenori Honda
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
| | - Hideaki Miyamoto
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
| | - Masatoshi Nakashima
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
| | - Ryosuke Gushima
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
| | - Hideaki Naoe
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
| | - Rin Yamada
- Department of Cell PathologyGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yoshihiro Komohara
- Department of Cell PathologyGraduate School of Medical SciencesKumamoto UniversityKumamotoJapan
| | - Yasuhito Tanaka
- Department of Gastroenterology and HepatologyKumamoto University HospitalKumamotoJapan
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2
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Yang W, Wen W, Ren X, Zhai Q, Li S, Xuan J. Zipper repair of 3 cm iatrogenic colonic perforation with dual-channel endoscope and twin grasper-assisted titanium clip. DEN Open 2024; 4:e276. [PMID: 37483878 PMCID: PMC10361542 DOI: 10.1002/deo2.276] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
A 53-year-old man undergoing painless colonoscopy for long-term diarrhea. After colonoscopy withdrawing to the sigmoid colon, a local perforation was found, about 3 cm in size, oval in shape. We used a two-channel endoscope and grip to pull the edges of the intestinal wall on both sides of the perforation site to close together, and then repair the 3 cm oval perforation of the colon through multiple ordinary titanium clips. The patient had no obvious infection after surgery and recovered well after 1 month of follow-up. Preliminary experience has shown that using multiple titanium clips under dual-channel endoscope to zipper suture can effectively repair 3 cm iatrogenic colonic perforations.
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Affiliation(s)
- Wei Yang
- Department of GastroenterologyJinling Clinical Medical CollegeNanjing Medical UniversityNanjingChina
| | - Wei Wen
- Department of GastroenterologyThe Second Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
| | - Xiaoli Ren
- Department of GastroenterologyJinling Hospital Affiliated to Nanjing UniversityNanjingChina
| | - Qi Zhai
- Department of GastroenterologyJinling Hospital Affiliated to Nanjing UniversityNanjingChina
| | - Shupei Li
- Department of GastroenterologyJinling Clinical Medical CollegeNanjing University of Chinese MedicineNanjingChina
| | - Ji Xuan
- Department of GastroenterologyJinling HospitalAffiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
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3
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Hashimoto Y, Kuribayashi S, Itoi Y, Satou K, Nakata K, Kasuga K, Tanaka H, Hosaka H, Masuo T, Maruhashi K, Furuya K, Masuda T, Takahashi K, Yamazaki S, Iwamoto A, Uraoka T. Safety of full bowel preparation and colonoscopy in elderly patients with ulcerative colitis: A real-world multicenter retrospective cohort study. DEN Open 2024; 4:e275. [PMID: 37492188 PMCID: PMC10363834 DOI: 10.1002/deo2.275] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023]
Abstract
Background The number of elderly patients with ulcerative colitis (UC) has been increasing worldwide. Complications are common in elderly patients who undergo colonoscopy, raising doubts about whether colonoscopy should be performed in the same way in this age group as in younger patients. The aim of this study was to determine the safety of full bowel preparation and colonoscopy in elderly patients with UC. Methods We retrospectively reviewed a cohort of patients with UC who had visited any of the 12 hospitals and were registered in our inflammatory bowel disease database. We compared complications associated with colonoscopy and bowel preparation and relapse of UC after colonoscopy in 133 patients aged ≥65 years with UC (the elderly group) and 116 randomly selected patients aged <65 years with UC (the non-elderly group). Results Nine elderly patients were not referred for colonoscopy by their physicians because of poor performance status or advanced age. There was no significant between-group difference in the complication rate (p = 0.57) or frequency of relapse of UC after colonoscopy (p = 0.67). Conclusions The findings of this study indicate that colonoscopy can be performed as safely in elderly patients with UC as in their younger counterparts. However, our results also indicate that colonoscopy is often avoided in elderly patients, possibly because of concerns about safety.
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Affiliation(s)
- Yu Hashimoto
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Shiko Kuribayashi
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Yuki Itoi
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Keigo Satou
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Kou Nakata
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Kengo Kasuga
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Hirohito Tanaka
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Hiroko Hosaka
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
| | - Takashige Masuo
- Department of GastroenterologyIsesaki Municipal HospitalGunmaJapan
| | - Kyoko Maruhashi
- Department of Gastroenterology and HepatologyKusunoki HospitalGunmaJapan
| | - Kensuke Furuya
- Department of GastroenterologyNational Hospital Organization Shibukawa Medical CenterGunmaJapan
| | - Tomoyuki Masuda
- Department of GastroenterologyNational Hospital Organization Takasaki General Medical CenterGunmaJapan
| | - Kazuhiro Takahashi
- Department of GastroenterologyJapanese Red Cross Haramachi HospitalGunmaJapan
| | - Setsuo Yamazaki
- Department of Gastroenterology and HepatologyJapanese Red Cross Maebashi HospitalGunmaJapan
| | - Atsuo Iwamoto
- Department of GastroenterologyPublic Tomioka General HospitalGunmaJapan
| | - Toshio Uraoka
- Department of Gastroenterology and HepatologyGunma University Graduate School of MedicineGunmaJapan
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Moriwake K, Isozaki H, Takama T, Murakami S, Matsumoto S. A case report of splenic injury related to colonoscopy: Fortunately treated with conservative treatment. DEN Open 2024; 4:e287. [PMID: 37663227 PMCID: PMC10474310 DOI: 10.1002/deo2.287] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023]
Abstract
Colonoscopy is a common procedure for screening of colon cancer. Although complications are rare, recently there have been reports of splenic injury associated with colonoscopy. Its causes are not clear. Herein, we report an 84-year-old man who underwent a colonoscopy for an annual routine examination. The colonoscopy was performed with moderate difficulty due to loop formation and took about 50 min. After the examination, he developed syncope, sweating, and abdominal distention with low blood pressure. Plain computed tomography revealed ascites, and the patient was hospitalized with close monitoring. The following day, his hemoglobin level was decreased by about 3.0 g/dL. Contrast-enhanced computed tomography revealed the splenic injury. The patient was hemodynamically stable and was treated conservatively. Splenic injury is an uncommon complication of colonoscopy; however, it may cause hemodynamic instability. Physicians performing colonoscopies should be aware of this potential complication.
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Iijima K, Matsuhashi T, Shimodaira Y, Mikami T, Yoshimura T, Yanai S, Kudara N, Tsuji T, Matsushita H, Watanabe H, Koike T, Kato K, Abe Y, Shirahata N, Hikichi T, Katakura K, Kono K, Sakuraba H, Ueno Y, Ohira H, Masamune A, Matsumoto T, Fukuda S. Impact of the COVID-19 pandemic on the performance of endoscopy in the Tohoku region of Japan. DEN Open 2024; 4:e249. [PMID: 37273519 PMCID: PMC10235797 DOI: 10.1002/deo2.249] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
Objectives The whole picture of the disturbance in endoscopy performance caused by the coronavirus disease 2019 (COVID-19) pandemic in Japan remains to be clarified. Therefore, the Japan Gastroenterological Endoscopy Society-Tohoku conducted this questionnaire survey in Tohoku region of Japan. Methods A questionnaire on the number of diagnostic endoscopy procedures and resulting diagnosed cancers in 2019 and 2020 was sent to all guidance/guidance cooperation hospitals in the Japan Gastroenterological Endoscopy Society who worked in the Tohoku region. The percentage change was calculated by comparing the numbers in 2020 with those in 2019 (the pre-COVID-19 period). Results Among the applicable 89 guidance/guidance cooperation hospitals, 83 (94%) returned the questionnaire. The number of endoscopy procedures promptly decreased to the nadir in April and May 2020 (during the first state of emergency in Japan); however, it recovered relatively quickly, within a few months after the state of emergency was lifted. Consequently, the annual reduction in the number of endoscopy procedures in 2020 (in comparison to 2019) was 10.1% for esophagogastroduodenoscopy and 7.9% for colonoscopy. The reduction in the number of diagnostic endoscopy procedures led to a 5.5% reduction in esophagogastric cancer and 2.7% in colorectal cancer. Conclusions This is the most comprehensive survey on the impact of the COVID-19 pandemic on the performance of endoscopy and the resulting diagnosis of cancer in Japan. Understanding the magnitude of the decline in endoscopic examinations and cancer detection due to the pandemic is critical to understanding how many people will ultimately be affected and establishing a strategy for providing endoscopy during national emergencies.
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Affiliation(s)
- Katsunori Iijima
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Tamotsu Matsuhashi
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Yosuke Shimodaira
- Department of GastroenterologyAkita University Graduate School of MedicineAkitaJapan
| | - Tatsuya Mikami
- Division of EndoscopyHirosaki University HospitalAomoriJapan
| | | | - Shunichi Yanai
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Norihiko Kudara
- Department of Internal Medicine and GastroenterologyIwate Prefectural Ofunato HospitalIwateJapan
| | | | | | | | - Tomoyuki Koike
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Katsuaki Kato
- Cancer Detection Center, Miyagi Cancer SocietyMiyagiJapan
| | - Yasuhiko Abe
- Division of EndoscopyYamagata University HospitalYamagataJapan
| | - Nakao Shirahata
- Department of GastroenterologyYamagata Prefectural Central HospitalYamagataJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Kyoko Katakura
- Department of GastroenterologyIwase general hospitalFukushimaJapan
| | - Koji Kono
- Department of Gastrointestinal Tract SurgeryFukushima Medical University School of MedicineFukushimaJapan
| | - Hirotake Sakuraba
- Department of GastroenterologyHirosaki University Graduate School of MedicineAomoriJapan
| | - Yoshiyuki Ueno
- Department of GastroenterologyFaculty of MedicineYamagata UniversityYamagataJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Atsushi Masamune
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Takayuki Matsumoto
- Department of Internal MedicineDivision of Gastroenterology and HepatologySchool of MedicineIwate Medical UniversityIwateJapan
| | - Shinsaku Fukuda
- Department of GastroenterologyHirosaki University Graduate School of MedicineAomoriJapan
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Kimura A, Bell-Brown A, Akinsoto N, Wood J, Peck A, Fang V, Issaka RB. Implementing an Organized Colorectal Cancer Screening Program: Lessons Learned From an Academic-Community Practice. AJPM Focus 2024; 3:100188. [PMID: 38357554 PMCID: PMC10864856 DOI: 10.1016/j.focus.2024.100188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Introduction The effectiveness of mailed fecal immunochemical test outreach might be enhanced through an organized colorectal cancer screening program, yet published real-world experiences are limited. We synthesized the process of implementing a colorectal cancer screening program that used mailed fecal immunochemical test outreach in a large integrated academic-community practice. Methods Data from a pilot mailed fecal immunochemical test program were shared with healthcare system leadership, which inspired the creation of a cross-institutional organized colorectal cancer screening program. In partnership with a centralized population health team and primary care, we defined (1) the institutional approach to colorectal cancer screening, (2) the target population and method for screening, (3) the team responsible for implementation, (4) the healthcare team responsible for decisions and care, (5) a quality assurance structure, and (6) a method for identifying cancer occurrence. Results The Fred Hutch/UW Medicine Population Health Colorectal Cancer Screening Program began in September 2021. The workflow for mailed fecal immunochemical test outreach included a mailed postcard, a MyChart message from the patient's primary care provider, a fecal immunochemical test kit with a letter signed by the primary care provider and program director, and up to 3 biweekly reminders. Patients without a colonoscopy 3 months after an abnormal fecal immunochemical test result received navigation through the program. In the first program year, we identified 9,719 patients eligible for outreach, and in an intention-to-treat analysis, 32% of patients completed colorectal cancer screening by fecal immunochemical test or colonoscopy. Conclusions Real-world experiences detailing how to implement organized colorectal cancer screening programs might increase adoption. In our experience, broadly disseminating pilot data, early institutional support, robust data management, and strong cross-departmental relationships were critical to successfully implementing a colorectal cancer screening program that benefits all patients.
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Affiliation(s)
- Amanda Kimura
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Nkem Akinsoto
- UW Medicine Primary Care and Population Health, University of Washington, Seattle, Washington
| | - Jerry Wood
- UW Medicine Primary Care and Population Health, University of Washington, Seattle, Washington
| | - Amy Peck
- UW Medicine Primary Care and Population Health, University of Washington, Seattle, Washington
| | - Victoria Fang
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Rachel B. Issaka
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, Washington
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington
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7
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Watahiki Y, Kawashima K, Hikichi T, Takagi T, Onizawa M, Gunji N, Watanabe C, Wada J, Oka Y, Hashimoto Y, Ohira H. A balloon-assisted endoscopic submucosal dissection using long colonoscope and guidewire. DEN Open 2024; 4:e259. [PMID: 37333980 PMCID: PMC10272917 DOI: 10.1002/deo2.259] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
Balloon-assisted endoscopy enables stable endoscopic maneuverability. Balloon-assisted endoscopic submucosal dissection (BA-ESD) is useful in the treatment of proximal colorectal tumors where scope maneuverability is poor. Herein, we reported a case in which BA-ESD was successfully performed using a long colonoscope with a guidewire, although the lesion could not be reached using the balloon-assisted endoscopy technique with a therapeutic colonoscopy. A 50-year-old man underwent a colonoscopy that revealed a tumor in the ascending colon. BA-ESD was performed using a conventional therapeutic endoscope due to excessive intestinal elongation and poor endoscopic maneuverability. However, the transverse colon loop could not be reduced, and the total colonoscopy failed despite using balloon-assisted endoscopy. The scope was then changed from a conventional colonoscope to a long colonoscope, inserted into the terminal ileum, and the loop was reduced. After the guidewire was placed at the terminal ileum and the long colonoscope was removed, a therapeutic colonoscopy with an overtube was inserted into the ascending colon without reforming the colonic loop, allowing safe BA-ESD.
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Affiliation(s)
- Yu Watahiki
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Kazumasa Kawashima
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Tadayuki Takagi
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Michio Onizawa
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Naohiko Gunji
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Chiharu Watanabe
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Jun Wada
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuka Oka
- Department of Diagnostic PathologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuko Hashimoto
- Department of Diagnostic PathologyFukushima Medical University School of MedicineFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical University School of MedicineFukushimaJapan
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8
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Horiuchi Y, Miyaguchi K, Matsumoto H, Ohgo H, Tsuzuki Y, Nakamoto H, Imaeda H. Intussusception associated with pneumatosis cystoides intestinalis in a male adolescent: A case report. DEN Open 2024; 4:e256. [PMID: 37325200 PMCID: PMC10267610 DOI: 10.1002/deo2.256] [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] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023]
Abstract
Pneumatosis cystoides intestinalis is an uncommon disease that rarely causes intussusception. We report the case of a 16-year-old male patient with intermittent abdominal pain who was diagnosed with intussusception. The patient had no history of raw food ingestion, fever, diarrhea, or hematochezia. Computed tomography revealed intussusception characterized by a crab-finger appearance, and pneumatosis cystoides intestinalis was diagnosed by colonoscopy. Treatment with hyperbaric enema and low-flow oxygen therapy resulted in a prominent improvement of the lesion. No recurrence was observed for > 1 year. Intermittent abdominal pain without diarrhea or hematochezia in male adolescents may represent pneumatosis cystoid-related intussusception, and the addition of low-flow oxygen therapy may help avoid surgery.
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Affiliation(s)
- Yugo Horiuchi
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
| | - Kazuya Miyaguchi
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
- Department of GastroenterologySaitama Medical UniversitySaitamaJapan
| | - Hisashi Matsumoto
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
| | - Hideki Ohgo
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
- Department of GastroenterologySaitama Medical UniversitySaitamaJapan
| | - Yoshikazu Tsuzuki
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
- Department of GastroenterologySaitama Medical UniversitySaitamaJapan
| | - Hidetomo Nakamoto
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
| | - Hiroyuki Imaeda
- Department of General Internal MedicineSaitama Medical UniversitySaitamaJapan
- Department of GastroenterologySaitama Medical UniversitySaitamaJapan
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9
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Suzuki K, Kudo S, Kudo T, Misawa M, Mori Y, Ichimasa K, Maeda Y, Hayashi T, Wakamura K, Baba T, Ishda F, Hamatani S, Inoue H, Yokoyama K, Miyachi H. Diagnostic performance of endocytoscopy with normal pit-like structure sign for colorectal low-grade adenoma compared with conventional modalities. DEN Open 2024; 4:e238. [PMID: 37168271 PMCID: PMC10165464 DOI: 10.1002/deo2.238] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
Objectives A "resect-and-discard" strategy has been proposed for diminutive adenomas in the colorectum. However, this strategy is sometimes difficult to implement because of the lack of confidence in differentiating low-grade adenoma (LGA) from advanced lesions such as high-grade adenoma or carcinoma. To perform real-time precise diagnosis of LGA with high confidence, we assessed whether endocytoscopy (EC) diagnosis, considering normal pit-like structure (NP-sign), an excellent indicator of LGA, could have additional diagnostic potential compared with conventional modalities. Methods All the neoplastic lesions that were observed by non-magnifying narrow-band imaging (NBI), magnifying NBI (M-NBI), magnifying pit pattern, and EC prior to pathological examination between 2005 and 2018 were retrospectively investigated. The neoplastic lesions were classified into two categories: LGA and other neoplastic lesions. We assessed the differential diagnostic ability of EC with NP-sign between LGA and other neoplastic lesions compared with that of NBI, M-NBI, pit pattern, and conventional EC in terms of sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC). Results A total of 1376 lesions from 1097 patients were eligible. The specificity (94.9%), accuracy (91.5%), and area under the receiver operating characteristic curve (0.95) of EC with NP-sign were significantly higher than those of NBI, M-NBI, pit pattern, and conventional EC. Conclusions EC diagnosis with NP-sign has significantly higher diagnostic performance for predicting colorectal LGA compared with the conventional modalities and enables stratification of neoplastic lesions for "resect-and-discard" with higher confidence.
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Affiliation(s)
- Kenichi Suzuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Suzuki Gastrointestinal ClinicAkitaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toyoki Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Tokyo Endoscopy ClinicTokyoJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuichi Mori
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Clinical Effectiveness Research GroupInstitute of Health and SocietyUniversity of OsloOsloNorway
| | - Katsuro Ichimasa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yasuharu Maeda
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Fumio Ishda
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shigeharu Hamatani
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Hamatani‐kikakuTokyoJapan
| | - Haruhiro Inoue
- Digestive Disease CenterShowa University Koto Toyosu HospitalTokyoJapan
| | | | - Hideyuki Miyachi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
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10
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Zhang Y, Yang G, Gong C, Zhang J, Wang S, Wang Y. Polyp segmentation with interference filtering and dynamic uncertainty mining. Phys Med Biol 2024; 69:075016. [PMID: 38382099 DOI: 10.1088/1361-6560/ad2b94] [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] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/21/2024] [Indexed: 02/23/2024]
Abstract
Objective.Accurate polyp segmentation from colo-noscopy images plays a crucial role in the early diagnosis and treatment of colorectal cancer. However, existing polyp segmentation methods are inevitably affected by various image noises, such as reflections, motion blur, and feces, which significantly affect the performance and generalization of the model. In addition, coupled with ambiguous boundaries between polyps and surrounding tissue, i.e. small inter-class differences, accurate polyp segmentation remains a challenging problem.Approach.To address these issues, we propose a novel two-stage polyp segmentation method that leverages a preprocessing sub-network (Pre-Net) and a dynamic uncertainty mining network (DUMNet) to improve the accuracy of polyp segmentation. Pre-Net identifies and filters out interference regions before feeding the colonoscopy images to the polyp segmentation network DUMNet. Considering the confusing polyp boundaries, DUMNet employs the uncertainty mining module (UMM) to dynamically focus on foreground, background, and uncertain regions based on different pixel confidences. UMM helps to mine and enhance more detailed context, leading to coarse-to-fine polyp segmentation and precise localization of polyp regions.Main results.We conduct experiments on five popular polyp segmentation benchmarks: ETIS, CVC-ClinicDB, CVC-ColonDB, EndoScene, and Kvasir. Our method achieves state-of-the-art performance. Furthermore, the proposed Pre-Net has strong portability and can improve the accuracy of existing polyp segmentation models.Significance.The proposed method improves polyp segmentation performance by eliminating interference and mining uncertain regions. This aids doctors in making precise and reduces the risk of colorectal cancer. Our code will be released athttps://github.com/zyh5119232/DUMNet.
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Affiliation(s)
- Yunhua Zhang
- Northeastern University, Shenyang 110819, People's Republic of China
- DUT Artificial Intelligence Institute, Dalian 116024, People's Republic of China
| | - Gang Yang
- Northeastern University, Shenyang 110819, People's Republic of China
| | - Congjin Gong
- Northeastern University, Shenyang 110819, People's Republic of China
| | - Jianhao Zhang
- Northeastern University, Shenyang 110819, People's Republic of China
| | - Shuo Wang
- Northeastern University, Shenyang 110819, People's Republic of China
| | - Yutao Wang
- Northeastern University, Shenyang 110819, People's Republic of China
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11
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Hajibandeh S, Hajibandeh S, Regan A, Waterman J, Stewart CMB, Ansell J, Horwood J, Phillips S, Davies M. Safety and feasibility of colonoscopy in nonagenarians: A systematic review, meta-analysis and meta-regression analysis. Colorectal Dis 2024. [PMID: 38527938 DOI: 10.1111/codi.16960] [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: 09/13/2023] [Revised: 12/03/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024]
Abstract
AIM The aim of this work was to evaluate the safety and feasibility of performing colonoscopy in patients aged 90 years or over. METHOD In compliance with PRISMA statement standards, a systematic review of studies reporting the outcomes of colonoscopy in patients aged ≥90 years was conducted. A proportional meta-analysis model was constructed to quantify the risk of outcomes and a direct comparison meta-analysis model was constructed to compare outcomes between nonagenarians and patients aged between 50 and 89 years via random-effects models. RESULTS Seven studies enrolling 1304 patients (1342 colonoscopies) were included. Analyses showed that complications related to bowel preparation occurred in 0.7% (95% CI 0.1%-1.6%), procedural complications in 0.6% (0.00%-1.7%), 30-day complications in 1.5% (0.6%-2.7%), procedural mortality in 0.3% (0.0%-1.1%) and 30-day mortality in 1.1% (0.3%-2.2%). Adequate bowel preparation and colonoscopy completion were achieved in 81.3% (73.8%-87.9%) and 92.1% (86.7%-96.3%), respectively. No difference was found in bowel preparation-related complications [risk difference (RD) 0.00, p = 0.78], procedural complications (RD 0.00, p = 0.60), 30-day complications (RD 0.01, p = 0.20), procedural mortality (RD 0.00, p = 1.00) or 30-day mortality (RD 0.01, p = 0.34) between nonagenarians and patients aged between 50 and 89 years. The colorectal cancer detection rate was 14.3% (9.8%-19.5%), resulting in therapeutic intervention in 65.9% (54.5%-76.6%). CONCLUSIONS Although the evidence is limited to a selected group of nonagenarians, it may be fair to conclude that if a colonoscopy is indicated in a nonagenarian with good performance status (based on initial less-invasive investigations), the level 2 evidence supports its safety and feasibility. Age on its own should not be a reason for failing to offer colonoscopy to a nonagenarian.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Azel Regan
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Jennifer Waterman
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | | | - James Ansell
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - James Horwood
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Simon Phillips
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Michael Davies
- Department of General and Colorectal Surgery, University Hospital of Wales, Cardiff, UK
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12
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Knapple WL, Yoho DS, Sheh A, Thul J, Feuerstadt P. Retrospective subgroup analysis of fecal microbiota, live-jslm (REBYOTA ®) administered by colonoscopy under enforcement discretion for the prevention of recurrent Clostridioides difficile infection. Therap Adv Gastroenterol 2024; 17:17562848241239547. [PMID: 38529070 PMCID: PMC10962041 DOI: 10.1177/17562848241239547] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Background Fecal microbiota, live-jslm (RBL; REBYOTA®), is the first Food and Drug Administration (FDA)-approved, single-dose, rectally administered, microbiota-based live biotherapeutic product for preventing Clostridioides difficile infection (CDI) recurrence. Alternative routes of administration are of clinical interest. Objectives Evaluate the safety and efficacy of RBL administration via colonoscopy. Design Retrospective analysis of electronic medical records of participants administered RBL via colonoscopy under FDA enforcement discretion. Methods The number of participants with treatment and/or procedure-emergent adverse events (TEAEs) was evaluated. Treatment success and sustained clinical response, defined as the absence of CDI recurrence within 8 weeks and 6 months, respectively, were evaluated. Results TEAEs were experienced by 75% (6/8) of participants; most were mild to moderate in severity, and none due to RBL or its administration. Most participants had treatment success (80%; 8/10); 75% (6/8) had sustained clinical response. Conclusion Real-world safety and efficacy of RBL administered via colonoscopy were consistent with clinical trials of rectally administered RBL. Graphical abstract
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Affiliation(s)
- Whitfield L. Knapple
- Arkansas Gastroenterology, 3401 Springhill Drive #400, North Little Rock, AR 72117, USA
| | - David S. Yoho
- Mid-Atlantic Permanente Medical Group, Springfield, VA, USA
| | | | - Joan Thul
- Ferring Pharmaceuticals, Inc., Parsippany, NJ, USA
| | - Paul Feuerstadt
- Yale University School of Medicine, New Haven, CT, USA
- PACT Gastroenterology Center, Hamden, CT, USA
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13
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Gao C, Zou D, Cao R, Li Y, Su D, Han J, Gao F, Qi X. Effect of Body Mass Index on Cecal Intubation Time During Unsedated Colonoscopy: Variation Across the Learning Stages of an Endoscopist. Med Sci Monit 2024; 30:e942661. [PMID: 38520116 PMCID: PMC10944010 DOI: 10.12659/msm.942661] [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] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/03/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Body mass index (BMI) and endoscopists' experiences can be associated with cecal intubation time (CIT), but such associations are controversial. This study aimed to clarify the association between BMI and CIT during unsedated colonoscopy at 3 learning stages of a single endoscopist. MATERIAL AND METHODS A total of 1500 consecutive patients undergoing unsedated colonoscopy by 1 endoscopist at our department from December 11, 2020, to August 21, 2022, were reviewed. They were divided into 3 learning stages according to the number of colonoscopies performed by 1 endoscopist, including intermediate (501-1000 colonoscopies), experienced (1001-1500 colonoscopies), and senior stages (1501-2000 colonoscopies). Variables that significantly correlated with CIT were identified by Spearman rank correlation analyses and then included in multiple linear regression analysis. RESULTS Overall, 1233 patients were included. Among them, 392, 420, and 421 patients were divided into intermediate, experienced, and senior stages, respectively. Median CIT was 7.83, 6.38, and 5.58 min at intermediate, experienced, and senior stages, respectively (P.
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Affiliation(s)
- Cong Gao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
- Postgraduate College, Dalian Medical University, Dalian, Liaoning, PR China
| | - Deli Zou
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
| | - Rongrong Cao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
| | - Yingchao Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
| | - Dongshuai Su
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
| | - Jie Han
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
| | - Fei Gao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, Liaoning, PR China
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14
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Gao RY, Wei XL, Wu JF, Zhou ZW, Yu XQ. The perilous consequences of bowel preparation: a case study with literature review of Boerhaave syndrome. Front Med (Lausanne) 2024; 11:1303305. [PMID: 38529122 PMCID: PMC10961334 DOI: 10.3389/fmed.2024.1303305] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 01/26/2024] [Indexed: 03/27/2024] Open
Abstract
Colonoscopy is widely acknowledged as a prevalent and efficacious approach for the diagnosis and treatment of gastrointestinal disorders. In order to guarantee an effective colonoscopy, it is imperative for patients to undergo an optimal bowel preparation regimen. This entails the consumption of a substantial volume of a non-absorbable solution to comprehensively purge the colon of any fecal residue. Nevertheless, it is noteworthy to acknowledge that the bowel preparation procedure may occasionally elicit adverse symptoms such as nausea and vomiting. In exceptional instances, the occurrence of excessive vomiting may lead to the rupture of the distal esophagus, a grave medical condition referred to as Boerhaave syndrome (BS). Timely identification and efficient intervention are imperative for the management of this infrequent yet potentially perilous ailment. This investigation presents a case study of a patient who developed BS subsequent to the ingestion of mannitol during bowel preparation. Furthermore, an exhaustive examination of extant case reports and pertinent literature on esophageal perforation linked to colonoscopy has been conducted. This analysis provides valuable insights into the prevention, reduction, and treatment of such serious complications.
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Affiliation(s)
| | | | | | | | - Xi-qiu Yu
- Department of Gastroenterology, Shenzhen Luohu People’s Hospital, Shenzhen, China
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15
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Heisser T, Sergeev D, Hoffmeister M, Brenner H. Contributions of early detection and cancer prevention to colorectal cancer mortality reduction by screening colonoscopy: a validated modelling study. Gastrointest Endosc 2024:S0016-5107(24)00163-9. [PMID: 38462054 DOI: 10.1016/j.gie.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND AIMS Screening colonoscopy, recommended every ten years, reduces mortality from colorectal cancer (CRC) by early detection of prevalent but undiagnosed CRC, as well as by prevention of CRC by removal of precursor lesions. The aim of this study was to assess the relative contribution of both components to total CRC mortality reduction over time. METHODS Using a validated multistate Markov model, we simulated hypothetical cohorts of 100,000 individuals aged 55-64 with and without use of screening at baseline. Main outcomes included proportions of prevented CRC deaths arising from (asymptomatic) CRC already prevalent at baseline and from newly developed CRC during 15-years of follow-up, and mortality rate ratios of screened versus unscreened groups over time. RESULTS Early detection of prevalent cases accounted for 52%, 30% and 18% of deaths prevented by screening colonoscopy within 5, 10 and 15 years, respectively. Relative reduction of mortality was estimated to be much larger for mortality from incident cancers than for mortality from cancers that were already present and early detected at screening endoscopy and for total CRC mortality (i.e., 88% versus 67% and 79% within 10 years from screening). CONCLUSIONS Reduction of CRC mortality mainly arises from early detection of prevalent cancers during the early years after screening colonoscopy, but prevention of incident cases accounts for the majority of prevented deaths in the longer run. Prevention of incident cases leads to sustained strong reduction of colorectal cancer mortality, possibly warranting an extension of screening intervals.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Dmitry Sergeev
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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16
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Tominaga N, Sadashima E, Aoki T, Fujita M, Kobayashi K, Yamauchi A, Yamada A, Omori J, Ikeya T, Aoyama T, Sato Y, Kishino T, Ishii N, Sawada T, Murata M, Takao A, Mizukami K, Kinjo K, Fujimori S, Uotani T, Sato H, Suzuki S, Narasaka T, Hayasaka J, Funabiki T, Kinjo Y, Mizuki A, Kiyotoki S, Mikami T, Gushima R, Fujii H, Fuyuno Y, Hikichi T, Toya Y, Narimatsu K, Manabe N, Nagaike K, Kinjo T, Sumida Y, Funakoshi S, Kobayashi K, Matsuhashi T, Komaki Y, Miki K, Watanabe K, Kaise M, Nagata N. A novel prediction tool for mortality in patients with acute lower gastrointestinal bleeding requiring emergency hospitalization: a large multicenter study. Sci Rep 2024; 14:5367. [PMID: 38438534 PMCID: PMC10912311 DOI: 10.1038/s41598-024-55889-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
The study aimed to identify prognostic factors for patients with acute lower gastrointestinal bleeding and to develop a high-accuracy prediction tool. The analysis included 8254 cases of acute hematochezia patients who were admitted urgently based on the judgment of emergency physicians or gastroenterology consultants (from the CODE BLUE J-study). Patients were randomly assigned to a derivation cohort and a validation cohort in a 2:1 ratio using a random number table. Assuming that factors present at the time of admission are involved in mortality within 30 days of admission, and adding management factors during hospitalization to the factors at the time of admission for mortality within 1 year, prognostic factors were established. Multivariate analysis was conducted, and scores were assigned to each factor using regression coefficients, summing these to measure the score. The newly created score (CACHEXIA score) became a tool capable of measuring both mortality within 30 days (ROC-AUC 0.93) and within 1 year (C-index, 0.88). The 1-year mortality rates for patients classified as low, medium, and high risk by the CACHEXIA score were 1.0%, 13.4%, and 54.3% respectively (all P < 0.001). After discharge, patients identified as high risk using our unique predictive score require ongoing observation.
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Affiliation(s)
- Naoyuki Tominaga
- Department of Gastroenterology, Saga-Ken Medical Centre Koseikan, 400 Nakabaru, Kasemachi, Saga, 840-8571, Japan.
| | - Eiji Sadashima
- Department of Medical Research Institute, Saga-Ken Medical Centre Koseikan, Saga, Japan
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Katsumasa Kobayashi
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Atsushi Yamauchi
- Department of Gastroenterology and Hepatology, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International University, Tokyo, Japan
| | - Taiki Aoyama
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Yoshinori Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Naoki Ishii
- Department of Gastroenterology, Tokyo Shinagawa Hospital, Tokyo, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Aichi, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akinari Takao
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Ken Kinjo
- Department of Gastroenterology, Chikushi Hospital, Fukuoka University, Fukuoka, Japan
| | - Shunji Fujimori
- Department of Gastroenterology, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan
| | - Takahiro Uotani
- Department of Gastroenterology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Hiroki Sato
- Division of Gastroenterology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Sho Suzuki
- Department of Gastroenterology and Hepatology, Center for Digestive Disease and Division of Endoscopy, University of Miyazaki Hospital, Miyazaki, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
- Division of Endoscopic Center, University of Tsukuba Hospital, Ibaraki, Japan
| | | | - Tomohiro Funabiki
- Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
- Department of Emergency Medicine, Fujita Health University Hospital, Aichi, Japan
| | - Yuzuru Kinjo
- Department of Gastroenterology, Naha City Hospital, Okinawa, Japan
| | - Akira Mizuki
- Department of Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Aomori, Japan
| | - Ryosuke Gushima
- Department of Gastroenterology and Hepatology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Fukuoka, Japan
| | - Yuta Fuyuno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Iwate, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Okayama, Japan
| | - Koji Nagaike
- Department of Gastroenterology and Hepatology, Suita Municipal Hospital, Osaka, Japan
| | - Tetsu Kinjo
- Department of Endoscopy, University of the Ryukyus Hospital, Okinawa, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Sadahiro Funakoshi
- Department of Gastroenterological Endoscopy, Fukuoka University Hospital, Fukuoka, Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuga Komaki
- Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kuniko Miki
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kazuhiro Watanabe
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Nippon Medical School, Graduate School of Medicine, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
- Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan
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Nishimura T, Tanaka T, Ishimaru S, Arataki K, Shimamoto F. Benign Lymphoid Polyp of the Rectum Diagnosed and Treated With Endoscopic Submucosal Resection With a Ligation Device. Cureus 2024; 16:e55921. [PMID: 38469365 PMCID: PMC10925817 DOI: 10.7759/cureus.55921] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 03/13/2024] Open
Abstract
Benign lymphoid polyps of the rectum, also termed "Rectal tonsil" or "Pseudolymphoma," are submucosal tumor-like growths with localized hyperplasia of the lymphoid follicles and are often discovered incidentally during colonoscopy. Its diagnosis and differentiation from other submucosal tumors pose challenges owing to their similar endoscopic features. A 72-year-old woman presented with a positive fecal occult blood test, which led to the discovery of a 10-mm lower rectal tumor resembling a neuroendocrine tumor during colonoscopy. Upon closer examination, the lesion had a yellow submucosal appearance with dilated capillaries. Endoscopic submucosal resection with a ligation device (ESMR-L) was performed because the patient preferred immediate removal. Histopathological examination revealed lymphocytic infiltration with germinal center-containing lymphoid follicles, confirming the diagnosis of benign lymphoid polyp. Benign lymphoid polyps are often difficult to differentiate from carcinoid tumors and malignant lymphomas because the endoscopic findings are similar. Although preoperative endoscopic ultrasonography aids localization and characterization, definitive differentiation remains elusive and necessitates complete lesion resection. ESMR-L is a viable approach for diagnostic accuracy and therapeutic intervention, offering advantages in terms of procedural efficiency and patient care, particularly in cases involving submucosal rectal lesions.
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Affiliation(s)
- Tomoyuki Nishimura
- Department of Gastroenterology, Tsuchiya General Hospital, Hiroshima, JPN
| | - Tomotaka Tanaka
- Department of Gastroenterology, Tsuchiya General Hospital, Hiroshima, JPN
| | - Syohei Ishimaru
- Department of Gastroenterology, Tsuchiya General Hospital, Hiroshima, JPN
| | - Keiko Arataki
- Department of Gastroenterology, Tsuchiya General Hospital, Hiroshima, JPN
| | - Fumio Shimamoto
- Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, JPN
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18
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Liang SY, Oscarson B, Kenkare P, Yan SX, Mudiganti S, Martinez MC, Huang ES. Trends in Detection of Adenoma and Sessile Serrated Lesions Over a Decade in a Community-Based Healthcare System. Clin Transl Gastroenterol 2024; 15:e00683. [PMID: 38270213 PMCID: PMC10962881 DOI: 10.14309/ctg.0000000000000683] [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: 01/02/2024] [Accepted: 01/19/2024] [Indexed: 01/26/2024] Open
Abstract
INTRODUCTION Adenoma detection rate (ADR) is an accepted benchmark for screening colonoscopy. Factors driving ADR and its relationship with sessile serrated lesions detection rate (SSLDR) over time remain unclear. We aim to explore patient, physician, and procedural influences on ADR and SSLDR trends. METHODS Using a large healthcare system in northern California from January 2010 to December 2020, a total of 146,818 screening colonoscopies performed by 33 endoscopists were included. ADR and SSLDR were calculated over time using natural language processing. Logistic regression was used to calculate the odd ratios of patient demographics, physician attributes, and procedural details over time. RESULTS Between 2010 and 2020, ADR rose from 19.4% to 44.4%, whereas SSLDR increased from 1.6% to 11.6%. ADR increased by 2.7% per year (95% confidence interval 1.9%-3.4%), and SSLDR increased by 1.0% per year (95% confidence interval 0.8%-1.2%). Higher ADR was associated with older age, male sex, higher body mass index, current smoker, higher comorbidities, and high-risk colonoscopy. By contrast, SSLDR was associated with younger age, female sex, white race, and fewer comorbidities. Patient and procedure characteristics did not significantly change over time ( P -interaction >0.05). Longer years in practice and male physician were associated with lower ADR and SSLDR in 2010, but significantly attenuated over time ( P -interaction <0.05). DISCUSSION Both ADR and SSLDR have increased over time. Patient and procedure factors did not significantly change over time. Male endoscopist and longer years in practice had lower initial ADR and SSLDR, but significantly lessened over time.
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Affiliation(s)
- Su-Ying Liang
- Center for Health Systems Research, Palo Alto, California, USA
| | | | - Pragati Kenkare
- Center for Health Systems Research, Palo Alto, California, USA
| | - Sherry X. Yan
- Center for Health Systems Research, Walnut Creek, California, USA
| | - Satish Mudiganti
- Center for Health Systems Research, Walnut Creek, California, USA
| | | | - Edward S. Huang
- Department of Gastroenterology, Palo Alto Medical Foundation, Sutter Health, San Jose, California, USA
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19
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Clark GRC, Godfrey T, Purdie C, Strachan J, Carey FA, Fraser CG, Steele RJC. Interval cancers in a national colorectal screening programme based on faecal immunochemical testing: Implications for faecal haemoglobin concentration threshold and sex inequality. J Med Screen 2024; 31:21-27. [PMID: 37469171 PMCID: PMC10878005 DOI: 10.1177/09691413231188252] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To compare interval cancer proportions (ICP) in the faecal immunochemical test (FIT)-based Scottish Bowel Screening Programme (SBoSP) with the former guaiac faecal occult blood test (gFOBT)-based SBoSP and investigate associations between interval cancer (IC) and faecal haemoglobin concentration (f-Hb) threshold, sex, age, deprivation, site, and stage. METHODS The ICP data from first year of the FIT-based SBoSP and the penultimate year of the gFOBT-based SBoSP were compared in a prospective cohort design. RESULTS With FIT, 801 colorectal cancers (CRCs) were screen detected (SDC), 802 were in non-participants, 548 were ICs, 39 were colonoscopy missed and 72 were diagnosed after incomplete screening; with gFOBT: 540, 904, 556, 45, and 13, respectively. FIT had a significantly higher proportion of SDC compared to IC than gFOBT. For FIT and gFOBT, ICP was significantly higher in women than men. As f-Hb threshold increased, ICP increased and, for any f-Hb threshold for men, a lower threshold was required for comparable ICP in women. In Scotland, the current threshold of ≥80 µg Hb/g faeces would have to be lowered to ≥40 µg Hb/g faeces for women to achieve sex equality for ICP. In the FIT-based SBoSP, there were four times as many stage I SDC than IC. This was reversed in advanced stages, with twice as many stage IV CRC diagnosed as IC versus SDC. CONCLUSIONS Reducing the numbers of IC requires lowering the f-Hb threshold. Using different f-Hb thresholds for women and men could eliminate the sex disparity, but with additional colonoscopy.
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Affiliation(s)
- Gavin RC Clark
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
- Public Health Scotland, Edinburgh, UK
| | | | | | - Judith Strachan
- Blood Sciences and Scottish Bowel Screening Laboratory, Ninewells Hospital and Medical School, Dundee, UK
| | - Francis A Carey
- Department of Pathology, Ninewells Hospital and Medical School, Dundee, UK
| | - Callum G Fraser
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Robert JC Steele
- Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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20
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Liang PS, Dubner R, Xia Y, Glenn M, Lin K, Nagpal N, Ng S, Trinh-Shevrin C, Troxel AB, Kwon SC. Up-to-Date Colonoscopy Use in Asian and Hispanic Subgroups in New York City, 2003-2016. J Clin Gastroenterol 2024; 58:259-270. [PMID: 36753456 PMCID: PMC10397368 DOI: 10.1097/mcg.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Colorectal cancer screening uptake in the United States overall has increased, but racial/ethnic disparities persist and data on colonoscopy uptake by racial/ethnic subgroups are lacking. We sought to better characterize these trends and to identify predictors of colonoscopy uptake, particularly among Asian and Hispanic subgroups. STUDY We used data from the New York City Community Health Survey to generate estimates of up-to-date colonoscopy use in Asian and Hispanic subgroups across 6 time periods spanning 2003-2016. For each subgroup, we calculated the percent change in colonoscopy uptake over the study period and the difference in uptake compared to non-Hispanic Whites in 2015-2016. We also used multivariable logistic regression to identify predictors of colonoscopy uptake. RESULTS All racial and ethnic subgroups with reliable estimates saw a net increase in colonoscopy uptake between 2003 and 2016. In 2015-2016, compared with non-Hispanic Whites, Puerto Ricans, Dominicans, and Central/South Americans had higher colonoscopy uptake, whereas Chinese, Asian Indians, and Mexicans had lower uptake. On multivariable analysis, age, marital status, insurance status, primary care provider, receipt of flu vaccine, frequency of exercise, and smoking status were the most consistent predictors of colonoscopy uptake (≥4 time periods). CONCLUSIONS We found significant variation in colonoscopy uptake among Asian and Hispanic subgroups. We also identified numerous demographic, socioeconomic, and health-related predictors of colonoscopy uptake. These findings highlight the importance of examining health disparities through the lens of disaggregated racial/ethnic subgroups and have the potential to inform future public health interventions.
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Affiliation(s)
- Peter S. Liang
- Department of Medicine, NYU Langone Health
- Department of Population Health, NYU Langone Health
- Department of Medicine, VA New York Harbor Health Care System
| | - Rachel Dubner
- Department of Medicine, McGaw Medical Center of Northwestern University
| | - Yuhe Xia
- Department of Population Health, NYU Langone Health
| | | | - Kevin Lin
- Department of Medicine, NYU Langone Health
| | | | - Sandy Ng
- Department of Medicine, Stony Brook University Hospital
| | - Chau Trinh-Shevrin
- Department of Medicine, NYU Langone Health
- Department of Population Health, NYU Langone Health
| | | | - Simona C. Kwon
- Department of Medicine, NYU Langone Health
- Department of Population Health, NYU Langone Health
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21
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Cheney C, Parish A, Niedzwiecki D, Oko C, Walters C, Halpern D, Helmueller L, Hoyek NE, Miller-Wilson LA, Sullivan BA. Colorectal cancer screening uptake and adherence by modality at a large tertiary care center in the United States: a retrospective analysis. Curr Med Res Opin 2024; 40:431-439. [PMID: 38197407 DOI: 10.1080/03007995.2024.2303090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Real-world data is crucial to inform existing opportunistic colorectal cancer (CRC) prevention programs. This study aimed to assess CRC screening adherence and utilization of various screening modalities within a Primary Care network over a three-year period (2017-2019). METHODS A retrospective review of individuals aged 50-75 years at average CRC risk, with at least one clinic visit in the previous 24 months. The primary outcome, CRC screening adherence (overall and by modality) was examined among the entire eligible population and newly adherent individuals each calendar year. The final sample included 107,366 patients and 218,878 records. RESULTS Overall CRC screening adherence increased from 71% in 2017 to 78% in 2019. For "up-to-date" individuals, colonoscopy was the predominant modality (accounting for approximately 74%, versus 4% of adherence for non-invasive options). However, modality utilization trends changed over time in these individuals: mt-sDNA increased 10.2-fold, followed by FIT (1.6-fold) and colonoscopy (1.1-fold). Among newly adherent individuals, the proportion screened by colonoscopy and FOBT decreased over time (89% to 80% and 2.4% to 1.2%, respectively), while uptake of FIT and mt-sDNA increased (7.7% to 11.5% and 0.9% to 6.8%, respectively). Notably, FIT and mt-sDNA increases were most evident in age and race-ethnicity groups with the lowest screening rates. CONCLUSIONS In an opportunistic CRC screening program, adherence increased but remained below the national 80% goal. While colonoscopy remained the most utilized modality, new colonoscopy uptake declined, compared with rising mt-sDNA and FIT utilization. Among minority populations, new uptake increased most with mt-sDNA and FIT.
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Affiliation(s)
- Catherine Cheney
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alice Parish
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Chukwuemeka Oko
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christy Walters
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David Halpern
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | | | | | | | - Brian A Sullivan
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
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22
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Wang PY, Weng KH, Liou JY, Kuo HT, Ho CH, Sheu MJ. Clinical significance of abdominal computed tomography and colonoscopy in the evaluation of phlebosclerotic colitis. Kaohsiung J Med Sci 2024; 40:296-303. [PMID: 37732706 DOI: 10.1002/kjm2.12761] [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] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/20/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
Clinical manifestations of phlebosclerotic colitis (PC) exhibit significant variability, necessitating diverse treatment strategies depending on disease severity. However, there is limited research exploring the relationship between imaging findings and disease severity. Hence, this retrospective study aimed to analyze the correlation between computed tomography (CT) findings, colonoscopic features, and disease severity. This study compared the abdominal CT characteristics, colonoscopy findings, and treatment modalities of 45 PC patients. CT images were assessed for the severity of mesenteric venous calcification, maximum colonic wall thickness, number of involved colonic segments, and presence of pericolic inflammation. Colonoscopic images were assessed for dark purple discoloration mucosa, erosive and ulcerative lesions, mucosal edema, luminal narrowing, and the number of involved colonic segments. In addition, patients were categorized into three groups: the observation (n = 15), medical treatment (n = 19), and operation (n = 11) groups. In CT images, a significant difference in pericolic inflammation (p = 0.039) was observed among groups. Further, significant differences in dark purple discoloration mucosa (p = 0.033), erosive or ulcerative lesions (p < 0.001), mucosal edema (p < 0.001), luminal narrowing (p = 0.012), and the number of involved colonic segments (p = 0.001) were observed in colonoscopy. Moreover, we found positive correlations between CT and colonoscopy features. In conclusion, CT manifestations and colonoscopy findings exhibited correlation with disease severity in PC. When limited to one diagnostic tool, observations from that tool can infer potential manifestations of the alternative tool.
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Affiliation(s)
- Pin-Yi Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kung-Hsun Weng
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Jyun-Yan Liou
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsing-Tao Kuo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ming-Jen Sheu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
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23
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Ramalingam N, Coury J, Barnes C, Kenzie ES, Petrik AF, Mummadi RR, Coronado G, Davis MM. Provision of colonoscopy in rural settings: A qualitative assessment of provider context, barriers, facilitators, and capacity. J Rural Health 2024; 40:272-281. [PMID: 37676061 PMCID: PMC10918036 DOI: 10.1111/jrh.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/07/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Colonoscopy can prevent morbidity and mortality from colorectal cancer (CRC) and is the most commonly used screening method in the United States. Barriers to colonoscopy at multiple levels can contribute to disparities. Yet, in rural settings, little is known about who delivers colonoscopy and facilitators and barriers to colonoscopy access through screening completion. METHODS We conducted a qualitative study with providers in rural Oregon who worked in endoscopy centers or primary care clinics. Semistructured interviews, conducted in July and August, 2021, focused on clinician experiences providing colonoscopy to rural Medicaid patients, including workflows, barriers, and access. We used thematic analysis, through immersion crystallization, to analyze interview transcripts and develop emergent themes. FINDINGS We interviewed 19 providers. We found two categories of colonoscopy providers: primary care providers (PCPs) doing colonoscopy on their own patients (n = 9; 47%) and general surgeons providing colonoscopy to patients referred to their services (n = 10; 53%). Providers described barriers to colonoscopy at the provider, community, and patient levels and suggested patient supports could help overcome them. Providers found current colonoscopy capacity sufficient, but noted PCPs trained to perform colonoscopy would be key to continued accessibility. Finally, providers shared concerns about the shrinking number of PCP endoscopists, especially with anticipated increased screening demand related to the CRC screening guideline shift. CONCLUSIONS These themes reflect opportunities to address multilevel barriers to improve access, colonoscopy capacity, and patient education approaches. Our results highlight that PCPs are an essential part of the workforce that provides colonoscopy in rural areas.
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Affiliation(s)
- NithyaPriya Ramalingam
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Jennifer Coury
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Chrystal Barnes
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
| | - Erin S. Kenzie
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
- Department of Family Medicine & School of Public Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
| | - Amanda F. Petrik
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Rajasekhara R Mummadi
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Gloria Coronado
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227
| | - Melinda M. Davis
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3030 S Moody Avenue, Suite 160, Portland, OR 97201
- Department of Family Medicine & School of Public Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
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24
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Scotti GB, Iannone I, DE Padua C, Crocetti D, Fiori G, Sapienza P, Fiori E, Avenia S, Lamazza A. Occurrence of Colorectal Cancer After a Negative Colonoscopy in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. In Vivo 2024; 38:523-530. [PMID: 38418112 PMCID: PMC10905472 DOI: 10.21873/invivo.13470] [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] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND/AIM Despite the application of colorectal cancer (CRC) surveillance guidelines, the detection of early neoplastic lesions might be difficult in patients with inflammatory bowel disease (IBD). To explore the risk of post-colonoscopy CRC (PCCRC) in patients with IBD we performed a systematic review and meta-analysis. PATIENTS AND METHODS A systematic literature search was performed (PROSPERO; no. CRD42023453049). We included studies reporting the 3-year PCCRC (PCCRC-3y) prevalence, according to World Endoscopy Organization (WEO)-endorsed definition, in IBD and non-IBD patients. As primary outcome we evaluated the PCCRC-3y prevalence, according to WEO definitions, in IBD- and non-IBD patients and calculated the odds ratio (OR). The secondary outcome was to assess risk factors for PCCRC development in IBD patients. RESULTS Three retrospective observational cohort studies were included. The pooled PCCRC-3y rate in patients with IBD was 30.8% [95% confidence interval (CI)=24.4-37.5%] and in non-IBD patients was 6.8% (95%CI=6.2-7.4%). The PCCRC-3y occurrence in IBD patients was significantly higher than that in non-IBD patients (OR=6.04; 95%CI=4.04-9.4; I2=95%), but a high heterogeneity among studies was noted. Furthermore, patients with ulcerative colitis (UC) had a significantly higher prevalence of PCCRC than patients with Crohn's Disease (CD): 30.9% (95%CI=27.8-34.2%) vs. 22.3% (95%CI=18-27%), respectively (OR=1.6, 95%CI=1.2-2.2; I2=0%). CONCLUSION One-third of CRC in IBD patients were PCCRC, and these numbers were significantly higher when compared with those in non-IBD patients. Furthermore, the prevalence of PCCRC in patients with UC was higher compared to those with CD. However, prospective studies are required to better characterize risk factors for PCCRC development in patients with IBD.
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Affiliation(s)
| | | | | | | | - Giulia Fiori
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Paolo Sapienza
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Enrico Fiori
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Stefano Avenia
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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25
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Wei MT, Fay S, Yung D, Ladabaum U, Kopylov U. Artificial Intelligence-Assisted Colonoscopy in Real-World Clinical Practice: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol 2024; 15:e00671. [PMID: 38146871 PMCID: PMC10962886 DOI: 10.14309/ctg.0000000000000671] [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: 10/22/2023] [Accepted: 11/29/2023] [Indexed: 12/27/2023] Open
Abstract
INTRODUCTION Artificial intelligence (AI) could minimize the operator-dependent variation in colonoscopy quality. Computer-aided detection (CADe) has improved adenoma detection rate (ADR) and adenomas per colonoscopy (APC) in randomized controlled trials. There is a need to assess the impact of CADe in real-world settings. METHODS We searched MEDLINE, EMBASE, and Web of Science for nonrandomized real-world studies of CADe in colonoscopy. Random-effects meta-analyses were performed to examine the effect of CADe on ADR and APC. The study is registered under PROSPERO (CRD42023424037). There was no funding for this study. RESULTS Twelve of 1,314 studies met inclusion criteria. Overall, ADR was statistically significantly higher with vs without CADe (36.3% vs 35.8%, risk ratio [RR] 1.13, 95% confidence interval [CI] 1.01-1.28). This difference remained significant in subgroup analyses evaluating 6 prospective (37.3% vs 35.2%, RR 1.15, 95% CI 1.01-1.32) but not 6 retrospective (35.7% vs 36.2%, RR 1.12, 95% CI 0.92-1.36) studies. Among 6 studies with APC data, APC rate ratio with vs without CADe was 1.12 (95% CI 0.95-1.33). In 4 studies with GI Genius (Medtronic), there was no difference in ADR with vs without CADe (RR 0.96, 95% CI 0.85-1.07). DISCUSSION ADR, but not APC, was slightly higher with vs without CADe among all available real-world studies. This difference was attributed to the results of prospective but not retrospective studies. The discrepancies between these findings and those of randomized controlled trials call for future research on the true impact of current AI technology on colonoscopy quality and the subtleties of human-AI interactions.
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Affiliation(s)
- Mike Tzuhen Wei
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Shmuel Fay
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University Medical School, Tel Aviv, Israel
| | - Diana Yung
- Gold Coast Hospital and Health Service, Gold Coast, Australia.
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel
- Tel Aviv University Medical School, Tel Aviv, Israel
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26
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Kato S, Kudo SE, Minegishi Y, Miyata Y, Maeda Y, Kuroki T, Takashina Y, Mochizuki K, Tamura E, Abe M, Sato Y, Sakurai T, Kouyama Y, Tanaka K, Ogawa Y, Nakamura H, Ichimasa K, Ogata N, Hisayuki T, Hayashi T, Wakamura K, Miyachi H, Baba T, Ishida F, Nemoto T, Misawa M. Impact of computer-aided characterization for diagnosis of colorectal lesions, including sessile serrated lesions: Multireader, multicase study. Dig Endosc 2024; 36:341-350. [PMID: 37937532 DOI: 10.1111/den.14612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/06/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Computer-aided characterization (CADx) may be used to implement optical biopsy strategies into colonoscopy practice; however, its impact on endoscopic diagnosis remains unknown. We aimed to evaluate the additional diagnostic value of CADx when used by endoscopists for assessing colorectal polyps. METHODS This was a single-center, multicase, multireader, image-reading study using randomly extracted images of pathologically confirmed polyps resected between July 2021 and January 2022. Approved CADx that could predict two-tier classification (neoplastic or nonneoplastic) by analyzing narrow-band images of the polyps was used to obtain a CADx diagnosis. Participating endoscopists determined if the polyps were neoplastic or not and noted their confidence level using a computer-based, image-reading test. The test was conducted twice with a 4-week interval: the first test was conducted without CADx prediction and the second test with CADx prediction. Diagnostic performances for neoplasms were calculated using the pathological diagnosis as reference and performances with and without CADx prediction were compared. RESULTS Five hundred polyps were randomly extracted from 385 patients and diagnosed by 14 endoscopists (including seven experts). The sensitivity for neoplasia was significantly improved by referring to CADx (89.4% vs. 95.6%). CADx also had incremental effects on the negative predictive value (69.3% vs. 84.3%), overall accuracy (87.2% vs. 91.8%), and high-confidence diagnosis rate (77.4% vs. 85.8%). However, there was no significant difference in specificity (80.1% vs. 78.9%). CONCLUSIONS Computer-aided characterization has added diagnostic value for differentiating colorectal neoplasms and may improve the high-confidence diagnosis rate.
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Affiliation(s)
- Shun Kato
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yosuke Minegishi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuki Miyata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Takanori Kuroki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kenichi Mochizuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Eri Tamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masahiro Abe
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuta Sato
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tatsuya Sakurai
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kenta Tanaka
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hiroki Nakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore City, Singapore
| | - Noriyuki Ogata
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tomokazu Hisayuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Toshiyuki Baba
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Tetsuo Nemoto
- Department of Diagnostic Pathology and Laboratory Medicine, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
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VanDerslice J, Carroll M. Acute hypernatremia and hypocalcemia after oral sodium phosphate administration to a dog. J Vet Intern Med 2024; 38:1157-1159. [PMID: 38205655 PMCID: PMC10937494 DOI: 10.1111/jvim.16989] [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] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
A 15-year-old male neutered mixed breed dog weighing 28 kg presented to a referral center after developing severe tremors and altered mentation. There was hypocalcemia and hypernatremia after oral administration of sodium phosphate as a bowel cleansing agent in preparation for colonoscopy. The dog was treated intravenously with low sodium fluids and calcium gluconate. Neurologic status and electrolyte derangements normalized over the next 12 hours. Oral administration of sodium phosphate appeared to cause clinical electrolyte derangements in this dog.
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Affiliation(s)
- Julia VanDerslice
- Emergency and Critical Care ServiceAngell Animal Medical CenterBostonMassachusettsUSA
| | - Maureen Carroll
- Emergency and Critical Care ServiceAngell Animal Medical CenterBostonMassachusettsUSA
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28
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Soo JMP, Koh FHX. Detection of sessile serrated adenoma using artificial intelligence-enhanced endoscopy: an Asian perspective. ANZ J Surg 2024; 94:362-365. [PMID: 38149749 DOI: 10.1111/ans.18785] [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] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND As the serrated pathway has gained prominence as an alternative colorectal carcinogenesis pathway, sessile serrated adenomas or polyps (SSA/P) have been highlighted as lesions to rule out during colonoscopy. These lesions are however morphologically difficult to detect on endoscopy and can be mistaken for hyperplastic polyps due to similar endoscopic features. With the underlying nature of rapid progression and malignant transformation, interval cancer is a likely consequence of undetected or overlooked SSA/P. Real-time artificial intelligence (AI)-assisted colonoscopy via the computer-assisted detection system (CADe) is an increasingly useful tool in improving adenoma detection rate by providing a second eye during the procedure. In this article, we describe a guide through a video to illustrate the detection of SSA/P during AI-assisted colonoscopy. METHODS Consultant-grade endoscopists utilized real-time AI-assisted colonoscopy device, as part of a larger prospective study, to detect suspicious lesions which were later histopathologically confirmed to be SSA/P. RESULTS All lesions were picked up by the CADe where a real-time green box highlighted suspicious polyps to the clinician. Three SSA/P of varying morphology are described with reference to classical SSA/P features and with comparison to the features of the hyperplastic polyp found in our study. All three SSA/P observed are in keeping with the JNET Classification (Type 1). CONCLUSION In conclusion, CADe is a most useful aid to clinicians during endoscopy in the detection of SSA/P but must be complemented with factors such as good endoscopy skill and bowel prep for effective detection, and biopsy coupled with subsequent accurate histological diagnosis.
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Affiliation(s)
- Joycelyn Mun-Peng Soo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Frederick Hong-Xiang Koh
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
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29
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Petrik AF, Johnson ES, Slaughter M, Leo MC, Thompson J, Mummadi R, Jimenez R, Hussain S, Coronado G. The recalibration and redevelopment of a model to calculate patients' probability of completing a colonoscopy following an abnormal fecal test. J Med Screen 2024; 31:28-34. [PMID: 37661831 PMCID: PMC10909915 DOI: 10.1177/09691413231195568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Fecal immunochemical testing (FIT) is an effective screening tool for colorectal cancer. If an FIT is abnormal, a follow-up colonoscopy is necessary to remove polyps or find cancers. We sought to develop a usable risk prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test. METHODS We recalibrated and then redeveloped a prediction model in federally qualified health centers (FQHCs), using a retrospective cohort of patients aged 50-75 with an abnormal FIT test and clinical data. Logistic and Cox regressions were used to recalibrate and then redevelop the model. RESULTS The initial risk model used data from eight FQHCs (26 clinics) including 1723 patients. When we applied the model to a single large FQHC (34 clinics, 884 eligible patients), the model did not recalibrate successfully (c-statistic dropped more than 0.05, from 0.66 to 0.61). The model was redeveloped in the same FQHC in a cohort of 1401 patients with a c-statistic of 0.65. CONCLUSIONS The original model developed in a group of FQHCs did not adequately recalibrate in the single large FQHC. Health system, patient characteristics or data differences may have led to the inability to recalibrate the model. However, the redeveloped model provides an adequate model for the single FQHC.
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Affiliation(s)
- Amanda F. Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Eric S. Johnson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Matthew Slaughter
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Michael C. Leo
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie Thompson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Raj Mummadi
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | | - Syed Hussain
- SeaMar Community Health Centers, Seattle, Washington
| | - Gloria Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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Karki D, Ngakhusi S. Serrated adenocarcinoma of sigmoid colon with mismatch repair protein-proficient phenotype: Histopathological recognition of a new subtype of colorectal adenocarcinoma. Clin Case Rep 2024; 12:e8669. [PMID: 38510231 PMCID: PMC10950788 DOI: 10.1002/ccr3.8669] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/21/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
Serrated adenocarcinoma is a distinct subtype of colorectal carcinoma characterized by unique histological and molecular features. Here we present a case study of a 58-year-old female patient who presented with generalized weakness, abdominal discomfort, and per-rectal bleeding. This case report highlights the importance of understanding the histopathological features of serrated adenocarcinoma for accurate diagnosis which has impact on further management.
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Affiliation(s)
- Diksha Karki
- Department of PathologyBhaktapur Cancer HospitalBhaktapurBagmatiNepal
| | - Sajan Ngakhusi
- Department of PathologyBhaktapur Cancer HospitalBhaktapurBagmatiNepal
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Liu S, Wang Y, Wang Y, Duan C, Liu F, Zhang H, Tian X, Ding X, Zhang M, Cao D, Liu Y, Jiang R, Zhuo D, Peng J, Zhu S, Zhao L, Wang J, Wei L, Shi Z. Population-based screening for colorectal cancer in Wuhan, China. Front Oncol 2024; 14:1284975. [PMID: 38487726 PMCID: PMC10937563 DOI: 10.3389/fonc.2024.1284975] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Fecal DNA test has emerged as a non-invasive alternative for colorectal cancer (CRC) screening in average-risk population. However, there is currently insufficient evidence in China to demonstrate the effectiveness of population-based CRC screening using fecal DNA based test. Here, a large-scale real-world study for CRC screening was implemented in Wuhan, Hubei province, China. A total of 98,683 subjects aged between 45 and 60 years were screened by a fecal DNA test (ColoTect®) which detected methylation status of SDC2, ADHFE1, and PPP2R5C. Participants who tested positive were advised to receive diagnostic colonoscopy. 4449 (4.5%) subjects tested positive for fecal DNA test, and 3200 (71.9%) underwent colonoscopy. Among these, 2347 (73.3%) had abnormal colonoscopy findings, of which 1330 (56.7%) subjects received pathological diagnosis. Detection rates for CRC and advanced precancerous lesions were 1.3% and 2.3%, respectively. Detection rates for nonadvanced adenomas and polyps were 14.0% and 21.6%, respectively. 28.0% of all colonoscopies showed colorectal neoplasm but lack pathological diagnosis. 6.1% showed other abnormalities such as enteritis. In conclusion, preliminary real-world evidence suggested that fecal DNA tests had promising diagnostic yield in population-based CRC screening. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=192838, identifier ChiCTR2300070520.
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Affiliation(s)
- Song Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yifan Wang
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Chaofan Duan
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fan Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Heng Zhang
- Department of Gastroenterology, Wuhan Central Hospital, Wuhan, Hubei, China
| | - Xia Tian
- Department of Gastroenterology, The Third Hospital of Wuhan (Tongren Hospital of Wuhan University), Wuhan, Hubei, China
| | - Xiangwu Ding
- Department of Gastroenterology, The Fourth Hospital of Wuhan, Wuhan, Hubei, China
| | - Manling Zhang
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Dan Cao
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Liu
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Duan Zhuo
- BGI Genomics Co., Ltd., Shenzhen, China
| | | | - Shida Zhu
- BGI Genomics Co., Ltd., Shenzhen, China
| | | | - Jian Wang
- BGI Genomics Co., Ltd., Shenzhen, China
| | - Li Wei
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhaohong Shi
- Department of Gastroenterology, Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
- Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Abdulelah ZA, Abdulelah AA, Alqaisieh M, Khanfar AN, Hammad NH, Al Masoud EB, Odeh QB, Alshrouf MA, Abuaisheh RM, Abd-Alrahman HM, Khatib A. National survey of barriers to colorectal cancer screening in Jordan. East Mediterr Health J 2024; 30:125-135. [PMID: 38491898 DOI: 10.26719/emhj.24.028] [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] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 10/05/2023] [Indexed: 03/18/2024]
Abstract
Background Colorectal cancer is among the leading malignancies globally and in Jordan. It causes significant morbidity and mortality. It can be detected early, but uptake of colorectal cancer screening in Jordan is substantially low. Aim To determine the underlying barriers to the uptake of colorectal cancer screening in Jordan. Methods A cross-sectional study was conducted in the northern, central and southern regions of Jordan using selfadministered questionnaire that evaluated the barriers and attitudes towards colorectal cancer screening among adults aged 45 years and above living in Jordan. The data was analyzed using SPSS version 25.0. Results Of the 1477 participants enrolled in the study, 29.1% reported the lack of information about screening as a major barrier to uptake, followed by the fear of any potential complications due to the test (10%), embarrassment associated with colonoscopy (7.8%), and fear of the result (7.4%). Only 9% of the study participants had taken the colonoscopy test for colorectal cancer screening. Conclusion Lack of information about colorectal cancer screening, misconceptions and embarrassment drive the low uptake of colorectal cancer screening in Jordan. There is a need for nationwide education and awareness on colorectal cancer screening to address the barriers reported in this study and increase screening uptake.
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Affiliation(s)
- Zaid Ali Abdulelah
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Asim N Khanfar
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Nouran Husam Hammad
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Qusai B Odeh
- School of Medicine, The Hashemite University, Zarqa, Jordan
| | | | | | | | - Amer Khatib
- Department of Gastroenterology, The University of Jordan, Amman, Jordan
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Vachon EA, Katz ML, Rawl SM, Stump TE, Emerson B, Baltic RD, Biederman EB, Monahan PO, Kettler CD, Paskett ED, Champion VL. Comparative effectiveness of two interventions to increase colorectal cancer screening among females living in the rural Midwest. J Rural Health 2024. [PMID: 38391093 DOI: 10.1111/jrh.12828] [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: 08/07/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To assess the comparative effectiveness of a tailored, interactive digital video disc (DVD) intervention versus DVD plus patient navigation (PN) intervention versus usual care (UC) on the uptake of colorectal cancer (CRC) screening among females living in Midwest rural areas. METHODS As part of a larger study, 663 females (ages 50-74) living in rural Indiana and Ohio and not up-to-date (UTD) with CRC screening at baseline were randomized to one of three study groups. Demographics , health status/history, and beliefs and attitudes about CRC screening were measured at baseline. CRC screening was assessed at baseline and 12 months from medical records and self-report. Multivariable logistic regression was used to determine whether females in each group were UTD for screening and which test they completed. RESULTS Adjusted for covariates, females in the DVD plus PN group were 3.5× more likely to complete CRC screening than those in the UC group (odds ratio [OR] 3.62; 95% confidence interval [CI]: 2.09, 6.47) and baseline intention to receive CRC screening (OR 3.45, CI: 2.21,5.42) at baseline. Adjusting for covariates, there was no difference by study arm whether females who became UTD for CRC screening chose to complete a colonoscopy or fecal occult blood test/fecal immunochemical test. CONCLUSIONS Many females living in the rural Midwest are not UTD for CRC screening. A tailored intervention that included an educational DVD and PN improved knowledge, addressed screening barriers, provided information about screening test options, and provided support was more effective than UC and DVD-only to increase adherence to recommended CRC screening.
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Affiliation(s)
- Eric A Vachon
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Timothy E Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brent Emerson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ryan D Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Erika B Biederman
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Patrick O Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carla D Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
- Department of Medicine, Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Victoria L Champion
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
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Kim DS, Ryu JE, Shin J, Koo HS, Lee S, Cho H, Na J, Huh KC. Diagnostic Value of Ileal Lesions Found during Colonoscopy with Reference to Endoscopic Indications and Findings. J Clin Med 2024; 13:1161. [PMID: 38398473 PMCID: PMC10889396 DOI: 10.3390/jcm13041161] [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: 01/09/2024] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The diagnostic value of ileoscopy is not well established, and its routine practice is controversial. We aimed to investigate the diagnostic value of biopsy for macroscopically abnormal lesions in the terminal ileum and to identify the association between endoscopic indications and findings and the presence of significant disease. This retrospective study included 551 patients who underwent biopsy of abnormal lesions in the terminal ileum (TI) during colonoscopy between February 2000 and June 2019. Biopsy results were analyzed in relation to the endoscopic indications and gross findings. Significant disease was defined as a case in which a specific disease was suspected or confirmed by the biopsy results, requiring additional examination or treatment. Among the 551 biopsies from macroscopically abnormal lesions in the TI, 44 (8.0%) had significant diseases. The frequency of significant disease was high in patients with clinically suspected inflammatory bowel disease (IBD) (50.0%), anemia (31.6%), right lower quadrant (RLQ) pain (28.6%), and radiological abnormalities in the TI (27.5%). The frequency of Crohn's disease (CD) was high in patients with clinically suspected IBD. A concurrent abnormality in the ileocecal valve (ICV) (14.3%) and the presence of an ulcer (14.2%), mass, or polyp (25.4%) correlated with a high incidence of significant disease, particularly CD. In cases of suspected IBD, anemia, RLQ pain, and radiologic abnormalities in the TI, there is a high possibility of significant disease. Ulcers, masses, polyps, and concurrent abnormalities in the ICV were also associated with significant disease.
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Affiliation(s)
- Dae Sung Kim
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Ji Eun Ryu
- Healthcare Center, Konyang University Hospital, Daejeon 35365, Republic of Korea
| | - Jieun Shin
- Konyang Medical Data Research Group-KYMERA, Konyang University Hospital, Daejeon 35365, Republic of Korea
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea
| | - Hoon Sup Koo
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Sanghyuk Lee
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Hwanhyi Cho
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Jongheon Na
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Kyu Chan Huh
- Division of Gastroenterology, Department of Internal Medicine, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
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Barakat MT, Banerjee S, Angelotti T. Anesthetic Considerations for Patients with Locked-In Syndrome Undergoing Endoscopic Procedures. Am J Case Rep 2024; 25:e942906. [PMID: 38356258 PMCID: PMC10877638 DOI: 10.12659/ajcr.942906] [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] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/01/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Delivering safe anesthetic care to a patient unable to communicate easily and effectively with the anesthesia team presents many unique challenges. Communication may be limited by language, which can be resolved with translation services, or neurological conditions, such as stroke or traumatic brain injury, which are not easily remedied. In such patients, the inability to communicate effectively can lead to anxiety and negatively impact the patient-anesthesiologist relationship, especially when higher cognitive functions are preserved. CASE REPORT We present a case of a patient with locked-in syndrome (LIS), who presented to our endoscopy unit for a routine colonoscopy. The patient could only communicate with eye movements and blinking, thus limiting our ability to assess their pain or other needs in the perioperative period; however, she was otherwise cognitively intact. By utilizing the patient's home healthcare team and quickly adapting their unique communication methods during the perioperative period, we were able to provide an appropriate, safe anesthetic for this patient with LIS. CONCLUSIONS Many patients requiring an anesthetic are unable to effectively communicate due to language issues, hearing loss/mutism, neurological injury/stroke (aphasia), or developmental disabilities. The unique communication needs of this patient with LIS went beyond utilizing a translator and required the healthcare team to quickly learn a new communication method. We also discuss forms of intraoperative monitoring that can be used to differentiate consciousness from the anesthetized state in LIS patients, as well as making recommendations for future care of such patients.
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Affiliation(s)
- Monique T. Barakat
- Department of Internal Medicine, Division of Gastroenterology and Hepatology,Stanford University, Stanford, CA, USA
| | - Subhas Banerjee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology,Stanford University, Stanford, CA, USA
| | - Timothy Angelotti
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
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Liao F, Huang Y, Lai Y, Xie J. The status quo of short videos as a source of health information regarding bowel preparation before colonoscopy. Front Public Health 2024; 12:1309632. [PMID: 38414898 PMCID: PMC10896954 DOI: 10.3389/fpubh.2024.1309632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/02/2024] [Indexed: 02/29/2024] Open
Abstract
Background For high-quality colonoscopies, adequate bowel preparation is a prerequisite, closely associated with the diagnostic accuracy and therapeutic safety of colonoscopy. Although popular-science short videos can help people quickly access health information, the overall quality of such short videos as a source of health information regarding bowel preparation before colonoscopy is unclear. Therefore, we intend to conduct a cross-sectional study to investigate the quality of bowel preparation information before colonoscopy through short videos taken on TikTok and Bilibili. Methods The Chinese phrases "colonoscopy" and "bowel preparation" were used as keywords to search for and screen the top 100 videos in the comprehensive rankings on TikTok and Bilibili. The Global Quality Score (GQS) and the modified DISCERN score were used to assess the quality of the information provided in these short videos. Results A total of 186 short videos were included in this study; 56.5% of them were posted by health professionals, whereas 43.5% of them were posted by nonhealth professionals. The overall quality of these videos was unsatisfactory, with a median DISCERN score of 3 (2-4) and a median GQS of 3 (3-4). The radar maps showed that videos posted by gastroenterologists had higher completeness scores regarding outcomes, management, and risk factors, while nongastroenterologists had higher completeness scores concerning adverse effects, symptoms, and definitions of bowel preparation. Additionally, the median DISCERN score and GQS of the videos posted by gastroenterologists were 3 (3-4) and 3 (3-4), respectively, whereas the quality of the videos posted by patients was the worst, with a median DISCERN score of 2 (1-2) and a median GQS of 2 (1.25-3). Conclusion In conclusion, the overall quality of health information-related videos on bowel preparation before colonoscopy posted on specified short video platforms was not satisfactory. Gastroenterologists provide more information on the outcomes, management, and risk factors for bowel preparation before colonoscopy, while nongastroenterologists focus on adverse effects, symptoms, and definitions of bowel preparation.
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Affiliation(s)
- Foqiang Liao
- Department of Gastroenterology, Jiangxi Medical College, Affiliated Ganzhou People’s Hospital, Nanchang University, Ganzhou, China
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yunfeng Huang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yongkang Lai
- Department of Gastroenterology, Jiangxi Medical College, Affiliated Ganzhou People’s Hospital, Nanchang University, Ganzhou, China
| | - Junfeng Xie
- Department of Gastroenterology, Jiangxi Medical College, Affiliated Ganzhou People’s Hospital, Nanchang University, Ganzhou, China
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Popescu Crainic I, Djinbachian R, Rex DK, Barkun A, Shaukat A, East J, Hassan C, Mori Y, Pohl H, Rastogi A, Sharma P, Anderson JC, Taghiakbari M, Medawar E, von Renteln D. Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study. Scand J Gastroenterol 2024:1-7. [PMID: 38333956 DOI: 10.1080/00365521.2024.2308519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND AIMS Accurate polyp size estimation during colonoscopy has an impact on clinical decision-making. A laser-based virtual scale endoscope (VSE) is available to allow measuring polyp size using a virtual adaptive scale. This study evaluates video-based polyp size measurement accuracy among expert endoscopists using either VSE or visual assessment (VA) with either snare as reference size or without any reference size information. METHODS A prospective, video-based study was conducted with 10 expert endoscopists. Video sequences from 90 polyps with known reference size (fresh specimen measured using calipers) were distributed on three different slide sets so that each slide set showed the same polyp only once with either VSE, VA or snare-based information. A slide set was randomly assigned to each endoscopist. Endoscopists were asked to provide size estimation based on video review. RESULTS Relative accuracies for VSE, VA, and snare-based estimation were 75.1% (95% CI [71.6-78.5]), 65.0% (95% CI [59.5-70.4]) and 62.0% (95% CI [54.8-69.0]), respectively. VSE yielded significantly higher relative accuracy compared to VA (p = 0.002) and to snare (p = 0.001). A significantly lower percentage of polyps 1-5 mm were misclassified as >5 mm using VSE versus VA and snare (6.52% vs. 19.6% and 17.5%, p = 0.004) and a significantly lower percentage of polyps >5 mm were misclassified as 1-5 mm using VSE versus VA and snare (11.4% vs. 31.9% and 14.9%, p = 0.038). CONCLUSIONS Endoscopists estimate polyp size with the highest accuracy when virtual adaptive scale information is displayed. Using a snare to assist sizing did not improve measurement accuracy compared to displaying visual information alone.
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Affiliation(s)
- Ioana Popescu Crainic
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Roupen Djinbachian
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, IN University Medical Center, Indianapolis, Indiana, USA
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Québec, Canada
| | - Aasma Shaukat
- Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York City, New York, USA
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK
- Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Cesare Hassan
- Division of Gastroenterology, Regina Margherita Hospital, Rome, Italy
| | - Yuichi Mori
- Division of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Heiko Pohl
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Division of Gastroenterology, White River Junction Veteran Affairs Medical Center, White River Junction, Vermont, USA
| | - Amit Rastogi
- Division of Gastroenterology, University of KS School of Medicine, Kansas City, Kansas, USA
| | - Prateek Sharma
- Division of Gastroenterology, University of KS School of Medicine, Kansas City, Kansas, USA
- Division of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Joseph C Anderson
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mahsa Taghiakbari
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Edgard Medawar
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
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Ye Q, Xu K, Tong Y, Zhao M. The role of gastrin 17 and pepsinogen I:pepsinogen II ratio in pathological diagnosis and endoscopic selection in gastritis patients. Lab Med 2024:lmad119. [PMID: 38333933 DOI: 10.1093/labmed/lmad119] [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] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The noninvasive serum markers pepsinogen I (PGI), pepsinogen II (PGII), gastrin-17 (G17), and PGI:PGII ratio (PGR) have recently been proposed as a new tool for predicting various gastric pathologies. METHODS A total of 83 gastritis patients confirmed by gastroscopy were enrolled, with 78 undergoing concurrent colonoscopies. The control group included 99 healthy subjects. Enzyme-linked immunosorbent assay was used to detect PGI, PGII, G17, and PGR. The performance of serological analysis for detecting gastritis pathology was evaluated using receiver operating characteristic (ROC) curves. RESULTS The G17 and PGII levels increased significantly (P < .001), whereas PGR levels decreased (P = .001) in the gastritis group. The ROC analysis revealed that PGR had a sensitivity and specificity of 70.83% and 86.67%, respectively, in predicting Helicobacter pylori-infected gastritis and a sensitivity and specificity of 88% and 65.52%, respectively, in predicting active gastritis. The G17 levels were significantly elevated in gastritis patients undergoing concurrent colonoscopies (P < .05). CONCLUSION Pepsinogen I:pepsinogen II ratio was found to be a useful predictor of active gastritis and H pylori-infected gastritis. Furthermore, G17 was found to be closely related to pathological conditions found by colonoscopy and may provide recommendations for whether gastritis patients should undergo a concurrent colonoscopy.
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Affiliation(s)
- Qian Ye
- Department of Clinical Laboratory, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Kai Xu
- Department of Clinical Laboratory, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Yu Tong
- Department of Clinical Laboratory, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Misheng Zhao
- Department of Clinical Laboratory, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
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Li Y, Meng F, Cao R, Gao C, Su D, Wang K, Han J, Qi X. Excellent Bowel Preparation Quality Is Not Superior to Good Bowel Preparation Quality for Improving Adenoma/Polyp Detection Rate. Clin Med Insights Oncol 2024; 18:11795549241229190. [PMID: 38332773 PMCID: PMC10851725 DOI: 10.1177/11795549241229190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Background Adequate bowel preparation quality is essential for high-quality colonoscopy according to the current guidelines. However, the excellent effect of bowel preparation on adenoma/polyp detection rate (ADR/PDR) remained controversial. Methods During the period from December 2020 to August 2022, a total of 1566 consecutive patients underwent colonoscopy by an endoscopist. Their medical records were reviewed. According to the Boston bowel preparation scale, patients were divided into excellent, good, and poor bowel preparation quality groups. ADR/PDR, diminutive ADR/PDR, small ADR/PDR, intermediate ADR/PDR, large ADR/PDR, and number of adenomas/polyps were compared among them. Logistic regression analyses were performed to identify the factors that were significantly associated with ADR/PDR. Results Overall, 1232 patients were included, of whom 463, 636, and 133 were assigned to the excellent, good, and poor groups, respectively. The good group had a significantly higher ADR/PDR (63% vs 55%, P = .015) and a larger number of adenomas/polyps (2.5 ± 3.2 vs 2.0 ± 2.8, P = .030) than the poor group. Both ADR/PDR (63% vs 55%, P = .097) and number of adenomas/polyps (2.2 ± 2.8 vs 2.0 ± 2.8, P = .219) were not significantly different between excellent and poor groups. The excellent (9% vs 4%, P = .045) and good (9% vs 4%, P = .040) groups had a significantly higher intermediate ADR/PDR than the poor group. Logistic regression analyses showed that either good (odds ratio [OR] = 1.786, 95% CI = 1.046-3.047, P = .034) or excellent (OR = 2.179, 95% CI = 1.241-3.826, P = .007) bowel preparation quality was independently associated with a higher ADR/PDR compared with poor bowel preparation quality. Excellent (OR = 1.202, 95% CI = 0.848-1.704, P = .302) bowel preparation quality was not independently associated with a higher ADR/PDR compared with good bowel preparation quality. Conclusions The pursuit of excellence in bowel preparation does not show an association with increased ADR/PDR and number of adenomas/polyps compared with a good level. In addition, our study further contributes to the existing evidence that poor bowel preparation compromises ADR/PDR and number of adenomas/polyps.
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Affiliation(s)
- Yingchao Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Fanjun Meng
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Rongrong Cao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Cong Gao
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Dalian Medical University, Dalian, China
| | - Dongshuai Su
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Ke Wang
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Jie Han
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
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van Riswijk MLM, van Keulen KE, Neumann H, Siersema PD. An intraprocedural bowel cleansing system for difficult-to-prepare patients-A multicenter prospective feasibility study. United European Gastroenterol J 2024; 12:56-65. [PMID: 38213079 PMCID: PMC10859716 DOI: 10.1002/ueg2.12501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Adequate bowel preparation is a prerequisite for colonoscopy. However, up to 20% of colonoscopies remain inadequately prepared. Risk factors for inadequate bowel preparation often overlap with those of failed cecal intubation. This study aimed to assess the feasibility of an intraprocedural bowel cleansing system (BCS) in patients with a history of inadequate bowel preparation. METHODS Patients (n = 44) with a history of inadequate bowel preparation in the past 2 years were included. After a limited preparation with 300 mL split-dose sodium picosulfate magnesium citrate, additional cleansing during colonoscopy was performed with the BCS. The primary outcome was adequate bowel preparation using the Boston Bowel Preparation Scale (BBPS). Secondary outcomes included cecal intubation rate, procedure times, usability, and safety. RESULTS Median BBPS increased from 1-2-2 (IQR 1-2) to 3-3-3 (IQR) (p < 0.0001), with 31.8% and 88.6% of patients adequately prepared before and after using the BCS, respectively (p < 0.0001). Cecal intubation rate was 88.6%. Reasons for incomplete colonoscopy were looping (n = 2), technical failure (n = 1), relative stricture (n = 1), and residual feces (n = 1). In patients with complete colonoscopy, the adequate cleansing rate was 97.5%. Median total procedure time was 26 min, of which 5.3 min were spent on cleaning. General ease of use was scored with a median of 4 out of 5, representing "as good as conventional colonoscopy". No serious adverse events occurred. CONCLUSIONS Adequate bowel cleaning can be achieved with an intraprocedural BCS in patients with a history of inadequate bowel preparation, which may reduce repeat colonoscopies and clinical admissions for bowel preparation. However, since these patients more frequently have complicated anatomy (surgical scarring, diverticulosis, etc.), adequate patient selection is advised to avoid incomplete procedures.
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Affiliation(s)
- Milou L. M. van Riswijk
- Department of Gastroenterology and HepatologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Kelly E. van Keulen
- Department of Gastroenterology and HepatologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
| | - Helmut Neumann
- Department of Interdisciplinary EndoscopyI. Medizinische Klinik und PoliklinikUniversity HospitalMainzGermany
- GastroZentrum LippeBad SalzuflenGermany
| | - Peter D. Siersema
- Department of Gastroenterology and HepatologyRadboud Institute for Health SciencesRadboud University Medical CenterNijmegenThe Netherlands
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Shah ED, Ahuja NK, Brenner DM, Chan WW, Curley MA, Nee J, Iturrino-Moreda J, Staller K, Saini SD, Chey WD. Optimizing the Management Algorithm for Adults With Functional Constipation Failing a Fiber/Laxative Trial in General Gastroenterology: Cost-Effectiveness and Cost-Minimization Analysis. Am J Gastroenterol 2024; 119:342-352. [PMID: 37734345 PMCID: PMC10872778 DOI: 10.14309/ajg.0000000000002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Anorectal function testing is traditionally relegated to subspecialty centers. Yet, it is an office-based procedure that appears capable of triaging care for the many patients with Rome IV functional constipation that fail empiric over-the-counter therapy in general gastroenterology, as an alternative to empirical prescription drugs. We aimed to evaluate cost-effectiveness of routine anorectal function testing in this specific population. METHODS We performed a cost-effectiveness analysis from the patient perspective and a cost-minimization analysis from the insurer perspective to compare 3 strategies: (i) empiric prescription drugs followed by pelvic floor physical therapy (PFPT) for drug failure, (ii) empiric PFPT followed by prescription drugs for PFPT failure, or (iii) care directed by up-front anorectal function testing. Model inputs were derived from systematic reviews of prospective clinical trials, national cost data sets, and observational cohort studies of the impact of chronic constipation on health outcomes, healthcare costs, and work productivity. RESULTS The most cost-effective strategy was upfront anorectal function testing to triage patients to appropriate therapy, in which the subset of patients without anal hypocontractility on anorectal manometry and with a balloon expulsion time of at least 6.5 seconds would be referred to PFPT. In sensitivity analysis, empiric PFPT was more cost effective than empiric prescription drugs except for situations in which the primary goal of treatment was to increase bowel movement frequency. If adopted, gastroenterologists would refer ∼17 patients per year to PFPT, supporting feasibility. DISCUSSION Anorectal function testing seems to be an emergent technology to optimize cost-effective outcomes, overcoming testing costs by phenotyping care.
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Affiliation(s)
| | - Nitin K. Ahuja
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Darren M. Brenner
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Walter W. Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Michael A. Curley
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Judy Nee
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Kyle Staller
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, MI, USA
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O-Pad N, Supachai K, Boonyapibal A, Suebwongdit C, Panaiem S, Sirisophawadee T. Bowel Preparation Burden, Rectal Pain and Abdominal Discomfort: Perspective of Participants Undergoing CT Colonography and Colonoscopy. Asian Pac J Cancer Prev 2024; 25:529-536. [PMID: 38415539 DOI: 10.31557/apjcp.2024.25.2.529] [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] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate bowel preparation burden, rectal pain and abdominal discomfort levels and to determine the association between demographic characteristics and those levels among participants undergoing CT colonography and colonoscopy. METHODS A cross-sectional survey was conducted in eligible Thai citizens who consented to participate all four visits of a free colorectal cancer screening protocol. Three levels (mild, moderate and severe) of burden, pain and discomfort were used to ask the perspective of participants at the final visit, one week after undergoing those two procedures. RESULTS Data from 1,271 participants completed for analyses - females 815 (64.1%), males 456 (35.9%). The majority of participants experienced mild burden, pain and discomfort. Association between characteristic groups and burden levels differed regarding own income, chronic disease and laxative. Between characteristic groups and pain and discomfort levels differed regarding own income and chronic disease. Participants without their own income rated severe burden lower than those who had (p<0.001), but those without chronic disease rated moderate burden lower than who had (p=0.003). Participants prepared bowel with spilt-dose of PEG rated moderate burden higher than those who prepared with NaP (p<0.001). Participants undergoing CT colonography without their own income and presenting no chronic disease faced severe rectal pain lower than those who had (p<0.001 and p=0.04). Participants without their own income rated moderate and severe abdominal discomfort lower than those who had (p<0.01 and p=0.008). Participants undergoing colonoscopy without their own income and no chronic diseases faced severe rectal pain lower than those who had (p<0.001 and p=0.007). Participants without their own income and no chronic disease rated severe abdominal discomfort lower than those who had (p<0.001 and p=0.005). CONCLUSION Evaluating the perspectives of customers alongside quality improvement and innovation to reduce unpleasant experiences remains needed in CT colonography and colonoscopy to promote CRC screening.
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Chino A, Ide D, Abe S, Yoshinaga S, Ichimasa K, Kudo T, Ninomiya Y, Oka S, Tanaka S, Igarashi M. Performance evaluation of a computer-aided polyp detection system with artificial intelligence for colonoscopy. Dig Endosc 2024; 36:185-194. [PMID: 37099623 DOI: 10.1111/den.14578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/25/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES A computer-aided detection (CAD) system was developed to support the detection of colorectal lesions by deep learning using video images of lesions and normal mucosa recorded during colonoscopy. The study's purpose was to evaluate the stand-alone performance of this device under blinded conditions. METHODS This multicenter prospective observational study was conducted at four Japanese institutions. We used 326 videos of colonoscopies recorded with patient consent at institutions in which the Ethics Committees approved the study. The sensitivity of successful detection of the CAD system was calculated using the target lesions, which were detected by adjudicators from two facilities for each lesion appearance frame; inconsistencies were settled by consensus. Successful detection was defined as display of the detection flag on the lesion for more than 0.5 s within 3 s of appearance. RESULTS Of the 556 target lesions from 185 cases, detection success sensitivity was 97.5% (95% confidence interval [CI] 95.8-98.5%). The "successful detection sensitivity per colonoscopy" was 93% (95% CI 88.3-95.8%). For the frame-based sensitivity, specificity, positive predictive value, and negative predictive value were 86.6% (95% CI 84.8-88.4%), 84.7% (95% CI 83.8-85.6%), 34.9% (95% CI 32.3-37.4%), and 98.2% (95% CI 97.8-98.5%), respectively. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN000044622).
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Affiliation(s)
- Akiko Chino
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Ide
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Toyoki Kudo
- Tokyo Endoscopic Clinic, Tokyo, Japan
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yuki Ninomiya
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Masahiro Igarashi
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Stoian M, Becheanu G, Balescu I, Eftimie M, Petrea S, Diaconu C, Gaspar B, Pop L, Varlas V, Hasegan A, Martac C, Bolca C, Stroescu C, Zgura A, Bacalbasa N. Recurrence and Carcinogenetic Rates of Colorectal Polyps. Chirurgia (Bucur) 2024; 119:21-35. [PMID: 38465713 DOI: 10.21614/chirurgia.2024.v.119.i.1.p.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 03/12/2024]
Abstract
AIM to determin the recurrence rate of benign recto-colonic polyps in a 5-year interval, and compare the development rate of intrapolypoid carcinomatous lesions in polypectomized versus nonpolypectomized subjects. MATERIAL AND METHOD a group of 77 patients diagnosed with recto-colonic polypoid lesions during the period 2014-2019 underwent colonoscopy at the time of study initiation and then annually during a five-year interval. Results: The recurrence rate of polyps increased annually from 5 to 12.5%; the highest rate was noted in the last two years. The five-year cumulative risk of neoplastic lesions was 73% in patients without polypectomy and 20% among those with endoscopic resection (p 0.05). Comparing the recurrence rate of benign lesions (60%) in patients without neoplastic findings with the recurrence rate of adenomas in patients with benign lesions (40%), a higher risk of recurrence was found in the first category, and seemed to be influenced by the personal history of pre-existing adenomatous lesions. CONCLUSION an increased risk of colorectal polyps recurrence was reported during five year follow up; moreover, during the first three years an increased risk of malignant transformation was observed among cases in which endoscopic resection was not feasible when compared to those in which complete excision was feasible.
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Kim A, Teoh M, Vu L, Noches-Garcia A, Nyandoro MG. Practice Implications of Colonoscopic Investigation of Microscopic Colitis in Patients Above 50 Years of Age Presenting With Chronic Diarrhoea: A Multi-Centre Review. Cureus 2024; 16:e54865. [PMID: 38405637 PMCID: PMC10894505 DOI: 10.7759/cureus.54865] [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] [Accepted: 02/25/2024] [Indexed: 02/27/2024] Open
Abstract
Background Patients with an unknown cause for chronic diarrhoea will usually undergo a colonoscopy as part of the investigative work-up, and it is acceptable practice for the patients to undergo random biopsies. The optimum number of biopsies has yet to be established. This study investigated the implications of routine random biopsies for diagnosing microscopic colitis in patients 50 years and older who presented with chronic diarrhoea. Methodology A retrospective cohort study of a prospectively maintained internal hospital database across three tertiary teaching hospitals in Perth, Western Australia, on participants >50 years old who presented for an elective colonoscopy to investigate chronic diarrhoea between January 2016 and June 2019. Data was captured from medical records, imaging, colonoscopy, and histopathology reports, and patient follow-up was analysed using SPSS v.29 (IBM Corp., Armonk, NY). Results There were 216 patients, with the majority female (67%) and a mean age of 64.6 (SD±9.9). Microscopic colitis was identified in 7.4% (95% CI = 3.9-10.9%). Most positive biopsies (81.3%) were from the left colon. The median number of biopsies per case was seven (IQR=5). The median procedure duration and scope withdrawal time were 23 and eight minutes, respectively. Most of the procedures were done by a consultant (77%). Bowel was adequately prepped in 76.9% of the cases. Univariate analysis demonstrated that the rate of identification of microcolitis was associated with the number of biopsies taken; microcolitis positivity had a higher mean number of biopsies, 10.8 vs 6.7 (p<0.001). Key complications were a 30-day readmission rate, seven-day re-presentation with acute colitis, post-procedure bleeding, requiring further imaging or angioembolisation and increased length of stay on readmission. Conclusion The prevalence of positive biopsies for microcolitis is low (7.4%). Biopsies during colonoscopy are associated with clinically significant morbidity and health care costs. Most positive biopsies were attained from the left colon. It may be time to standardise practice in investigating microscopic colitis as a cause of chronic diarrhoea in patients > 50 years old.
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Affiliation(s)
- Audrey Kim
- General Surgery, Fiona Stanley Hospital, Perth, AUS
| | - Mary Teoh
- General and Colorectal Surgery, Fiona Stanley Hospital, Perth, AUS
| | - Linda Vu
- General and Colorectal Surgery, Fiona Stanley Hospital, Perth, AUS
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Ow TW, Angelica B, Burn S, Chu M, Lee SZ, Lin R, Tran V, Iyngkaran G, Bampton P, Sukocheva O, Tse E, Rayner CK. Comparing the resource implications of old and new colorectal adenoma surveillance guidelines in Australia. Intern Med J 2024; 54:250-257. [PMID: 37287100 DOI: 10.1111/imj.16149] [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] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The latest update to the Australian adenoma surveillance guideline in 2018 introduced a novel risk stratification system with updated surveillance recommendations. The resource implications of adopting this new system are unclear. AIMS To quanitfy the resource demands of adopting new over old adenoma surveillance guidelines. METHODS We studied data from 2443 patients undergoing colonoscopies, in which a clinically significant lesion was identified in their latest, or previous procedure(s) across five Australian hospitals. We excluded procedures with inflammatory bowel disease, new or prior history of colorectal cancer or resection, inadequate bowel preparation and incomplete procedures. Old and new Australian surveillance intervals were calculated according to the number, size and histological characteristics of lesions identified. We used these data to compare the rate of procedures according to each guideline. RESULTS Based on the procedures for 766 patients, the new surveillance guidelines significantly increased the number of procedures allocated an interval of 1 year (relative risk (RR): 1.57, P = 0.009) and 10 years (RR: 3.83, P < 0.00001) and reduced those allocated to half a year (RR: 0.08, P = 0.00219), 3 years (RR: 0.51, P < 0.00001) and 5 years (RR: 0.59, P < 0.00001). Overall, this reduced the relative number of surveillance procedures by 21% over 10 years (25.92 vs 32.78 procedures/100 patient-years), which increased to 22% after excluding patients 75 or older at the time of surveillance (19.9 vs 25.65 procedures/100 patient-years). CONCLUSION The adoption of the latest Australian adenoma surveillance guidelines can reduce demand for surveillance colonoscopy by more than a fifth (21-22%) over 10 years.
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Affiliation(s)
- Tsai-Wing Ow
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Bianca Angelica
- Department of Gastroenterology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sophie Burn
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Matthew Chu
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Shawn Z Lee
- Department of Gastroenterology and Hepatology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Richard Lin
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Vy Tran
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Guru Iyngkaran
- Department of Gastroenterology and Hepatology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Peter Bampton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Olga Sukocheva
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Edmund Tse
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Chris K Rayner
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Soheilipour M, Tabesh E, Afsharzadeh M, Tabibian A. Rectus abdominis muscle abscess after performing colonoscopy-A case report. Clin Case Rep 2024; 12:e8552. [PMID: 38415191 PMCID: PMC10896747 DOI: 10.1002/ccr3.8552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/05/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
Endoscopic removal of premalignant polyps can prevent colorectal cancers. It is considered a safe procedure, yet there are some complications reported. Rectus abdominis muscle abscess (RAMA) is a type of pyomyositis seen as a complication of rectus sheath hematoma. Predisposing factors to RAMA include trauma, diabetes mellitus, alcohol abuse, Intravenous drug abuse and hematologic diseases.In this article, we report a case of a 74-year-old patient with abscess formation in the Rectus Abdominis muscle after colonoscopy and polypectomy with the application of abdominal pressure techniques without any early complications. Diagnosis of RAMA was made after a Computed Tomography scan and ultrasound-guided drainage, in addition to antibiotic therapy, were used as treatment.Although colonoscopy is considered a generally safe procedure, endoscopists should be aware of Rectus Abdominis sheath hemorrhage and RAMA in the following as a complication with the presentation of abdominal pain. Applying abdominal pressure should be done carefully To reduce minor trauma likelihood, owing to it being a predisposing factor of RAMA.
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Affiliation(s)
- Maryam Soheilipour
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
| | - Elham Tabesh
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
| | | | - Amirhossein Tabibian
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC)Isfahan University of Medical SciencesIsfahanIran
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Roy H, Johnson G, Singh H, Hyun E, Moffatt D, Vergis A, Helewa R. Implementation of Synoptic Reporting for Endoscopic Localization of Complex Colorectal Neoplasms. Cureus 2024; 16:e54480. [PMID: 38524081 PMCID: PMC10957508 DOI: 10.7759/cureus.54480] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Lack of documented tattooing of colorectal neoplasms at index colonoscopy results in high repeat preoperative colonoscopy rates. We developed national consensus recommendations for endoscopic localization and piloted an electronic synoptic reporting template. We report on the implementation and perceptions of using synoptic reporting to enhance colorectal lesion marking in a central Canadian healthcare system. Methods We implemented the template within our endoscopy reporting system and ran an infographic education campaign. We then conducted a follow-up email-based interview with all regional endoscopists. Thematic analysis and a mixed-methods triangulation approach were employed to synthesize qualitative and quantitative data. Results The interview was completed by 28/52 endoscopists (54%). Most (60.7%; n = 17) completed >100 colonoscopies and 71.4% (n = 20) identified six to 20 neoplasms requiring tattooing since introduction. A total of 50% (n = 14) used the template. Those not using it were unaware of it (42.9%; n = 12), or preferred using narrative text (17.9%; n = 5). Users reported modest mean functionality scores (intuitiveness: 3.56/5; efficiency: 3.7/5) and high impact scores (credible: 4.22/5; informative: 4.21/5). However, the perception of the synoptic template's ability to reduce the repeat preoperative colonoscopy rate was more circumspect (3.76/5). Conclusions Endoscopists believed the synoptic template was a functional, impactful tool that would improve communication and help to decrease the repeat preoperative colonoscopy rate. However, synoptic template uptake was limited by provider awareness, therefore more educational efforts are needed to increase uptake.
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Affiliation(s)
- Haven Roy
- Surgery, University of Manitoba, Winnipeg, CAN
| | | | | | - Eric Hyun
- Surgery, University of Manitoba, Winnipeg, CAN
| | - Dana Moffatt
- Internal Medicine, University of Manitoba, Winnipeg, CAN
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Patwa A, Kumar S, Bhagchandani D, Kumar A, Atam V, Anil N, Mishra P, Singh A, Devi A, Pal AK. Comparison of Objectively Assessed Versus Patient-Reported Clarity of Last Rectal Effluent for the Prediction of Quality of Bowel Preparation for Colonoscopy: A Prospective, Case-Control Study. Cureus 2024; 16:e53828. [PMID: 38465118 PMCID: PMC10924430 DOI: 10.7759/cureus.53828] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION Colonoscopy is a crucial procedure for various clinical purposes, including screening for colorectal cancer. Adequate bowel preparation is essential for its success. Poor bowel preparation can lead to bad outcomes. An objective assessment of bowel preparation quality is typically only possible after the colonoscope is inserted. This study aimed to objectively correlate the clarity of last rectal effluent, directly collected in a transparent container, with the quality of bowel preparation, and compare it with patient-reported descriptions. METHODS This prospective, single-centre, case-control study obtained ethical clearance and included patients aged >18 years undergoing colonoscopies. Cases included patients who collected the last rectal effluent and took photographs, while controls relied on verbal descriptions. Data collected included demographics, clinical information, bowel preparation quality, and lastly, stool clarity. A statistical analysis was performed to identify correlations and associations. RESULTS Of the 70 included patients, 45 were male. The mean age was 35.8 ± 14.3 years. Cases had a higher mean age (37.8 ± 14.6). A higher number of cases had comorbidities (11, 68.8%). Photographic recording of the last rectal effluent was not associated with the adequacy of bowel preparation. Thin yellow fluid was the most common last-rectal effluent clarity (33, 47.1%). Thin, clear fluid was significantly associated with adequate bowel preparation. CONCLUSION Objective assessment of last rectal effluent clarity correlates with the quality of bowel preparation. This can improve the quality of bowel preparation for colonoscopies and potentially reduce the need for repeat procedures, contributing to better patient outcomes and cost savings in healthcare systems.
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Affiliation(s)
- Ajay Patwa
- Medicine, Gastroenterology and Hepatology Unit, King George's Medical University, Lucknow, IND
| | - Satish Kumar
- Medicine, King George's Medical University, Lucknow, IND
| | | | - Amit Kumar
- Medicine, King George's Medical University, Lucknow, IND
| | - Virendra Atam
- Internal Medicine, King George's Medical University, Lucknow, IND
| | - Navneet Anil
- Medicine, King George's Medical University, Lucknow, IND
| | - Priya Mishra
- Medicine, King George's Medical University, Lucknow, IND
| | - Abhishek Singh
- Community Medicine & Public Health, King George's Medical University, Lucknow, IND
| | - Archana Devi
- Medicine, King George's Medical University, Lucknow, IND
| | - Ajay K Pal
- Surgery, King George's Medical University, Lucknow, IND
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Vikash F, Vikash S, Mintz M, Elshafey S, Kim D, Wan D. Cytokine Release Syndrome-Associated Colitis: Insights From a Case of Rituximab-Induced Pancolitis. ACG Case Rep J 2024; 11:e01274. [PMID: 38371469 PMCID: PMC10871758 DOI: 10.14309/crj.0000000000001274] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/05/2024] [Indexed: 02/20/2024] Open
Abstract
Rituximab (RTX), a widely used monoclonal antibody for hematologic malignancies and rheumatologic disorders, is known for infusion-related reactions. However, its potential to induce colitis is often overlooked. We present an 85-year-old woman with chronic lymphocytic leukemia experiencing severe adverse effects during her fourth RTX infusion, including abdominal pain, hypotension, and bright red blood per rectum. Computed tomography of the abdomen and pelvis with contrast revealed pancolonic mural wall thickening without perforation. Prompt treatment with vasopressors and intravenous fluids led to symptom resolution within 24 hours. We highlighted the importance of recognizing RTX-induced colitis and discussed and depicted immunological dysregulation mechanisms involved.
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Affiliation(s)
- Fnu Vikash
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY
| | - Sindhu Vikash
- Department of Medicine, Albert Einstein College of Medicine/Jacobi Medical Center, Bronx, NY
| | - Michael Mintz
- Department of Gastroenterology, Weill Cornell Medicine, Manhattan, NY
| | - Suzanne Elshafey
- Department of Gastroenterology, Weill Cornell Medicine, Manhattan, NY
| | - Daniel Kim
- Department of Gastroenterology, Weill Cornell Medicine, Manhattan, NY
| | - David Wan
- Department of Gastroenterology, Weill Cornell Medicine, Manhattan, NY
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