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Gomez Cifuentes JD, Berger S, Caskey K, Jove A, Sealock RJ, Hair C, Velez M, Jarbrink-Sehgal M, Thrift AP, da Costa W, Gyanprakash K. Evolution of endoscopic mucosal resection (EMR) technique and the reduced recurrence of large colonic polyps from 2012 to 2020. Scand J Gastroenterol 2023; 58:435-440. [PMID: 36254785 DOI: 10.1080/00365521.2022.2134734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) is an effective method for removing non-pedunculated polyps ≥ 20 mm. We aimed to examine changes in EMR techniques over a 9-year period and evaluate frequency of histologic-confirmed recurrence. METHODS We identified patients who underwent EMR of non-pedunculated polyps ≥ 20 mm at a safety net and the Veteran's Affairs (VA) hospital in Houston, Texas between 2012 and 2020. Odds ratios (ORs) and 95% confidence intervals (CI) for associations with recurrence risk were estimated using multivariable logistic regression. RESULTS 461 unique patients were included. The histologic-confirmed recurrence was 29.0% at 15.6 months median follow up (IQR 12.3 - 17.4). Polyps removed between 2018 and 2020 had a 0.43 decreased odds of recurrence vs. polyps removed between 2012 and 2014. The use of viscous lifting agents increased over time (from 0 to 54%), and the use of saline was associated with increased risk of recurrence (OR 2.28 [CI 1.33 - 3.31]). CONCLUSIONS Histologic-confirmed recurrence after EMR for non-pedunculated polyps ≥ 20 mm decreased over the seven year-period. Saline was associated with a higher risk of recurrence and the use of more viscous agents increased over time.
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Affiliation(s)
| | - Scott Berger
- Internal Medicine Department, Baylor College of Medicine, Houston, TX, USA
| | | | - Andre Jove
- Baylor College of Medicine, Houston, TX, USA
| | - Robert J Sealock
- Gastroenterology Department, Baylor College of Medicine, Houston, TX, USA
| | - Clark Hair
- Gastroenterology Department, Baylor College of Medicine, Houston, TX, USA
| | - Maria Velez
- Gastroenterology Department, Baylor College of Medicine, Houston, TX, USA
| | | | - Aaron P Thrift
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Wilson da Costa
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
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Bai J, Huang JH, Price CPE, Schauer JM, Suh LA, Harmon R, Conley DB, Welch KC, Kern RC, Shintani-Smith S, Peters AT, Stevens WW, Kato A, Schleimer RP, Tan BK. Prognostic factors for polyp recurrence in chronic rhinosinusitis with nasal polyps. J Allergy Clin Immunol 2022; 150:352-361.e7. [PMID: 35305978 PMCID: PMC9378510 DOI: 10.1016/j.jaci.2022.02.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [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: 10/31/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps is frequently managed with endoscopic sinus surgery (ESS). Prior studies describe individual clinical variables and eosinophil density measures as prognostic for polyp recurrence (PR). However, the relative prognostic significance of these have not been extensively investigated. OBJECTIVES We sought to evaluate the impact of PR on measures of disease severity post-ESS and quantify the prognostic value of various clinical variables and biomarkers. METHODS Ninety-four patients with chronic rhinosinusitis with nasal polyps and prospectively biobanked polyp homogenates at the time of ESS were recruited 2 to 5 years post-ESS. Patients were evaluated with patient-reported outcome measures and endoscopic and radiographic scoring pre- and post-ESS. Biomarkers in polyp homogenates were measured with ELISA and Luminex. Relaxed least absolute shrinkage and selection operator regression optimized predictive clinical, biomarker, and combined models. Model performance was assessed using receiver-operating characteristic curve and random forest analysis. RESULTS PR was found in 39.4% of patients, despite significant improvements in modified Lund-Mackay (MLM) radiographic and 22-item Sinonasal Outcomes Test scores (both P < .0001). PR was significantly associated with worse post-ESS MLM, modified Lund-Kennedy, and 22-item Sinonasal Outcomes Test scores. Relaxed least absolute shrinkage and selection operator identified 2 clinical predictors (area under the curve = 0.79) and 3 biomarkers (area under the curve = 0.78) that were prognostic for PR. When combined, the model incorporating these pre-ESS factors: MLM, asthma, eosinophil cationic protein, anti-double-stranded DNA IgG, and IL-5 improved PR predictive accuracy to area under the curve of 0.89. Random forest analysis identified and validated each of the 5 variables as the strongest predictors of PR. CONCLUSIONS PR had strong associations with patient-reported outcome measures, endoscopic and radiographic severity. A combined model comprised of eosinophil cationic protein, IL-5, pre-ESS MLM, asthma, and anti-double-stranded DNA IgG could accurately predict PR.
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Affiliation(s)
- Junqin Bai
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Julia H Huang
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Caroline P E Price
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jacob M Schauer
- Department of Preventive Medicine-Biostatistics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Lydia A Suh
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Regan Harmon
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - David B Conley
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Kevin C Welch
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert C Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Anju T Peters
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Atsushi Kato
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Robert P Schleimer
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce K Tan
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Guo M, Alasousi F, Okpaleke C, Habib AR, Javer A. Prognosis of Chronic Rhinosinusitis With Nasal Polyps Using Preoperative Eosinophil/Basophil Levels and Treatment Compliance. Am J Rhinol Allergy 2018; 32:440-446. [PMID: 30112918 DOI: 10.1177/1945892418793523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have a high risk of disease recurrence and revision surgery. The ability to predict a polyp recurrence in this patient population is critical in order to provide adequately tailored postoperative management. Objective We aim to explore the role of appropriate postoperative care in the prognosis of CRSwNP patients in relation to preoperative eosinophil and basophils levels. Methods This was a retrospective case series; data were collected for 102 CRSwNP patients over a period of 15 months after surgery. Baseline eosinophil and basophil levels were compared between patients with and without polyp recurrences. The analysis was then stratified based on clinical diagnosis, comorbidities (atopy, asthma, and aspirin allergy), a single versus multiple episodes of sinonasal polyp recurrences, and medication adherence. Results Of the 102 included patients, 65 (63.7%) of the patients experienced no recurrences, 26 (25.5%) experienced a single episode of recurrence, and 11 (10.8%) experienced multiple recurrences. Mean baseline eosinophil count and percentage of total white blood cells were significantly higher in the multiple recurrences group (0.70 × 109/L and 10%) compared with the no recurrences group (0.36 × 109/L and 5%). Adherence to prescribed medical therapy prior to the first episode of recurrence was significantly lower for the single exacerbations group (42.3%) than the multiple recurrences group (88.9%). Conclusions Patients with multiple recurrences of nasal polyps had significantly higher baseline eosinophil counts and significantly higher medication adherence compared to single exacerbations of nasal polyps. Single exacerbations may not reflect true failures of surgery but rather a failure of postoperative medical care. Basophil levels were inadequate to predict polyp recurrence rates.
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Affiliation(s)
- Michael Guo
- 1 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fahad Alasousi
- 2 Ear, Nose, and Throat Department, Farwaniya Hospital, Al Farwaniyah Governorate, Kuwait
| | - Christopher Okpaleke
- 3 St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Al-Rahim Habib
- 3 St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Amin Javer
- 3 St. Paul's Sinus Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada.,4 Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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