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Tursi A, Palieri AP, Lattarulo V, Elefante A, Gigliobianco A, Spinazzola D, Elisei W, Papa A. How we can improve the appropriateness of ambulatory gastrointestinal endoscopy: the lesson of the COVID-19 outbreak. Eur J Gastroenterol Hepatol 2023; 35:1149-1153. [PMID: 37665614 DOI: 10.1097/meg.0000000000002626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) outbreak has significantly modified hospital and outpatient activities. AIMS To assess the pandemic's impact on the appropriateness of outpatient gastrointestinal (G.I.) endoscopy in a southern Italy Region. METHODS Between 1 January 2019 and 31 December 2022, we compared the number, the type of activities, and the appropriateness of the G.I. endoscopy procedures in the four territorial gastroenterology and digestive endoscopy services of the Apulia region. RESULTS In 2019, 11 173 outpatient procedures were provided, which dropped by about 44% (P < 0.05) during 2020. The endoscopic activity was slightly reduced during 2020 (-18.77%), while every other activity dropped significantly. During 2021-2022, the overall activities slightly increased but remained below the number of activities provided before the pandemic (P < 0.05). However, the endoscopic activity increased by +6.86% from 2019 to 2022, mainly due to more colonoscopies. During the 4 years analysed, the overall appropriateness rate of the endoscopic examinations increased during 2020 (2019: 67%; 2020: 81%) while dropping again in the following years (2021: 75%; 2022; 69%). CONCLUSION The appropriateness of the G.I. endoscopic procedures in the territorial gastroenterology services in the Apulia Region has improved during the acute phase of the COVID-19 pandemic, dropping again in the following years. Overall, the appropriateness of endoscopic procedures remains suboptimal; thus, educational activities are needed to improve the appropriateness rate to optimise the limited resources.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria (BT)
- Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome
| | | | - Vincenzo Lattarulo
- Territorial Digestive Endoscopy Service, Gioia del Colle Territorial Hospital, ASL BA, Gioia del Colle (BA)
| | - Antonio Elefante
- Territorial Digestive Endoscopy Service, Mesagne Territorial Hospital, ASL BR, Mesagne (BR)
| | | | | | - Walter Elisei
- Division of Gastroenterology, 'S. Camillo' Hospital, Rome
| | - Alfredo Papa
- Department of Medical and Surgical Sciences, School of Medicine, Catholic University, Rome
- Center for Diagnosis and Treatment of Digestive Diseases, CEMAD, Fondazione Policlinico Universitario 'A. Gemelli', IRCCS, Rome, Italy
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Rudnicki Y, Horesh N, Harbi A, Lubianiker B, Green E, Raveh G, Slavin M, Segev L, Gilshtein H, Khalifa M, Barenboim A, Wasserberg N, Khaikin M, Tulchinsky H, Issa N, Duek D, Avital S, White I. Rectal Cancer following Local Excision of Rectal Adenomas with Low-Grade Dysplasia-A Multicenter Study. J Clin Med 2023; 12:jcm12031032. [PMID: 36769680 PMCID: PMC9917362 DOI: 10.3390/jcm12031032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Purpose: Rectal polyps with low-grade dysplasia (LGD) can be removed by local excision surgery (LE). It is unclear whether these lesions pose a higher risk for recurrence and cancer development and might warrant an early repeat rectal endoscopy. This study aims to assess the rectal cancer rate following local excision of LGD rectal lesions. Methods: A retrospective multicenter study including all patients that underwent LE for rectal polyps over a period of 11 years was conducted. Demographic, clinical, and surgical data of patients with LGD werecollected and analyzed. Results: Out of 274 patients that underwent LE of rectal lesions, 81 (30%) had a pathology of LGD. The mean patient age was 65 ± 11 years, and 52 (64%) were male. The mean distance from the anal verge was 7.2 ± 4.3 cm, and the average lesion was 3.2 ± 1.8 cm. Full thickness resection was achieved in 68 patients (84%), and four (5%) had involved margins for LGD. Nine patients (11%) had local recurrence and developed rectal cancer in an average time interval of 19.3 ± 14.5 months, with seven of them (78%) diagnosed less than two years after the initial LE. Seven of the nine patients were treated with another local excision, whilst one had a low anterior resection, and one was treated with radiation. The mean follow-up time was 25.3 ± 22.4 months. Conclusions: Locally resected rectal polyps with LGD may carry a significant risk of recurring and developing cancer within two years. This data suggests patients should have a closer surveillance protocol in place.
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Affiliation(s)
- Yaron Rudnicki
- Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
- Correspondence:
| | - Nir Horesh
- Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel
| | - Assaf Harbi
- Rambam Health Care Campus, Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Barak Lubianiker
- Rabin Medical Center-Hasharon Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel
| | - Eraan Green
- Tel Aviv Sourasky Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Guy Raveh
- Rabin Medical Center-Beilinson Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
| | - Moran Slavin
- Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
| | - Lior Segev
- Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel
| | - Haim Gilshtein
- Rambam Health Care Campus, Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Muhammad Khalifa
- Rabin Medical Center-Hasharon Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel
| | - Alexander Barenboim
- Tel Aviv Sourasky Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nir Wasserberg
- Rabin Medical Center-Beilinson Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
| | - Marat Khaikin
- Sheba Medical Center, Department of General Surgery B and Organ Transplantation, Faculty of Medicine, Tel Aviv University, Ramat Gan 5265601, Israel
| | - Hagit Tulchinsky
- Tel Aviv Sourasky Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nidal Issa
- Rabin Medical Center-Hasharon Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 49100, Israel
| | - Daniel Duek
- Rambam Health Care Campus, Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| | - Shmuel Avital
- Meir Medical Center, Department of Surgery, Faculty of Medicine, Tel Aviv University, Kfar Saba 4428164, Israel
| | - Ian White
- Rabin Medical Center-Beilinson Hospital, Department of Surgery, Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
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Heisser T, Guo F, Niedermaier T, Holleczek B, Hoffmeister M, Brenner H. Low Risk of Advanced Neoplasms for up to 20 Years After Negative Colonoscopy Result: Potential for Personalized Follow-up Screening Intervals. Gastroenterology 2020; 159:2235-2237.e4. [PMID: 32777288 DOI: 10.1053/j.gastro.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany.
| | - Feng Guo
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Saarland Cancer Registry, Saarbrücken, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
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4
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Saxena A, Pauli EM, Haluck RS, Fell B, Moore J. Tubular Locomotion and Positioning Using Tip Eversion for Endoscopy. J Med Device 2020. [DOI: 10.1115/1.4046433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Abstract
Colonoscopy is a minimally invasive procedure to examine the large intestine using a flexible endoscope. Currently, colonoscopic procedures require physically pushing the endoscope through the large intestine which potentially imparts damaging forces on the intestinal wall, requires a high level of expertise to perform safely, and can require extensive procedure time. This paper presents the use of inverted tubular element locomotion (ITEL) for improved endoscope translation and positioning that works via tip eversion of inverted plastic tubes. Experiments were performed to examine the fluid pressure required for locomotion through a large intestinal model and in both straight and curved paths and determine the optimal tube dimensions for insertion via ITEL. Experiments were then performed to compare intestinal forces during manual and ITEL-based insertion. The experiments established a relationship between the tip eversion pressure and the tube thickness and diameter. In addition, it was found that pressure required for locomotion was only minimally impeded by being enclosed in the intestinal manikin but significantly impacted by the curvature of the turn. Measured insertion forces for ITEL were found to be 10.1% less compared to traditional insertion. These results will aid in the future design and development of ITEL for endoscopic positioning.
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Affiliation(s)
- Ankit Saxena
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16803
| | - Eric M. Pauli
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Randy S. Haluck
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Barry Fell
- Thermoplastic Products Corp., Hummelstown, PA 17036
| | - Jason Moore
- Department of Mechanical Engineering, Pennsylvania State University, University Park, PA 16802
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Heisser T, Peng L, Weigl K, Hoffmeister M, Brenner H. Outcomes at follow-up of negative colonoscopy in average risk population: systematic review and meta-analysis. BMJ 2019; 367:l6109. [PMID: 31722884 PMCID: PMC6853024 DOI: 10.1136/bmj.l6109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To review and summarise the evidence on the prevalence of colorectal adenomas and cancers at a follow-up screening colonoscopy after negative index colonoscopy, stratified by interval between examinations and by sex. DESIGN Systematic review and meta-analysis of all available studies. DATA SOURCES PubMed, Web of Science, and Embase. Two investigators independently extracted characteristics and results of identified studies and performed standardised quality ratings. ELIGIBILITY CRITERIA Studies assessing the outcome of a follow-up colonoscopy among participants at average risk for colorectal cancer with a negative previous colonoscopy (no adenomas). RESULTS 28 studies were identified, including 22 cohort studies, five cross sectional studies, and one case-control study. Findings for an interval between colonoscopies of one to five, five to 10, and more than 10 years were reported by 17, 16, and three studies, respectively. Summary estimates of prevalences of any neoplasm were 20.7% (95% confidence interval 15.8% to 25.5%), 23.0% (18.0% to 28.0%), and 21.9% (14.9% to 29.0%) for one to five, five to 10, and more than 10 years between colonoscopies. Corresponding summary estimates of prevalences of any advanced neoplasm were 2.8% (2.0% to 3.7%), 3.2% (2.2% to 4.1%), and 7.0% (5.3% to 8.7%). Seven studies also reported findings stratified by sex. Summary estimates stratified by interval and sex were consistently higher for men than for women. CONCLUSIONS Although detection of any neoplasms was observed in more than 20% of participants within five years of a negative screening colonoscopy, detection of advanced neoplasms within 10 years was rare. Our findings suggest that 10 year intervals for colonoscopy screening after a negative colonoscopy, as currently recommended, may be adequate, but more studies are needed to strengthen the empirical basis for pertinent recommendations and to investigate even longer intervals. STUDY REGISTRATION Prospero CRD42019127842.
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Affiliation(s)
- Thomas Heisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Le Peng
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 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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Seo M, Yang DH, Kim J, Song EM, Kim GU, Hwang SW, Park SH, Kim KJ, Ye BD, Byeon JS, Myung SJ, Yang SK. Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 29:473-480. [PMID: 30249563 DOI: 10.5152/tjg.2018.17400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS We aimed to investigate the factors associated with piecemeal resection of colorectal neoplasia (CRN), in spite of endoscopic submucosal dissection (ESD). MATERIALS AND METHODS We analyzed the retrospective data for colorectal ESD cases from January 2005 to April 2014. We also reviewed the piecemeal endoscopic mucosal resection (EMR) for CRNs ≥20 mm, performed over the same period. RESULTS En bloc resection was possible in 648 (85.7%) of 756 lesions in 740 patients. Multivariate analysis showed that hybrid ESD (odds ratio (OR), 29.07; 95% confidence interval (CI), 15.46-54.65; p<0.01) and mild or severe submucosal fibrosis (OR, 3.62; 95% CI, 1.94-6.76; p<0.01) were independently associated with piecemeal ESD. The en bloc ESD group showed higher histologic complete resection rate than the piecemeal ESD group (80.4% vs. 56.5%; p<0.01), and the piecemeal ESD group showed higher recurrence rate than in the en bloc ESD group (5.6% [4/72] vs. 0.7% [3/450]; p<0.01). Overall recurrence rate was 1.3% (7/522). CONCLUSION Hybrid ESD and submucosal fibrosis are independently associated with piecemeal ESD. Piecemeal ESD cases recurred more frequently than en bloc ESD cases.
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Affiliation(s)
- Myeongsook Seo
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Eun Mi Song
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Gwang Un Kim
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
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Hong S, Suh M, Choi KS, Park B, Cha JM, Kim HS, Jun JK, Han DS. Guideline Adherence to Colonoscopic Surveillance Intervals after Polypectomy in Korea: Results from a Nationwide Survey. Gut Liver 2018; 12:426-432. [PMID: 29429156 PMCID: PMC6027840 DOI: 10.5009/gnl17403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Aims People around the world are increasingly choosing to undergo colorectal cancer screening via colonoscopy. As a result, guideline adherence to postpolypectomy colonoscopy surveillance has drawn increasing attention. The present study was performed to assess recognition and adherence to guidelines among primary care physicians and gastroenterologists and to identify characteristics associated with compliance. Methods A nationwide sample of primary care physicians employed at cancer screening facilities and registered members of the Korean Society of Gastrointestinal Endoscopy were recruited. Participants were asked to complete a survey of six hypothetical clinical scenarios designed to assess their potential course of action in response to screening or follow-up colonoscopy results. Frequencies and odds ratios and 95% confidence intervals for guideline adherence were estimated. Results The proportions of doctors recommending shortened colonoscopy surveillance intervals for low- and high-risk adenomas were greater than 90% among primary physicians and were much lower among gastroenterologists. Guideline adherence was relatively good among groups of doctors who were young, had a specialty in gastroenterology, worked at tertiary hospitals, and cared for an appropriate number of patients. Conclusions The present study reveals a remaining discrepancy between practitioner recommendations and current guidelines for postpolypectomy surveillance. Several factors were shown to be related to guideline adherence, suggesting a need for appropriate control and continuing education or training programs among particular groups of practitioners.
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Affiliation(s)
- Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Katsoula A, Paschos P, Haidich AB, Tsapas A, Giouleme O. Diagnostic Accuracy of Fecal Immunochemical Test in Patients at Increased Risk for Colorectal Cancer: A Meta-analysis. JAMA Intern Med 2017; 177. [PMID: 28628706 PMCID: PMC5710432 DOI: 10.1001/jamainternmed.2017.2309] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE The potential role of the fecal immunochemical test (FIT) for screening patients at increased risk for colorectal cancer (CRC) has not yet been elucidated. OBJECTIVE To assess the diagnostic accuracy of FIT for CRC or advanced neoplasia (AN) in asymptomatic patients at above-average risk. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, and gray literature sources through August 2016. STUDY SELECTION Diagnostic studies evaluating the accuracy of FIT for CRC or AN in patients with a personal or familial history of CRC using colonoscopy as the reference standard. DATA EXTRACTION AND SYNTHESIS Two authors (A.K. and P.P.) independently extracted data and evaluated study quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, and evaluated the quality of the body of evidence by means of GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Hierarchical models were used to synthesize available evidence. MAIN OUTCOMES AND MEASURES The primary outcome was the diagnostic performance of FIT for detecting CRC or AN. RESULTS We included 12 studies (6204 participants). Seven studies were deemed at high or unclear risk of bias. The average sensitivity of FIT for CRC was 93% (95% CI, 53%-99%), and the average specificity was 91% (95% CI, 89%-92%), yielding a positive likelihood ratio (LR+) of 10.30 (CI 7.7-13.9) and a negative likelihood ratio (LR-) of 0.08 (95% CI, 0.01-0.75) (GRADE: very low). The average sensitivity of FIT for AN was 48% (95% CI, 39%-57%); and the average specificity was 93% (95% CI, 91%-94%), yielding an LR+ of 6.55 (95% CI, 5.0-8.5) and an LR- of 0.57 (95% CI, 0.48-0.67) (GRADE: very low). Subgroup analyses indicated that FIT cutoff values between 15- and 25-μg/g feces provided the best combination of sensitivity and specificity for the diagnosis of CRC (93% and 94%, respectively). Quantitative and 1-sample FIT showed adequate test performance, but data on other FIT brands and multiple samples were insufficient. CONCLUSIONS AND RELEVANCE The FIT has high overall diagnostic accuracy for CRC but moderate accuracy for AN in patients at above-average personal or familial risk. Heterogeneity and wide confidence intervals limit the trustworthiness of our findings.
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Affiliation(s)
- Anastasia Katsoula
- Second Propedeutic Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Paschalis Paschos
- Second Propedeutic Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene and Epidemiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Harris Manchester College, University of Oxford, Oxford, United Kingdom
| | - Olga Giouleme
- Second Propedeutic Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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López-Picazo J, Alberca de Las Parras F, Sánchez Del Río A, Pérez Romero S, León Molina J, Júdez FJ. Quality indicators in digestive endoscopy: introduction to structure, process, and outcome common indicators. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:435-450. [PMID: 28553719 DOI: 10.17235/reed.2017.5035/2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The general goal of the project wherein this paper is framed is the proposal of useful quality and safety procedures and indicators to facilitate quality improvement in digestive endoscopy units. This initial offspring sets forth procedures and indicators common to all digestive endoscopy procedures. First, a diagram of pre- and post-digestive endoscopy steps was developed. A group of health care quality and/or endoscopy experts under the auspices of the Sociedad Española de Patología Digestiva (Spanish Society of Digestive Diseases) carried out a qualitative review of the literature regarding the search for quality indicators in endoscopic procedures. Then, a paired analysis was used for the selection of literature references and their subsequent review. Twenty indicators were identified, including seven for structure, eleven for process (five pre-procedure, three intra-procedure, three post-procedure), and two for outcome. Quality of evidence was analyzed for each indicator using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification.
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Affiliation(s)
- Julio López-Picazo
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
| | | | | | - Shirley Pérez Romero
- Servicio de Calidad Asistencial, Hospital Clínico Universitario Virgen de la Arrixaca
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10
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Pozza A, Ruffolo C, Fiorot A, Padoan L, Erroi F, Massani M, Caratozzolo E, Bonariol L, Ferrara F, Norberto L, Castoro C, Bassi N, Scarpa M. Synchronous polyps predict metachronous colorectal lesions after curative resection of colorectal cancer. Acta Chir Belg 2016; 116:225-230. [PMID: 27426670 DOI: 10.1080/00015458.2016.1171075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The principal aim of endoscopic follow-up programs after curative resection of colorectal cancer (CRC) is to improve survival and identify local recurrence and metachronous CRC. The aim of our study was to identify the possible predictors of metachronous colorectal lesions. METHODS The records of 348 consecutive patients with CRC and who completed at least 1 year of endoscopic follow-up after surgery were analyzed. In this group, 336 patients underwent surgery for primitive CRC and 12 for metachronous cancer. Patients' characteristics, operative details, and endoscopical follow-up findings were retrieved. Multivariate survival analyses were used to identify patient categories at risk of metachronous colonic lesions. RESULTS 128 patients presented a metachronous lesion: 118 adenomas and 10 adenocarcinomas. At multivariate analysis, active smoke (HR = 1.84, p = 0.03), neoadjuvant therapy (HR = 0.24, p = 0.01), and presence of synchronous polyps (HR = 1.55, p = 0.04) resulted independent predictors of metachronous adenoma after CRC removal while neoadjuvant therapy (HR = 0.25, p = 0.02), active smoke (HR = 1.54, p = 0.04), and presence of synchronous polyps (HR = 1.86, p = 0.02) resulted independent predictors of metachronous lesions after CRC removal. CONCLUSIONS This study demonstrated a high rate of metachronous lesions in the early follow-up after curative CRC resection. The negative effects of synchronous polyps should be carefully evaluated when planning patients' follow-up.
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11
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So H, Han S, Park HW, Kim EH, Lee JY, Lee HS, Chang HS, Kim HK, Choe J, Park SH, Yang DH, Myung SJ, Yang SK, Byeon JS. Metabolic factors affect the occurrence of colorectal neoplasm on surveillance colonoscopies. J Gastroenterol Hepatol 2016; 31:1273-9. [PMID: 26729234 DOI: 10.1111/jgh.13286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/27/2015] [Accepted: 12/28/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM Although metabolic factors such as obesity and hyperlipidemia were reported to be associated with high prevalence of colorectal neoplasm (CRN), their influence on the occurrence of CRN at surveillance colonoscopy has not been clarified. The purpose of this study was to analyze the association between metabolic factors and the risk of CRN at the time of surveillance colonoscopy. METHODS We reviewed the medical records of 1792 asymptomatic subjects (average 52.1 years, 1233 male) who underwent screening and follow-up surveillance colonoscopies. Fasting glucose level, fasting insulin level, hemoglobin A1c (HbA1c), lipid profile, high sensitivity C-reactive protein, and colonoscopic findings at the time of baseline screening were analyzed to find any associations with the occurrence of CRN at the time of surveillance colonoscopy. RESULTS The median interval between screening and surveillance colonoscopies was 3.34 years. The 3- and 5-year cumulative CRN incidences were 22.3% and 54.8%, respectively. Several metabolic factors such as hypertension, waist circumference, fasting insulin, fasting glucose, HbA1c, and triglyceride were associated with the occurrence of CRN in univariate analysis. Age, current alcohol drinker status, and high-risk colonoscopy findings at baseline remained independent risk factors for CRN occurrence in multivariate analysis. High waist circumference was also an independent risk factor (hazard ratio 1.03, 95% CI 1.02-1.04; P < 0.001). CONCLUSIONS Metabolic factors, especially waist circumference, affect CRN occurrence at the time of surveillance colonoscopy. The surveillance colonoscopy interval may be optimized based on metabolic factors and screening colonoscopy findings.
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Affiliation(s)
- Hoonsub So
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon University, Seongnam-si, Korea
| | - Hye Won Park
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Hee Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Su Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Sook Chang
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jaewon Choe
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kuijpers CCHJ, Sluijter CE, von der Thüsen JH, Grünberg K, van Oijen MGH, van Diest PJ, Jiwa M, Nagtegaal ID, Overbeek LIH, Willems SM. Interlaboratory variability in the grading of dysplasia in a nationwide cohort of colorectal adenomas. Histopathology 2016; 69:187-97. [DOI: 10.1111/his.12923] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Chantal C H J Kuijpers
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Symbiant Pathology Expert Centre; Alkmaar The Netherlands
| | - Caro E Sluijter
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Department of Pathology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Jan H von der Thüsen
- Department of Pathology; Erasmus Medical Centre; Rotterdam The Netherlands
- NVVP (Dutch Society of Pathology); Utrecht The Netherlands
| | - Katrien Grünberg
- NVVP (Dutch Society of Pathology); Utrecht The Netherlands
- Department of Pathology; VU University Medical Centre; Amsterdam The Netherlands
| | - Martijn G H van Oijen
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Department of Medical Oncology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Paul J van Diest
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
| | - Mehdi Jiwa
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
- Symbiant Pathology Expert Centre; Alkmaar The Netherlands
| | - Iris D Nagtegaal
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
- Department of Pathology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Lucy I H Overbeek
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
| | - Stefan M Willems
- Department of Pathology; University Medical Centre Utrecht; Utrecht The Netherlands
- Foundation PALGA (the Nationwide Network and Registry of Histo- and Cytopathology in The Netherlands); Houten The Netherlands
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13
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Vega P, Valentín F, Cubiella J. Colorectal cancer diagnosis: Pitfalls and opportunities. World J Gastrointest Oncol 2015; 7:422-433. [PMID: 26690833 PMCID: PMC4678389 DOI: 10.4251/wjgo.v7.i12.422] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 07/28/2015] [Accepted: 09/28/2015] [Indexed: 02/05/2023] Open
Abstract
Colorectal cancer (CRC) is a major health problem in the Western world. The diagnostic process is a challenge in all health systems for many reasons: There are often no specific symptoms; lower abdominal symptoms are very common and mostly related to non-neoplastic diseases, not CRC; diagnosis of CRC is mainly based on colonoscopy, an invasive procedure; and the resource for diagnosis is usually scarce. Furthermore, the available predictive models for CRC are based on the evaluation of symptoms, and their diagnostic accuracy is limited. Moreover, diagnosis is a complex process involving a sequence of events related to the patient, the initial consulting physician and the health system. Understanding this process is the first step in identifying avoidable factors and reducing the effects of diagnostic delay on the prognosis of CRC. In this article, we describe the predictive value of symptoms for CRC detection. We summarize the available evidence concerning the diagnostic process, as well as the factors implicated in its delay and the methods proposed to reduce it. We describe the different prioritization criteria and predictive models for CRC detection, specifically addressing the two-week wait referral guideline from the National Institute of Clinical Excellence in terms of efficacy, efficiency and diagnostic accuracy. Finally, we collected information on the usefulness of biomarkers, specifically the faecal immunochemical test, as non-invasive diagnostic tests for CRC detection in symptomatic patients.
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14
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Choe EK, Park KJ, Chung SJ, Moon SH, Ryoo SB, Oh HK. Colonoscopic surveillance after colorectal cancer resection: who needs more intensive follow-up? Digestion 2015; 91:142-9. [PMID: 25677684 DOI: 10.1159/000370308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Although there are guidelines for colonoscopic surveillance after colorectal cancer (CRC) surgery, the data evaluating the effectiveness of these guidelines are limited. We determined the risk factors for metachronous neoplasia (MN) by performing annual colonoscopy examinations after curative resection. METHODS We performed annual colonoscopic surveillance on stage I-III CRC patients after curative resection. We stratified the patients based on the advanced neoplasia risk during the surveillance. RESULTS Advanced MN detected was in 59 (13.1%) of 451 patients. Overall, the cumulative incidence of advanced MN was 17.3% at 5 years. By the multivariate analysis, the risk factors for advanced MN were male gender, age >65, left-sided index cancer and being in the high-risk group. The cumulative incidence of advanced MN was 38.9% at 5 years in the high-risk group. Among the patients who had advanced MN, secondary advanced MN was detected in 13 patients (22.0%) with a subsequent colonoscopy. The 2-year cumulative incidence of secondary advanced MN was 16.9%. Four (0.88%) patients had metachronous CRC during the surveillance and the interval from the index CRC was a median of 58.5 months. CONCLUSIONS Although the current follow-up guidelines for colonoscopic surveillance after CRC are well established, the high-risk group calls for more meticulous follow-up, which should be continued for a sufficient time.
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Affiliation(s)
- Eun Kyung Choe
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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15
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Chiu HM, Lee YC, Tu CH, Chang LC, Hsu WF, Chou CK, Tsai KF, Liang JT, Shun CT, Wu MS. Effects of metabolic syndrome and findings from baseline colonoscopies on occurrence of colorectal neoplasms. Clin Gastroenterol Hepatol 2015; 13:1134-42.e8. [PMID: 25445768 DOI: 10.1016/j.cgh.2014.10.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/20/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Metabolic syndrome is associated with increased risk of colorectal neoplasm, but little is known about its effects on the occurrence of neoplasm after colonoscopy. We investigated the effects of metabolic syndrome on the risk of advanced neoplasm after colonoscopy. METHODS We performed a prospective study of 4483 subjects age 50 years and older who underwent screening and surveillance colonoscopies as part of an annual health check-up at National Taiwan University Hospital. Baseline demographic data and colonoscopic findings were recorded. Subjects with either advanced adenoma or 3 or more adenomas detected at baseline were classified as high risk; those with fewer than 3 nonadvanced adenomas were classified as low risk; and those without any neoplastic lesions were classified as normal. The cumulative risk of detecting an advanced neoplasm during surveillance colonoscopies (3 and 5 years later) was correlated with risk group and metabolic syndrome. Hazard ratios (HRs) were calculated for occurrence of neoplasm according to baseline colonoscopic findings and clinical risk factors, including metabolic syndrome. RESULTS Advanced neoplasms were detected during the surveillance colonoscopies in 1.3% of subjects in the normal group and in 2.4% of those in the low-risk group at 5 years, and in 8.5% of subjects in the high-risk group at 3 years. Subjects with metabolic syndrome had a significantly higher risk for subsequent advanced neoplasms (P < .0001). After stratification based on findings from baseline colonoscopies, the risk for neoplasm was significant in the normal (P < .001) and low-risk groups (P = .04), but not in the high-risk group (P = .48). In Cox regression analysis, metabolic syndrome had significant effects on the risk for advanced neoplasms in the normal (HR, 2.07; 95% confidence interval, 1.13-3.81) and low-risk groups (HR, 2.34; 95% confidence interval, 1.01-5.41), but not in the high-risk group. CONCLUSIONS Metabolic syndrome is a significant risk factor for occurrence of an advanced adenoma after a negative or low-risk finding from a baseline colonoscopy. Metabolic syndrome should be considered in risk stratification for surveillance intervals.
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Affiliation(s)
- Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
| | - Wen-Feng Hsu
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taipei, Taiwan
| | - Chu-Kuang Chou
- Division of Gastroenterology and Hepatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Kun-Feng Tsai
- Department of Internal Medicine, National Taiwan University Hospital, Jin-Shan Branch, Taipei, Taiwan
| | - Jin-Tung Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Tung Shun
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Health Management Center, National Taiwan University Hospital, Taipei, Taiwan.
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16
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Andújar X, Sainz E, Galí A, Loras C, Aceituno M, Espinós JC, Viver JM, Esteve M, Fernández-Bañares F. [Inappropriateness rate for colonoscopy indications in an open access unit]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:313-9. [PMID: 25744733 DOI: 10.1016/j.gastrohep.2014.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND OBJECTIVE The suitability of indications for colonoscopy is important to optimize the available resources. The aim of this study was to assess the appropriateness of colonoscopy indications in an open access endoscopy unit using the EPAGE II criteria. METHODS Colonoscopies performed between October 1 and November 30, 2011 were retrospectively included. The appropriateness of the colonoscopy was established according to the EPAGE II criteria. Demographics, medical applicants, indications and relevant findings from these examinations were recorded. RESULTS We included 440 colonoscopies (60.8 ± 016.3 years, 54% women). The indication was appropriate in 75.4% (CI, 71-79.3%), uncertain in 13.1% (CI, 10.2-16.6%) and inappropriate in 11.4% (CI, 8.7-14.8%). In the univariate analysis, the relevant findings in the colonoscopy were associated with age, sex, colonoscopy indications and EPAGE II. In the logistic regression analysis, factors independently associated with the presence of relevant findings were age (≥ 50 years) (OR, 1.84), male sex (OR, 2.7) and two indications, inflammatory bowel disease and post-polypectomy surveillance (P < .03). The diagnostic yield of EPAGE II criteria was 37.3% for appropriate colonoscopies and 28.3% for inappropriate colonoscopies (P = .09). CONCLUSIONS The rate of unnecessary colonoscopy is high, especially in young patients (<50 years) and some colonoscopy indications. Age (≥ 50 years) and male sex are independently associated with the presence of relevant findings in colonoscopy. The diagnostic yield of EPAGE II criteria does not differ between appropriate and inappropriate examinations.
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Affiliation(s)
- Xavier Andújar
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Empar Sainz
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Alex Galí
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Carme Loras
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Montserrat Aceituno
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Jorge C Espinós
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Josep M Viver
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
| | - Maria Esteve
- Servicio de Aparato Digestivo, Hospital Universitari Mutua Terrassa, CIBERehd, Terrassa, España
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17
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Massat NJ, Sasieni PD, Parmar D, Duffy SW. An ongoing case-control study to evaluate the NHS Bowel Cancer Screening Programme. BMC Cancer 2014; 14:945. [PMID: 25495609 PMCID: PMC4320602 DOI: 10.1186/1471-2407-14-945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Colorectal cancer is the third most common cause of cancer death in both males and females in England. A national bowel cancer screening programme was rolled out in England between 2006 and 2010. In the post-randomised controlled trials epoch, assessment of the impact of the programme using observational studies is needed. This study protocol was set up at the request of the UK Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis to evaluate the effect of the current bowel cancer screening programme on incidence of advanced primary colorectal cancer. METHODS/DESIGN All incident cases of primary colorectal cancer in England will be included. Cases will be matched to controls with respect to sex, age, area of registration and year of first invitation to screening. Each evaluation round will cover a 2-year period, starting from January 2012, and ongoing thereafter. In the first instance, a pilot will be carried out in a single region. Variables related to colorectal tumour pathology will be obtained to enable selection and matching of cases and controls, and to allow analyses stratification by anatomical subsite within the bowel. Cases at Duke's stage B or worse will be considered as "advanced stage". The influence of sex will also be investigated. The incidence ratio observed in randomised controlled trials between controls (not invited) and non-attender invitees will be used to correct for self-selection bias overall. Screening participation at other national screening programmes (cervical, breast) will also be collected to derive a more contemporaneous adjustment factor for self-selection bias and assess consistency in self-selection correction in female patients.Full ethical approval was obtained from the Health Research Authority. DISCUSSION The case-control design is potentially prone to a number of biases. The size of the planned study, the design specifications and the development of analytical strategies to cope with bias should enable us to obtain accurate estimates of reduction in incidence of advanced stage disease. The results of analyses by sex and anatomical subsite may highlight the potential need for sex-specific recommendations in the programme.
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Affiliation(s)
- Nathalie J Massat
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter D Sasieni
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dharmishta Parmar
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Stephen W Duffy
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
- />Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts’ and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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18
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Abstract
Purpose Several guidelines have been proposed for surveillance colonoscopy after polypectomy. However, some discrepancies still exist between the guidelines and clinical practice. This study was conducted to identify Korean doctors' recommendations for the colonoscopic surveillance interval after polypectomy. Methods A survey of the attendees at the symposium of the 64th Annual Congress of the Korean Surgical Society was conducted. When the prepared clinical scenarios were given, attendees answered using a wireless radio-frequency audience response system. All responders' results were automatically counted immediately. Frequencies of different answers to each question were calculated, and our results were compared with those of previous surveys performed using the same questionnaire in the United States or Japan. Results The number of responder varied from 38 to 41. About 50% of valid responders selected 'follow-up in 3 years' for low-risk lesions, such as a 6-mm hyperplastic polyp, a 6-mm tubular adenoma, or two 6-mm tubular adenomas. Responders most-commonly selected 'follow-up in 1 year' for high-risk lesions, such as a 12-mm tubular adenoma with high grade dysplasia or a 12-mm tubulovillous adenoma. The majority of Korean doctors recommend postpolypectomy colonoscopic surveillance more frequently than American physicians did. Conclusion A discrepancy between the guidelines and clinical practice for the surveillance after polypectomy still exists in Korea. A surveillance program that can be easily and widely applied in clinical practice needs to be established.
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Affiliation(s)
- Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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19
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Eskeland SL, Dalén E, Sponheim J, Lind E, Brunborg C, de Lange T. European panel on the appropriateness of gastrointestinal endoscopy II guidelines help in selecting and prioritizing patients referred to colonoscopy--a quality control study. Scand J Gastroenterol 2014; 49:492-500. [PMID: 24597781 DOI: 10.3109/00365521.2014.886715] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To use information from the referral letters to assess the appropriateness of colonoscopies in a primary open-access referral center, according to the criteria from the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) II, and to compare with the first EPAGE guidelines. Second, to evaluate how the appropriateness and other patient- or doctor-related factors affected the diagnostic yield (DY). MATERIAL AND METHODS A set of variables; symptoms, referring physician and final diagnosis, for 323 referrals accepted for colonoscopy were recorded prospectively and later on assessed using the EPAGE and EPAGE II criteria, respectively. Patients with incomplete visualization of the entire colon or colonoscopic findings as indication were excluded. RESULTS EPAGE and EPAGE II criteria were applicable in 287 (95.3%) and 295 (98.0%) referrals, respectively. A total of 166 (57.8%) patients were considered appropriate by EPAGE and 240 (81.4%) patients were considered appropriate by EPAGE II. DY for appropriate versus uncertain/inappropriate referrals was 34.9% versus 17.4% for EPAGE (odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.8-4.4, p = 0.003) and 31.3% versus 10.9% for EPAGE II (OR = 3.5, 95% CI: 1.4-8.9, p = 0.007). Sensitivity was higher for EPAGE II (92.6% vs. 73.4%). According to EPAGE II, 68 (23.1%) patients were referred due to lesions identified on other diagnostic procedures, producing a DY of 39.7%. In this group, 70% presented symptoms appropriate for a primary referral to colonoscopy. CONCLUSIONS The majority of colonoscopies were found appropriate by EPAGE II. There was a clear association between high appropriateness of the indication and a high DY. EPAGE II is a guideline-improvement that may be useful for both referring physicians and gastroenterologists when considering referrals.
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Affiliation(s)
- Sigrun Losada Eskeland
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust , Sandvika , Norway
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20
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Kwon SH, Choo JW, Kim HG, Jeon SR, Lee BH, Lee TH, Kim WJ, Ko BM, Kim JO, Cho JY, Lee JS, Lee MS. [Advanced neoplasm detection and its associated factors in colonoscopic surveillance of endoscopically resected early colorectal cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 62:219-26. [PMID: 24162709 DOI: 10.4166/kjg.2013.62.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Early colon cancer can be effectively diagnosed and treated by colonoscopy, and surveillance colonoscopy is necessary to detect precursor lesions or new early colon cancer. We analyzed the surveillance results of patients with endoscopically resected early colon cancer to evaluate the detection rate of advanced neoplasia and its associated factors. METHODS We conducted a retrospective study at Soonchunhyang University Seoul Hospital, from May 2003 to December 2011. Patients who underwent endoscopic resection for early colon cancer, showed mucosal and submucosal invasion on histopathologic examination, and received surveillance colonoscopy at least once were enrolled in the current study. Patients who underwent operation and those who were lost during surveillance period were excluded. RESULTS Among a total of 305 patients diagnosed with early colon cancer, 211 patients met our inclusion criteria. Of these patients, 15 (7.1%) advanced neoplasias were detected at first colonoscopy. One hundred ninety-eight patients (93.8%) underwent surveillance colonoscopy within one year and 14 (7.0%) advanced neoplasias were detected in this group of patients. When patients with and without advanced neoplasia at first surveillance colonoscopy performed within one year were compared, inadequate bowel preparation (OR, 18.237; 95% CI, 3.741-88.895; p<0.001) and three or more colon polyps (OR, 9.479; 95% CI, 1.103-81.452; p=0.040) were significant risk factors for detecting advanced neoplasia. CONCLUSIONS Considering the high detection rate of advanced neoplasia at first surveillance colonoscopy in patients with endoscopically resected early colon cancer, surveillance interval should be within one year, especially when the bowel preparation has been inadequate and three or more colon polyps have been detected.
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Affiliation(s)
- Soon Ha Kwon
- Digestive Disease Center, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Stock C, Hoffmeister M, Birkner B, Brenner H. Inter-physician variation in follow-up colonoscopies after screening colonoscopy. PLoS One 2013; 8:e69312. [PMID: 23874941 PMCID: PMC3715496 DOI: 10.1371/journal.pone.0069312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/07/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND AIMS Surveillance is an integral part of the colorectal cancer (CRC) screening process. We aimed to investigate inter-physician variation in follow-up procedures after screening colonoscopy in an opportunistic CRC screening program. METHODS A historical cohort study in the German statutory health insurance system was conducted. 55,301 individuals who underwent screening colonoscopy in 2006 in Bavaria, Germany, and who were not diagnosed with CRC were included. Utilization of follow-up colonoscopies performed by the same physician (328 physicians overall) within 3 years was ascertained. Mixed effects logistic regression modelling was used to assess the effect of physicians and other potential predictors (screening result, age group, and sex) on re-utilization of colonoscopy. Physicians were grouped into quintiles according to individual effects estimated in a preliminary model. Predicted probabilities of follow-up colonoscopy by screening result and physician group were calculated. RESULTS The observed rate of follow-up colonoscopy was 6.2% (95% confidence interval: 5.9-6.4%), 18.6% (17.8-19.4%), and 37.0% (35.5-38.4%) after negative colonoscopy, low-risk adenoma and high-risk adenoma detection, respectively. All considered predictors were statistically significantly associated with follow-up colonoscopy. The predicted probabilities of follow-up colonoscopy ranged from 1.7% (1.4-2.0%) to 11.0% (10.2-11.7%), from 7.3% (6.2-8.5%) to 35.1% (32.6-37.7%), and from 17.9% (15.5-20.6%) to 56.9% (53.5-60.3%) in the 1(st) quintile (lowest rates of follow-up) and 5(th) quintile (highest rates of follow-up) of physicians after negative colonoscopy, low-risk adenoma and high-risk adenoma detection, respectively. CONCLUSIONS This study suggests substantial inter-physician variation in follow-up habits after screening colonoscopy. Interventions, including organizational changes in CRC screening should be considered to reduce this variation.
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Affiliation(s)
- Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Couch DG, Bullen N, Ward-Booth SE, Adams C. What interval between colorectal cancer resection and first surveillance colonoscopy? An audit of practice and yield. Colorectal Dis 2013; 15:317-22. [PMID: 22845696 DOI: 10.1111/j.1463-1318.2012.03187.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Colonoscopic follow-up after colorectal cancer resection (CRC) is recommended to screen for anastomotic recurrence and metachronous neoplasia, although guidelines vary in the timings of the first investigation. We aimed to quantify current practice and yield of neoplasia at first colonoscopy in relation to time from original resection. METHOD We conducted a retrospective case note study of all CRCs treated with curative intent within our hospital between two time periods: 2001-2003 and 2006-2007. Variables collected were the extent of preoperative luminal imaging, tumour site, procedure, timing and findings of initial colonoscopy, postoperative CT findings and mortality. The first follow-up colonoscopy findings including neoplasia formation and recurrence rates were matched with rates of complete preoperative luminal imaging. Two-year and 5-year outcomes were sought. RESULTS A total of 863 patients underwent CRC with curative intent within these two time periods (518 vs 345). Colonoscopic follow-up rates by 2 years were 32.8%vs 54.1%. Within the first cohort 63.5% of patients underwent colonoscopy by 5 years. Significant volumes of neoplasia and resectable recurrences were found before 2 years within these groups. Earlier detection of recurrent malignancy was associated with an improved patient outcome. Complete preoperative screening of the bowel was not associated with a lower incidence of neoplasia at first postoperative colonoscopy. CONCLUSION Our study demonstrates significant colonoscopic detection rates of neoplasia within 2 years of CRC. Patient outcomes were improved with earlier detection. We would therefore suggest an interval of no more than 2 years between resection and first surveillance colonoscopy.
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Affiliation(s)
- D G Couch
- Department of Colorectal Surgery, Derriford Hospital PHNT, Plymouth, UK
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Viel JF, Studer JM, Ottignon Y, Hirsch JP. Predictors of colorectal polyp recurrence after the first polypectomy in private practice settings: a cohort study. PLoS One 2012; 7:e50990. [PMID: 23226555 PMCID: PMC3513321 DOI: 10.1371/journal.pone.0050990] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/29/2012] [Indexed: 01/29/2023] Open
Abstract
Background Supplementary observational data in the community setting are required to better assess the predictors of colorectal polyp recurrence and the effectiveness of colonoscopy surveillance under real circumstances. Aim The goal of this study was to identify patient characteristics and polyp features at baseline colonoscopy that are associated with the recurrence of colorectal polyps (including hyperplastic polyps) among patients consulting private practice physicians. Patients and Methods This cohort study was conducted from March 2004 to December 2010 in 26 private gastroenterology practices (France). It included 1023 patients with a first-time diagnosis of histologically confirmed polyp removed during a diagnostic or screening colonoscopy. At enrollment, interviews were conducted to obtain data on socio-demographic variables and risk factors. Pathology reports were reviewed to abstract data on polyp features at baseline colonoscopy. Colorectal polyps diagnosed at the surveillance colonoscopy were considered as end points. The time to event was analyzed with an accelerated failure time model assuming a Weibull distribution. Results Among the 1023 patients with colorectal polyp at baseline, 553 underwent a surveillance colonoscopy. The mean time interval from baseline colonoscopy to first surveillance examination was 3.42 (standard deviation, 1.45) years. The recurrence rates were 50.5% and 32.9% for all polyps and adenomas, respectively. In multivariate models, the number of polyps at baseline was the only significant predictor for both polyp recurrence (hazard ratio [HR] 1.19, 95% CI 1.06 to 1.33), and adenoma recurrence (HR 1.17, 95% CI 1.03 to 1.34). Conclusion The efficacy of surveillance colonoscopy in community gastroenterology practice compared favorably with academic settings. This study provides further evidence that the number of initial colorectal polyps is useful for predicting the risk of polyp recurrence, even in the community setting.
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Affiliation(s)
- Jean-François Viel
- Department of Epidemiology and Public Health, University Hospital, Rennes, France.
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Factors affecting colonoscope insertion time in patients with or without a colostomy after left-sided colorectal resection. Dig Dis Sci 2012; 57:3219-25. [PMID: 22678462 DOI: 10.1007/s10620-012-2257-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 05/15/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND/AIMS We examined whether the insertion time for colonoscopies performed after left-sided resection was different in patients with a colostomy from that in patients without a colostomy and identified factors that could impact colonoscopy performance. METHODS We included consecutive patients who underwent colonoscopy between July 2005 and March 2011 after left-sided colorectal resection for colorectal cancer. We classified surgical methods according to the presence or absence of a colostomy and evaluated colonoscope insertion time retrospectively. Furthermore, we analyzed factors that might affect insertion time. RESULTS A total of 1,041 patients underwent colonoscopy after left-sided colorectal resection during the study period. The colonoscopy completion rate was 98.6 %, and the mean insertion time was 6.1 ± 4.6 min (median 4.7 min, range 0.3-35.8 min). A shorter resection length of colon, the presence of a colostomy, and a lower endoscopist case volume were found to be independent factors associated with prolonged insertion time in patients with left-sided colorectal resection. Among experienced colonoscopists, no colonoscopy-associated or clinical factors were found to affect insertion time. However, a shorter resection length of colon, the presence of a colostomy, and poor bowel preparation were associated with prolonged insertion time among inexperienced endoscopists. CONCLUSIONS We identified three factors that affect colonoscope insertion time after left-sided colorectal resection, including the presence of a colostomy. Inexperienced endoscopists were much more affected by the presence of a colostomy after left-sided colorectal resection. These findings have implications for the practice and teaching of colonoscopy after left-sided colorectal resection.
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Radaelli F, Paggi S, Bortoli A, De Pretis G. Overutilization of post-polypectomy surveillance colonoscopy in clinical practice: a prospective, multicentre study. Dig Liver Dis 2012; 44:748-53. [PMID: 22627070 DOI: 10.1016/j.dld.2012.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/10/2012] [Accepted: 04/19/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although the adherence to post-polipectomy recommendations is advocated as a quality indicator of colonoscopy programmes, prospective data on actual use of surveillance are lacking. AIM To evaluate the appropriateness of post-polypectomy surveillance colonoscopy on a community-wide basis and to identify factors associated with it. METHODS Data on consecutive post-polypectomy surveillance examinations performed over a 4-week period in 29 Italian endoscopy units were collected. The time interval between index and surveillance colonoscopy was calculated and compared to guidelines recommendations. Determinants of surveillance timing appropriateness were assessed by logistic step-wise regression. RESULTS Of 7081 consecutive outpatients, 1218 (17.2%) were referred for post-polypectomy surveillance and 902 were included into the analysis. Surveillance colonoscopy was prescribed correctly in 330 subjects (36.6%) and earlier than recommended by guidelines in 490 (54.3%). Low-risk subjects had an anticipated surveillance colonoscopy more frequently than global cohort (67.4% vs. 54.3%, p<0.001). At multivariate analysis, determinants of correct surveillance timing were high-volume workload centres (OR 1.92; 1.41-2.63 95%CI), centres providing written recommendation on surveillance interval (OR 1.70; 1.18-2.58 95%CI) and surveillance examinations performed within the national screening programme (OR 2.62; 1.92-3.59 95%CI). CONCLUSIONS In community practice, post-polipectomy surveillance colonoscopy is often performed earlier than recommended, especially in low-risk subjects. Interventions to improve adherence to guidelines and to reduce unnecessary examinations are needed.
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Kawai K, Sunami E, Tsuno NH, Kitayama J, Watanabe T. Polyp surveillance after surgery for colorectal cancer. Int J Colorectal Dis 2012; 27:1087-93. [PMID: 22297866 DOI: 10.1007/s00384-012-1420-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Although it is known that those patients who have developed colorectal cancer (CRC) are at a higher risk to develop metachronous adenoma or CRC, no study has been performed to analyze the relationship between the risk factors and the time course for the formation of postoperative adenoma using survival analysis. METHODS One hundred seventy-six patients with CRC,who had received surgical resection, were endoscopically followed-up to detect the development of metachronous adenoma or adenocarcinoama. The association between the risk factors such as age, synchronous adenomas with index CRC or other clinicopathological variables and the formation of postoperative adenoma was assessed using the logrank test and the Cox proportional hazard model. RESULTS Age over 60, synchronous lesions at the time of surgery for primary CRCs and presence of diabetes mellitus(DM) as the associated disease were positively related to the formation of postoperative adenoma. Among those patients with the three risk factors, only 27.8% remained adenoma-free during 5 years after operation, whereas in the group without any risk factor, it was 90.4%. CONCLUSIONS From our data, age over 60, synchronous adenomas or CRCs and DM were the potential risk factors for the postoperative formation of adenoma or CRC, and they should be taken into consideration when defining the appropriate interval of postoperative colonoscopy.
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Affiliation(s)
- Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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Puente D, Cantero FX, Llagostera M, Piñeiro P, Nieto R, Saladich R, Mascort J, Marzo M, Almeda J, Segarra M. A cross-sectional study of the appropriateness of colonoscopy requests in the Spanish region of Catalonia. BMJ Open 2012; 2:e002207. [PMID: 23204141 PMCID: PMC3533100 DOI: 10.1136/bmjopen-2012-002207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Colonoscopies are being requested with increasing frequency in the last few years, as they are used both as a diagnostic and therapeutic procedure in several gastrointestinal diseases. Our purpose is to describe the appropriateness of colonoscopy requests issued both from primary care centres and from hospitals, according to the EPAGE II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). METHODS AND ANALYSIS Cross-sectional study. Colonoscopy requests issued since January 2011 and received at the endoscopy units of all six reference hospitals serving the primary care centres of the South Metropolitan and Central Catalonia districts will be collected (total=1500 requests). Variables to be collected include gender, date of birth, origin of the request and reference hospital, priority of the procedure, type of clinician requesting the procedure, date and indication of request, abdominal examination performed, anal inspection examination performed, date of last colonoscopy if applicable, diagnosis and date of diagnosis. Using the available information and the EPAGE II website, colonoscopy requests will be assigned as an appropriateness score. The association between the variables collected and the EPAGE II scores will be assessed using a Student's t test and a χ(2) test. A multilevel logistic model will be generated on the factors associated with the appropriateness of the requests. ETHICS AND DISSEMINATION Colonoscopy is a costly procedure and not free from complications. In order to increase cost effectiveness, reduce waiting lists and optimise resources, it is necessary to use tools such as the EPAGE II guidelines, which establish criteria to assess the appropriateness of colonoscopies. The purpose of this study is to describe the current situation and to discuss whether current clinical practice is appropriate. The results of the study will be published in the next few years. In consideration of the ethical principles and methods of the research study, approval was granted for the project.
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Affiliation(s)
- Diana Puente
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | | | - Maria Llagostera
- Gerència Territorial Metropolitana Sud, Institut Català de la Salut, L'Hospitalet del Llobregat, Spain
| | - Pilar Piñeiro
- Servei d'Atenció Primària (SAP) Penedès-Garraf-Llobregat Nord, ABS Penedès Rural, Institut Català de la Salut, Alt Penedès, Spain
| | - Raquel Nieto
- Servei d'Atenció Primària (SAP) Penedès-Garraf-Llobregat Nord, ABS Penedès Rural, Institut Català de la Salut, Alt Penedès, Spain
| | - Rosa Saladich
- EAP Sant Boi de Llobregat-4 (Vinyets), Institut Català de la Salut, Sant Boi de Llobregat, Spain
| | - Juanjo Mascort
- EAP L'Hospitalet de Llobregat-8 (Florida Sud), Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
- Campus Bellvitge, Universitat de Barcelona, L'Hospitalet del Llobregat, Spain
| | - Mercè Marzo
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà, Spain
| | - Jesús Almeda
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Unitat de Suport a la Recerca Costa de Ponent, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Manel Segarra
- EAP Hospitalet de Llobregat-1 (Centre), Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
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Zhang H, Cao HL, Wang BM. A follow-up study of 166 cases of advanced colorectal adenomas after polypectomy. Shijie Huaren Xiaohua Zazhi 2011; 19:2593-2596. [DOI: 10.11569/wcjd.v19.i24.2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the characteristics of recurrence of advanced colorectal adenomas after polypectomy.
METHODS: The clinical data for patients with advanced colorectal adenoma who underwent polypectomy from January 2004 to January 2009 were collected and reevaluated. The patients who had follow-up data were included in the study.
RESULTS: A total of 497 patients with diagnosed advanced colorectal adenoma were collected, and follow-up data were available in 166 patients. These patients ranged in age from 32 to 82 years (average, 61.64 ± 11.07 years), and 128 cases had an age of ≥ 55 years (128/166, 77.11%). Ninety-four (94/166, 56.63%) patients were males. The most common initial manifestations of advanced adenomas were hematochezia (71/166, 46.38%) and lobular changes (75/166, 54.82%). The interval between polypectomy and first reexamination was 1-28 months. There were 102 (102/166, 61.45%) recurrences in all. Advanced colorectal adenomas in the left hemicolon more likely recurred in the left hemicolon, while those in the right hemicolon more likely recurred in the right hemicolon. No pathological differences were found between recurrent adenomas and original ones (P > 0.05). The hazard curve of Cox model suggested that the risk of recurrence increased gradually from 6 months after polypectomy.
CONCLUSION: Advanced colorectal adenomas may recur after polypectomy. No pathological differences were found between recurrent adenomas and original ones. Colonoscopy should be performed 6 mo after polypectomy for detection of possible recurrence.
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Hyun YS, Han DS, Bae JH, Park HS, Eun CS. Graduated injection needles and snares for polypectomy are useful for measuring colorectal polyp size. Dig Liver Dis 2011; 43:391-4. [PMID: 21334993 DOI: 10.1016/j.dld.2010.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/13/2010] [Accepted: 12/27/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Accurate measurement of polyp size during colonoscopy is important; however, visual estimation of polyp size is inaccurate, and it is cumbersome to use additional accessories to measure polyp size whenever polyps are detected. AIMS To evaluate the accuracy and usefulness of graduated devices that can also be used for polypectomy. METHODS The ends of the outer sheath of the injection needles and snares were marked at intervals of 5mm (total 30mm). Four endoscopists measured 53 polyps of 36 patients in the following manner: visual estimation, estimation with biopsy forceps, and measurement with graduated devices. Actual size of all polyps measured through a calliper was used as reference standard. RESULTS The difference between actual size and size measured by visual estimation was statistically significant (1.27mm, P<0.001), whilst the differences between actual size and size measured by biopsy forceps (0.06mm, P=1.00) or graduated devices (0.15mm, P=0.620) were not. The linear correlation between the estimates and the actual sizes showed that the graduated device gave the largest positive linear correlation (0.986, P<0.001) of the three measurement methods tested. CONCLUSIONS The graduated devices are efficient methods when measuring polyp size and performing polypectomy in a single step.
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Affiliation(s)
- Yil Sik Hyun
- Department of Gastroenterology, Hanyang University College of Medicine, Republic of Korea
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Jang HW, Cheon JH, Nam CM, Moon CM, Lee JH, Jeon SM, Park JJ, Kim TI, Kim WH. Factors affecting insertion time for colonoscopy performed under intramuscular analgesia in patients with history of colorectal resection. Surg Endosc 2011; 25:2316-22. [PMID: 21298530 DOI: 10.1007/s00464-010-1555-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 12/13/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND Colonoscopy can detect both early intraluminal recurrence and metachronous neoplasia after colorectal cancer resection. Because colon length and location change after colorectal resection, factors affecting insertion time during colonoscopy also might be altered. The goal of this study was to examine whether colonoscope insertion time differs between left-sided resection and right-sided resection and to identify factors that impact the performance of colonoscopy after colorectal resection. METHODS We included consecutive patients who underwent colonoscopy between November 2005 and November 2009 after colorectal resection for colorectal cancer. We classified surgical methods into left-sided resection (left hemicolectomy, low anterior resection, anterior resection, Hartman, and Mile's operation) or right-sided resection (right hemicolectomy) and retrospectively evaluated the colonoscope insertion time. Moreover, we analyzed factors that might affect the insertion time. RESULTS A total of 1,260 patients underwent colonoscopy after colorectal resection during the study period. Of these, 1,248 patients (771 men) who underwent complete colonoscopy were evaluated in this study. The colonoscopy completion rate was 99%, and the mean insertion time was 6.5±5.1 min (median, 5 min; range, 0.3-61 min). Right-sided resection, female gender, poor quality of bowel preparation, lower endoscopist case volume, open laparotomy, and colonoscopy performed more than 1 year after colorectal resection were found to be independent factors associated with prolonged insertion time. CONCLUSIONS This large study identified six factors that affect colonoscope insertion time after colorectal resection. These findings have implications for the practice and teaching of colonoscopy after colorectal resection.
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Affiliation(s)
- Hui Won Jang
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea
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Sanchez-Mete L, Venturo I, Papaldo P, Sperduti I, Stigliano V. Colorectal cancer after breast cancer: A case-control study. Cancer Epidemiol 2011; 35:44-7. [DOI: 10.1016/j.canep.2010.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 09/03/2010] [Accepted: 09/06/2010] [Indexed: 01/22/2023]
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Søreide K. Endoscopic surveillance after curative surgery for sporadic colorectal cancer: patient-tailored, tumor-targeted or biology-driven? Scand J Gastroenterol 2010; 45:1255-61. [PMID: 20553114 DOI: 10.3109/00365521.2010.496492] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Endoscopy has been endorsed and introduced in most surveillance programs following curative surgery for colorectal cancer (CRC), yet little data are available to support its use in terms of patient selection, efficacy and frequency of surveillance. MATERIAL AND METHODS A literature search in the English language using the PubMed/Medline database for the MeSH terms "colorectal cancer", "surveillance", and "endoscopy", with focus on sporadic CRC, excluding CRC developed on a hereditary or inflammatory bowel disease background. Focus on results from the past 5 years was applied. RESULTS Recent systematic reviews, meta-analyses, randomized trials and prospective studies made the backbone of the article, supported by population-based findings and recent reports on tumor biology. Hard evidence to support a survival benefit from endoscopy alone is lacking. Definitions of "synchronous", "interval", and "metachronous" cancers are not uniform and hampers comparison of studies. The number of metachronous cancers (usually 2-4%) that develop after curative CRC surgery is small, and better patient-tailored surveillance could improve the diagnostic yield. Compliance with endoscopy is low compared to other modalities. Age and socio-demographic factors influence on the surveillance coverage and need to be addressed in any given program. The majority of local recurrences occur within the first 3 years after surgery independent of stage, and microsatellite instable (MSI) tumors appear to be at higher risk. CONCLUSIONS Endoscopy in surveillance after curative surgery for CRC is a resource demanding procedure. A tailored approach according to factors associated with an increased risk for metachronous cancer/local recurrence would increase efficiency.
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Affiliation(s)
- Kjetil Søreide
- Department of Surgery, Stavanger University Hospital, Stavanger, Norway.
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Carrión S, Marín I, Lorenzo-Zúñiga V, Moreno De Vega V, Boix J. Adecuación de la indicación de la colonoscopia según los nuevos criterios de EPAGE II. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:484-9. [DOI: 10.1016/j.gastrohep.2010.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 05/05/2010] [Accepted: 05/06/2010] [Indexed: 12/13/2022]
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Hotta K, Saito Y, Matsuda T, Shinohara T, Oyama T. Local recurrence and surveillance after endoscopic resection of large colorectal tumors. Dig Endosc 2010; 22 Suppl 1:S63-8. [PMID: 20590775 DOI: 10.1111/j.1443-1661.2010.00965.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Local recurrence rates after endoscopic piecemeal mucosal resection (EPMR) typically range from 10 to 23%. In our previous study, the local recurrence rate after a piecemeal resection was significantly higher than that after an en bloc resection, irrespective of tumor size or macroscopic features. To reduce local recurrence after an EPMR, it is important to carefully note the circumferences of the edge and base of the ulcer. Recently, endoscopic submucosal dissection (ESD) was developed and recognized for its effectiveness in large, complete, en bloc resections and precise pathological assessments. ESD also showed lower local recurrence rates, ranging from 0 to 3% in previous, retrospective studies. However, ESD showed a higher perforation rate and longer procedure times; thus, it is necessary to improve ESD. An appropriate surveillance interval after EPMR was still controversial, and recommendations of some guidelines ranged from 2 to 9 months. In order to determine the appropriate interval, a randomized controlled study is necessary.
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Affiliation(s)
- Kinichi Hotta
- Department of Gastroenterology, Saku Central Hospital, Saku, Nagano, Japan.
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Boix J, Lorenzo-Zúñiga V. [Seeking for the quality in colonoscopy]. Med Clin (Barc) 2010; 134:68-9. [PMID: 19896148 DOI: 10.1016/j.medcli.2009.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 09/23/2009] [Indexed: 11/28/2022]
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Gonvers JJ, Burnand B, Vader JP, Froehlich F. Colorectal cancer detection: how well do appropriateness criteria perform? Clin Gastroenterol Hepatol 2009; 7:807-8; author reply 808. [PMID: 19245855 DOI: 10.1016/j.cgh.2009.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 02/11/2009] [Indexed: 02/07/2023]
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