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Polychronidis G, He MM, Vithayathil M, Knudsen MD, Wang K, Song M. Risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps: a comprehensive evaluation of risk factors and surveillance use. Gut 2024; 73:1675-1683. [PMID: 38839270 DOI: 10.1136/gutjnl-2023-331729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Surveillance colonoscopy after polyp removal is recommended to prevent subsequent colorectal cancer (CRC). It is known that advanced adenomas have a substantially higher risk than non-advanced ones, but optimal intervals for surveillance remain unclear. DESIGN We prospectively followed 156 699 participants who had undergone a colonoscopy from 2007 to 2017 in a large integrated healthcare system. Using multivariable Cox proportional hazards regression we estimated the subsequent risk of CRC and high-risk polyps, respectively, according to index colonoscopy polyps, colonoscopy quality measures, patient characteristics and the use of surveillance colonoscopy. RESULTS After a median follow-up of 5.3 years, we documented 309 CRC and 3053 high-risk polyp cases. Compared with participants with no polyps at index colonoscopy, those with high-risk adenomas and high-risk serrated polyps had a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy (multivariable HR 5.44 (95% CI 3.56 to 8.29) and 8.35 (95% CI 4.20 to 16.59), respectively). Recurrence of high-risk polyps showed a similar risk distribution. The use of surveillance colonoscopy was associated with lower risk of CRC, with an HR of 0.61 (95% CI 0.39 to 0.98) among patients with high-risk polyps and 0.57 (95% CI 0.35 to 0.92) among low-risk polyps. Among 1548 patients who had high-risk polyps at both index and surveillance colonoscopies, 65% had their index polyps in the proximal colon and 30% had index and interval polyps in the same segments. CONCLUSION Patients with high-risk polyp findings were at higher risk of subsequent CRC and high-risk polyps and may benefit from early surveillance within 3 years. The subsite distribution of the index and recurrent high-risk polyps suggests the contribution of incomplete resection and missed lesions to the development of interval neoplasia.
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Affiliation(s)
- Georgios Polychronidis
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of General,Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Study Centre of the German Surgical Society, German Surgical Society/Heidelberg University Hospital, Heidelberg, Germany
| | - Ming-Ming He
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- State Key Laboratory of Oncology in South China, Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mathew Vithayathil
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Imperial College Healthcare NHS Trust, London, UK
| | - Markus D Knudsen
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Transplantation Medicine, Division of Surgery,Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Kai Wang
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Gorgun E, Yilmaz S, Ozgur I, Sommovilla J, Truong A, Maspero M, Bhatt A, Catalano B, Liska D, Steele SR. Predictors of En Bloc, R0 Resection, and Postprocedural Complications After Advanced Endoscopic Resections for Colorectal Neoplasms: Results of 1213 Procedures. Dis Colon Rectum 2024; 67:1185-1193. [PMID: 38889766 DOI: 10.1097/dcr.0000000000003394] [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: 06/20/2024]
Abstract
BACKGROUND Advanced endoscopic resection techniques are used to treat colorectal neoplasms that are not amenable to conventional colonoscopic resection. Literature regarding the predictors of the outcomes of advanced endoscopic resections, especially from a colorectal surgical unit, is limited. OBJECTIVE To determine the predictors of short-term and long-term outcomes after advanced endoscopic resections. DESIGN Retrospective case series. SETTINGS Tertiary care center. PATIENTS Patients who underwent advanced endoscopic resections for colorectal neoplasms from November 2011 to August 2022. INTERVENTIONS Endoscopic mucosal resection, endoscopic submucosal dissection, hybrid endoscopic submucosal dissection, and combined endoscopic laparoscopic surgery. MAIN OUTCOME MEASURES Predictors of en bloc and R0 resection, bleeding, and perforation were determined using univariable and multivariable logistic regression models. Cox regression models were used to determine the predictors of tumor recurrence. RESULTS A total of 1213 colorectal lesions from 1047 patients were resected (median age 66 [interquartile range, 58-72] years, 484 women [46.2%], median BMI 28.6 [interquartile range, 24.8-32.6]). Most neoplasms were in the proximal colon (898; 74%). The median lesion size was 30 (interquartile range, 20-40; range, 0-120) mm. Nine hundred eleven lesions (75.1%) underwent previous interventions. The most common Paris and Kudo classifications were 0 to IIa flat elevation (444; 36.6%) and IIIs (301; 24.8%), respectively. En bloc and R0 resection rates were 56.6% and 54.3%, respectively. Smaller lesions, rectal location, and procedure type (endoscopic submucosal dissection) were associated with significantly higher en bloc and R0 resection rates. Bleeding and perforation rates were 5% and 6.6%, respectively. Increased age was a predictor for bleeding (OR 1.06; 95% CI, 1.03-1.09; p < 0.0001). Lesion size was a predictor for perforation (OR 1.02; 95% CI, 1.00-1.03; p = 0.03). The tumor recurrence rate was 6.6%. En bloc (HR 1.41; 95% CI, 1.05-1.93; p = 0.02) and R0 resection (HR 1.49; 95% CI, 1.11-2.06; p = 0.008) were associated with decreased recurrence risk. LIMITATIONS Single-center, retrospective study. CONCLUSIONS Outcomes of advanced endoscopic resections can be predicted by patient-related and lesion-related characteristics. See Video Abstract . PREDICTORES DE LA RESECCION R, EN BLOQUE Y LAS COMPLICACIONES POR RESECCIONES ENDOSCPICAS AVANZADAS EN CASOS DE NEOPLASIA COLORRECTAL RESULTADOS DE PROCEDIMIENTOS ANTECEDENTES:Las técnicas avanzadas de resección endoscópica se utilizan para el tratamiento de neoplasias colorrectales que no son susceptibles de resección colonoscópica convencional. La literatura sobre los predictores de los resultados de las resecciones endoscópicas avanzadas, especialmente en una unidad de cirugía colorrectal, es limitada.OBJETIVO:Determinar los predictores de resultados a corto y largo plazo después de resecciones endoscópicas avanzadas.DISEÑO:Serie de casos retrospectivos.LUGAR:Centro de tercer nivel de atención.PACIENTES:Pacientes sometidos a resecciones endoscópicas avanzadas por neoplasias colorrectales desde noviembre de 2011 hasta agosto de 2022.INTERVENCIÓNES:Resección endoscópica de la mucosa, disección endoscópica submucosa (ESD), ESD híbrida, cirugía laparoscópica endoscópica combinada.PRINCIPALES MEDIDAS DE RESULTADO:Los predictores de resección en bloque y R0, sangrado y perforación se determinaron mediante modelos de regresión logística univariables y multivariables. Se utilizaron modelos de regresión de Cox para determinar los predictores de recurrencia del tumor.RESULTADOS:Se resecaron 1.213 lesiones colorrectales en 1.047 pacientes [edad media 66 (58-72) años, 484 (46,2%) mujeres, índice de masa corporal medio 28,6 (24,8-32,6) kg/m 2 ]. La mayoría de las neoplasias se encontraban en el colon proximal (898, 74%). El tamaño medio de la lesión fue de 30mm (RIC: 20-40, rango: 0-120). 911 (75,1%) lesiones tenían intervenciones previas. Las clasificaciones de París y Kudo más comunes fueron 0-IIa elevación plana (444, 36,6%) y III (301, 24,8%), respectivamente. Las tasas de resección en bloque y R0 fueron del 56,6% y 54,3%, respectivamente. Las lesiones más pequeñas, la ubicación rectal y el tipo de procedimiento (ESD) se asociaron con tasas de resección en bloque y R0 significativamente más altas. Las tasas de sangrado y perforación fueron del 5% y 6,6%, respectivamente. La edad avanzada [1,06 (1,03-1,09), p < 0,0001] fue un predictor de sangrado. El tamaño de la lesión [1,02 (1,00-1,03), p = 0,03] fue un predictor de perforación. La tasa de recurrencia del tumor fue del 6,6%. En bloque [HR 1,41 (IC 95% 1,05-1,93), p = 0,02] y la resección R0 [HR 1,49 (IC 95% 1,11-2,06), p = 0,008] se asociaron con un menor riesgo de recurrencia.LIMITACIONES:Estudio unicéntrico, retrospectivo.CONCLUSIONES:Los resultados de las resecciones endoscópicas avanzadas pueden predecirse según las características del paciente y de la lesión. (Traducción-Dr. Xavier Delgadillo ).
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Affiliation(s)
- Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sumeyye Yilmaz
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ilker Ozgur
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Sommovilla
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Adam Truong
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Marianna Maspero
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brogan Catalano
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
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Park J, Seo J, Yoon K, Lee S, Kim M, Ryu SY, Kim KG. Increasing the Beam Width and Intensity with Refraction Power Effect Using a Combination of Beam Mirrors and Concave Mirrors for Surgical-Fluorescence-Emission-Guided Cancer Monitoring Method. SENSORS (BASEL, SWITZERLAND) 2024; 24:5503. [PMID: 39275414 PMCID: PMC11398251 DOI: 10.3390/s24175503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024]
Abstract
The primary goal during cancer removal surgery is to completely excise the malignant tumor. Because the color of the tumor and surrounding tissues is very similar, it is difficult to observe with the naked eye, posing a risk of damaging surrounding blood vessels during the tumor removal process. Therefore, fluorescence emission is induced using a fluorescent contrast agent, and color classification is monitored through camera imaging. LEDs must be irradiated to generate the fluorescent emission electromotive force. However, the power and beam width of the LED are insufficient to generate this force effectively, so the beam width and intensity must be increased to irradiate the entire lesion. Additionally, there should be no shaded areas in the beam irradiation range. This paper proposes a method to enhance the beam width and intensity while eliminating shadow areas. A total reflection beam mirror was used to increase beam width and intensity. However, when the beam width increased, a shadow area appeared at the edge, limiting irradiation of the entire lesion. To compensate for this shadow area, a concave lens was combined with the beam mirror, resulting in an increase in beam width and intensity by more than 1.42 times and 18.6 times, respectively. Consequently, the beam width reached 111.8°, and the beam power was 13.6 mW. The proposed method is expected to be useful for observing tumors through the induction of fluorescence emission during cancer removal surgery or for pathological examination in the pathology department.
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Affiliation(s)
- Jina Park
- Premedicine Course & Department of Medicine, College of Medicine, Gachon University, Incheon 21565, Republic of Korea
- Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Jeongmin Seo
- Premedicine Course & Department of Medicine, College of Medicine, Gachon University, Incheon 21565, Republic of Korea
- Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Kicheol Yoon
- Premedicine Course & Department of Medicine, College of Medicine, Gachon University, Incheon 21565, Republic of Korea
- Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Sangyun Lee
- Department of Radiological Science, Dongnam Health University, Suwon 16328, Republic of Korea
| | - Minchan Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
| | - Seung Yeob Ryu
- Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
- Department of Biohealth & Medical Engineering Major and Biomedical Engineering, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Kwang Gi Kim
- Medical Devices R&D Center, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea
- Department of Biohealth & Medical Engineering Major and Biomedical Engineering, Gachon University, Seongnam-si 13120, Republic of Korea
- Department of Health Sciences and Technology, Gachon Advanced Institute for Health Sciences and Technology (GAIHST), Gachon University, Incheon 21565, Republic of Korea
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Aleissa M, Drelichman ER, Mittal VK, Bhullar JS. Barriers in early detection of colorectal cancer and exploring potential solutions. World J Clin Oncol 2024; 15:811-817. [PMID: 39071472 PMCID: PMC11271734 DOI: 10.5306/wjco.v15.i7.811] [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] [Received: 05/01/2024] [Revised: 06/21/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
This editorial discusses the literature review article by Tonini and Zanni, the paper was published in January 2024, and the authors provided very interesting conclusions regarding existing barriers to the early diagnosis of colon cancer. Many cancers do not have identifiable precursors, or there are currently no screening tests to find them. Therefore, these cancers do not have preventive screening options. Early detection is crucial for reducing mortality rates by identifying cancer at an earlier stage through screening, as opposed to no screening. Colorectal cancer develops from precancerous lesions, which can be detected early and potentially prevented and cured. Early detection leads to improved survival rates, decreased complications, and reduced healthcare expenses. This editorial provides a brief description of the biology of colon cancer, emphasizing the contrast in outcomes between early detection and late detection. We also describe screening programs around the globe and examine the barriers in each program. Finally, we explore potential future solutions to enhance inclusion in screening programs and improve patient compliance.
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Affiliation(s)
- Maryam Aleissa
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
- College of Medicine, Princess Norah University Hospital, Riyadh 11564, Saudi Arabia
| | - Ernesto Raul Drelichman
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
| | - Vijay K Mittal
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
| | - Jasneet Singh Bhullar
- Department of Surgery, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI 48075, United States
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Ortiz O, Daca-Alvarez M, Rivero-Sánchez L, Saez De Gordoa K, Moreira R, Cuatrecasas M, Balaguer F, Pellisé M. Linked-color imaging versus high definition white-light endoscopy for evaluation of post-polypectomy scars of nonpedunculated lesions: LCI-Scar study. Endoscopy 2024; 56:283-290. [PMID: 37931908 DOI: 10.1055/a-2204-3236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Detection and treatment of recurrence after piecemeal endoscopic mucosal resection of nonpedunculated colorectal polyps are crucial for avoidance of post-colonoscopy cancer. Linked-color imaging (LCI) has demonstrated improved polyp detection but has never been assessed for evaluation of post-polypectomy scars. Our aim was to compare sensitivity and negative predictive value (NPV) between LCI and white-light endoscopy (WLE) for detection of post-polypectomy recurrence. METHODS Patients undergoing surveillance colonoscopy after resection of lesions ≥15 mm were included in this prospective, single-center, randomized, crossover study. Each post-polypectomy scar underwent two examinations, one with LCI and the other with WLE, performed by two blinded endoscopists. Blue-light imaging (BLI) was then applied. A diagnosis of recurrence with a level of confidence was made for each modality and histopathology was the gold standard. RESULTS 129 patients with 173 scars were included. Baseline patient, lesion, and procedural characteristics were similar in both arms. Recurrence was detected in 56/173 (32.4%), with 27/56 (48.2%) adenomas and 29/56 (51.8%) serrated lesions. LCI had greater sensitivity (96.4% [95%CI 87.8%-99.5%]) versus WLE (89.3% [95%CI 78.1%-95.9%]) and greater NPV (98.1% [95%CI 93.4%-99.8%] versus 94.6% [95%CI 88.7%-98.0%]). Paired concordance between modalities was 96.0%. In discordant cases, LCI identified four true-positive cases not detected by WLE and reclassified one false-positive of WLE. WLE reclassified two false positives of LCI without any increase in recurrence detection. CONCLUSIONS LCI was highly accurate and had greater ability than WLE to rule out recurrence on post-polypectomy scars after resection of large polyps.
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Affiliation(s)
- Oswaldo Ortiz
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | | | - Rebeca Moreira
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain
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Patel SG, Dominitz JA. Screening for Colorectal Cancer. Ann Intern Med 2024; 177:ITC49-ITC64. [PMID: 38588547 DOI: 10.7326/aitc202404160] [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: 04/10/2024] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death. Screening has been proven to reduce both cancer incidence and cancer-related mortality. Various screening tests are available, each with their own advantages and disadvantages and varying levels of evidence to support their use. Clinicians should offer CRC screening to average-risk persons aged 50 to 75 years; starting screening at age 45 years remains controversial. Screening may be beneficial in select persons aged 76 to 85 years, based on their overall health and screening history. Offering a choice of screening tests or sequentially offering an alternate test for those who do not complete screening can significantly increase participation.
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Affiliation(s)
- Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz School of Medicine, and Division of Gastroenterology and Hepatology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado (S.G.P.)
| | - Jason A Dominitz
- Gastroenterology Section, Veterans Affairs Puget Sound Health Care System, and Division of Gastroenterology, University of Washington, Seattle, Washington (J.A.D.)
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Cronin O, Kirszenblat D, Forbes N, Gupta S, Whitfield A, O'Sullivan T, Gauci J, Abuarisha M, Wang H, Burgess NG, Lee EYT, Williams SJ, Bourke MJ. Geometry of cold snare polypectomy and risk of incomplete resection. Endoscopy 2024; 56:214-219. [PMID: 37774737 DOI: 10.1055/a-2184-1609] [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: 10/01/2023]
Abstract
BACKGROUND Cold snare polypectomy (CSP) is safer than and equally efficacious as hot snare polypectomy (HSP) for the removal of small (<10mm) colorectal polyps. The maximum polyp size that can be effectively managed by piecemeal CSP (p-CSP) without an excessive burden of recurrence is unknown. METHODS Resection error risks (RERs), defined as the estimated likelihood of incomplete removal of adenomatous tissue for a single snare resection pass, for CSP and HSP were calculated, based on an incomplete resection rate. Polyp area, snare size, estimated number of resections, and optimal resection defect area were modeled. Overall risk of incomplete resection (RIR) was defined as RIR=1 - (1 - p)n, where p is the RER and n the number of resections. RESULTS A 40-mm polyp has a four times greater area than a 20-mm polyp (314.16mm2 vs. 1256.64mm2), and requires three times more resections (11 vs. 33, respectively, assuming 8-mm piecemeal resection pieces for p-CSP). RIRs for a 40-mm polyp by HSP and p-CSP were 15.1%-23% and 40.74%-60.60% respectively. CONCLUSION RER is more important with p-CSP than with HSP. The number of resections, n, and consequently RIR increases with increasing polyp size. Given the overwhelming safety of CSP, specific techniques to minimize the RER should be studied and developed.
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Affiliation(s)
- Oliver Cronin
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - David Kirszenblat
- Department of Mathematics and Statistics, University of Melbourne, Parkville, Australia
| | | | - Sunil Gupta
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Anthony Whitfield
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Timothy O'Sullivan
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Julia Gauci
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Muhammad Abuarisha
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Hunter Wang
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Nicholas G Burgess
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Eric Y T Lee
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Stephen J Williams
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
| | - Michael J Bourke
- Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Medicine, University of Sydney Westmead Clinical School, Sydney, Australia
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Zhang N, Wang W, Gao X, Gao F. Editorial: Clinical risk assessment and intervention of gastrointestinal tumors driven by big-data. Front Med (Lausanne) 2024; 11:1379762. [PMID: 38476446 PMCID: PMC10927941 DOI: 10.3389/fmed.2024.1379762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Nan Zhang
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, China
| | - Wei Wang
- Department of Pathology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xin Gao
- Computational Bioscience Research Center, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
- Computer Science Program, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Feng Gao
- Department of General Surgery, Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
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9
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Jacques J, Schaefer M, Wallenhorst T, Rösch T, Lépilliez V, Chaussade S, Rivory J, Legros R, Chevaux JB, Leblanc S, Rostain F, Barret M, Albouys J, Belle A, Labrunie A, Preux PM, Lepetit H, Dahan M, Ponchon T, Crépin S, Marais L, Magne J, Pioche M. Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas : A Randomized Comparative Trial. Ann Intern Med 2024; 177:29-38. [PMID: 38079634 DOI: 10.7326/m23-1812] [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: 01/17/2024] Open
Abstract
BACKGROUND Endoscopic resection of adenomas prevents colorectal cancer, but the optimal technique for larger lesions is controversial. Piecemeal endoscopic mucosal resection (EMR) has a low adverse event (AE) rate but a variable recurrence rate necessitating early follow-up. Endoscopic submucosal dissection (ESD) can reduce recurrence but may increase AEs. OBJECTIVE To compare ESD and EMR for large colonic adenomas. DESIGN Participant-masked, parallel-group, superiority, randomized controlled trial. (ClinicalTrials.gov: NCT03962868). SETTING Multicenter study involving 6 French referral centers from November 2019 to February 2021. PARTICIPANTS Patients with large (≥25 mm) benign colonic lesions referred for resection. INTERVENTION The patients were randomly assigned by computer 1:1 (stratification by lesion location and center) to ESD or EMR. MEASUREMENTS The primary end point was 6-month local recurrence (neoplastic tissue on endoscopic assessment and scar biopsy). The secondary end points were technical failure, en bloc R0 resection, and cumulative AEs. RESULTS In total, 360 patients were randomly assigned to ESD (n = 178) or EMR (n = 182). In the primary analysis set (n = 318 lesions in 318 patients), recurrence occurred after 1 of 161 ESDs (0.6%) and 8 of 157 EMRs (5.1%) (relative risk, 0.12 [95% CI, 0.01 to 0.96]). No recurrence occurred in R0-resected cases (90%) after ESD. The AEs occurred more often after ESD than EMR (35.6% vs. 24.5%, respectively; relative risk, 1.4 [CI, 1.0 to 2.0]). LIMITATION Procedures were performed under general anesthesia during hospitalization in accordance with the French health system. CONCLUSION Compared with EMR, ESD reduces the 6-month recurrence rate, obviating the need for systematic early follow-up colonoscopy at the cost of more AEs. PRIMARY FUNDING SOURCE French Ministry of Health.
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Affiliation(s)
- Jérémie Jacques
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Marion Schaefer
- Hépato-Gastro-Entérologie, CHRU de Nancy, Nancy, France (M.S., J.-B.C.)
| | | | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital, Hamburg-Eppendorf, Hamburg, Germany (T.R.)
| | - Vincent Lépilliez
- Hépato-Gastro-Entérologie, Hôpital Privé Jean Mermoz, Lyon, France (V.L., S.L.)
| | | | - Jérôme Rivory
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
| | - Romain Legros
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | | | - Sarah Leblanc
- Hépato-Gastro-Entérologie, Hôpital Privé Jean Mermoz, Lyon, France (V.L., S.L.)
| | - Florian Rostain
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
| | - Maximilien Barret
- Hépato-Gastro-Entérologie, Hôpital Cochin, Paris, France (S.C., M.B., A.B.)
| | - Jérémie Albouys
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Arthur Belle
- Hépato-Gastro-Entérologie, Hôpital Cochin, Paris, France (S.C., M.B., A.B.)
| | - Anaïs Labrunie
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche (CEBIMER), CHU de Limoges, Limoges, France (A.L., P.-M.P., J.M.)
| | - Pierre-Marie Preux
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche (CEBIMER), CHU de Limoges, Limoges, France (A.L., P.-M.P., J.M.)
| | - Hugo Lepetit
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Martin Dahan
- Hépato-Gastro-Entérologie, CHU de Limoges, Limoges, France (J.J., R.L., J.A., H.L., M.D.)
| | - Thierry Ponchon
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
| | - Sabrina Crépin
- Service de Pharmacologie-Toxicologie et Pharmacovigilfance-Unité de Vigilance des Essais Cliniques, CHU de Limoges, Limoges, France (S.C.)
| | - Loïc Marais
- Direction de la Recherche et de l'Innovation, CHU de Limoges, Limoges, France (L.M.)
| | - Julien Magne
- Centre d'Epidémiologie de Biostatistiques et Méthodologie de la Recherche (CEBIMER), CHU de Limoges, Limoges, France (A.L., P.-M.P., J.M.)
| | - Mathieu Pioche
- Hépato-Gastro-Entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France (J.R., F.R., T.P., M.P.)
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10
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Da Cunha T, Vaziri H. Interval Colorectal Cancer in Inflammatory Bowel Disease: A Review. J Clin Gastroenterol 2024; 58:1-11. [PMID: 37548445 DOI: 10.1097/mcg.0000000000001901] [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: 08/08/2023]
Abstract
Inflammatory bowel disease (IBD) increases the risk of dysplasia and colorectal cancer (CRC). Moreover, colitis-associated CRC is responsible for a disproportionate number of CRC-related mortality. For this reason, societies recommend screening and surveillance colonoscopy as the standard of care for patients with ulcerative colitis and Crohn's colitis. Nonetheless, interval cancer defined as CRC detected within the appropriate surveillance interval might still occur despite following guideline recommendations. Even though there is limited data on risk factors associated with interval CRC in IBD, patient and disease-associated factors and technical aspects of the surveillance might play a role. This review aims to provide information on the epidemiology of interval CRC in IBD, the factors that might be associated with its occurrence, and the challenges of CRC screening and dysplasia management in patients with IBD.
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Affiliation(s)
- Teresa Da Cunha
- Department of Gastroenterology and Hepatology, University of Connecticut, Farmington, CT
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11
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Rosser R, Corfe BM, Chapple KS. Metachronous Colorectal Adenomas Occur Close to the Index Lesion. J Clin Gastroenterol 2023; 57:937-944. [PMID: 36731090 DOI: 10.1097/mcg.0000000000001758] [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] [Received: 03/22/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
GOALS The aim of this study is to assess the spatial relationship between index and metachronous colorectal adenoma location. BACKGROUND After the complete excision of a human sporadic colorectal adenoma, patients are at elevated risk of developing a further metachronous adenoma. Data regarding the occurrence site of a metachronous colorectal adenoma relative to the index adenoma are scarce. STUDY Prospectively maintained databases were interrogated to identify all colonoscopies and adenoma excisions performed over a 10-year period at a single university teaching hospital. Data for the colonic segments at which adenoma removal were reported at index and all subsequent colonoscopies were extracted and 2 allied data sets merged. RESULTS A total of 15,121 colonoscopies and 4759 polyp events were recorded. Four hundred fifty-two patients [296 male, 156 female, median (range) age 75 (32 to 100) y] developed at least 1 metachronous adenoma at follow-up colonoscopy. When single index events only are considered (ie, synchronous adenoma cases excluded), over 61% of metachronous adenomas were recorded in the same or an adjacent colonic segment. When the full span of the colon is considered, metachronous adenomas were more likely to occur in a section of the colon proximal to that of the index adenoma (41%±5%) than the same (39%±5%) or distal segment (20%±5%; P =0.006; 1-way χ 2 test). CONCLUSIONS A metachronous human sporadic colorectal adenoma is more likely to be found in the same colonic segment to that of the index adenoma or 1 immediately adjacent. These data suggest a shared origin of metachronous adenoma with preceding lesions, supporting the existence of precancerous fields.
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Affiliation(s)
- Ria Rosser
- Molecular Gastroenterology Research Group, Department of Oncology & Metabolism, The University of Sheffield
- Colorectal Surgical Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Bernard M Corfe
- Molecular Gastroenterology Research Group, Department of Oncology & Metabolism, The University of Sheffield
- Human Nutrition Research Centre, Newcastle University, Newcastle upon Tyne, England
| | - Keith S Chapple
- Colorectal Surgical Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
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12
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Kaltenbach T, Patel SG, Nguyen-Vu T, Malvar C, Keswani RN, Hall M, Aagaard E, Asokkumar R, Chin YK, Hammad H, Rastogi A, Shergill A, Simon V, Soetikno A, Soetikno R, Wani S. Varied Trainee Competence in Cold Snare Polypectomy: Results of the COMPLETE Randomized Controlled Trial. Am J Gastroenterol 2023; 118:1880-1887. [PMID: 37307537 DOI: 10.14309/ajg.0000000000002368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/27/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is strongly recommended as the optimal technique for the complete removal of small polyps. Though significant variability in polypectomy technique and quality has been established, the learning curve and impact of targeted training on CSP are unknown. Video feedback has shown promise as an effective pedagogy to improve performance among surgical trainees. We aimed to compare CSP performance between trainees who received video-based feedback and those who received conventional apprentice-based concurrent feedback. We hypothesized that video-based feedback would accelerate competence. METHODS We conducted a single-blinded, randomized controlled trial on competence for CSP of polyps <1 cm, comparing video-based feedback with conventional feedback. We randomly assigned deidentified consecutively recorded CSP videos to blinded raters to assess using the CSP Assessment Tool. We shared cumulative sum learning curves every 25 CSP with each trainee. The video feedback trainees also received biweekly individualized terminal feedback. Control trainees received conventional feedback during colonoscopy. The primary outcome was CSP competence. We also assessed competence across domains and change over polypectomy volume. RESULTS We enrolled and randomized 22 trainees, 12 to video-based feedback and 10 to conventional feedback, and evaluated 2,339 CSP. The learning curve was long; 2 trainees (16.7%) in the video feedback achieved competence, after a mean of 135 polyps, and no one in the control ( P = 0.481) achieved competence. Overall and in all steps of CSP, a higher percentage of the video feedback group met competence, increasing 3% every 20 CSP ( P = 0.0004). DISCUSSION Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine whether such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov : NCT03115008.
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Affiliation(s)
- Tonya Kaltenbach
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Swati G Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Gastroenterology, Rocky Mountain Regional Veterans Affairs Hospital, Aurora, Colorado, USA
| | - Tiffany Nguyen-Vu
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Carmel Malvar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, USA
| | - Matt Hall
- Biostatistics, Children's Hospital Association, Kansas City, Kansas, USA
| | - Eva Aagaard
- Department of Medicine, Division of General Internal Medicine, Washington University School of Medicine at St. Louis, St. Louis, Missouri, USA
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Yung Ka Chin
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Hazem Hammad
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amit Rastogi
- Division of Gastroenterology, Hepatology and Motility, University of Kansas Medical Center, Kansas City, Kansas, USA; and
| | - Amandeep Shergill
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Violette Simon
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alan Soetikno
- Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Roy Soetikno
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Gastroenterology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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13
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Rodríguez Sánchez J, Alvarez-Gonzalez MA, Pellisé M, Coto-Ugarte D, Uchima H, Aranda-Hernández J, Santiago García J, Marín-Gabriel JC, Riu Pons F, Nogales O, Carreño Macian R, Herreros-de-Tejada A, Hernández L, Patrón GO, Rodriguez-Tellez M, Redondo-Cerezo E, Sánchez Alonso M, Daca M, Valdivielso-Cortazar E, Álvarez Delgado A, Enguita M, Montori S, Albéniz E. Underwater versus conventional EMR of large nonpedunculated colorectal lesions: a multicenter randomized controlled trial. Gastrointest Endosc 2023; 97:941-951.e2. [PMID: 36572129 DOI: 10.1016/j.gie.2022.12.013] [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] [Received: 10/26/2022] [Revised: 11/23/2022] [Accepted: 12/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Underwater EMR (UEMR) is an alternative procedure to conventional EMR (CEMR) to treat large, nonpedunculated colorectal lesions (LNPCLs). In this multicenter, randomized controlled clinical trial, we aimed to compare the efficacy and safety of UEMR versus CEMR on LNPCLs. METHODS We conducted a multicenter, randomized controlled clinical trial from February 2018 to February 2020 in 11 hospitals in Spain. A total of 298 patients (311 lesions) were randomized to the UEMR (n = 149) and CEMR (n = 162) groups. The main outcome was the lesion recurrence rate in at least 1 follow-up colonoscopy. Secondary outcomes included technical aspects, en bloc resection rate, R0 resection rates, and adverse events, among others. RESULTS There were no differences in the overall recurrence rate (9.5% UEMR vs 11.7% CEMR; absolute risk difference, -2.2%; 95% CI, -9.4 to 4.9). However, considering polyp sizes between 20 and 30 mm, the recurrence rate was lower for UEMR (3.4% UEMR vs 13.1% CEMR; absolute risk difference, -9.7%; 95% CI, -19.4 to 0). The R0 resection showed the same tendency, with significant differences favoring UEMR only for polyps between 20 and 30 mm. Overall, UEMR was faster and easier to perform than CEMR. Importantly, the techniques were equally safe. CONCLUSIONS UEMR is a valid alternative to CEMR for treating LNPCLs and could be considered the first option of treatment for lesions between 20 and 30 mm due to its higher en bloc and R0 resection rates. (Clinical trial registration number: NCT03567746.).
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Affiliation(s)
- Joaquín Rodríguez Sánchez
- Endoscopy Unit, Hospital Universitario 12 de Octubre de Madrid, Madrid, Spain; Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
| | - Marco A Alvarez-Gonzalez
- Department of Digestive Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - David Coto-Ugarte
- Cruces University Hospital Endoscopy Unit Barakaldo, Basque Country, Spain
| | - Hugo Uchima
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Javier Aranda-Hernández
- Endoscopy Unit, Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Santiago García
- Gastroenterology Department, Research Institute Segovia de Arana, Puerta de Hierro University Hospital, Autonomous University of Madrid, Madrid, Spain
| | - José Carlos Marín-Gabriel
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute," Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Fausto Riu Pons
- Gastroenterology Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Oscar Nogales
- Endoscopy Unit, Department of Gastroenterology & Hepatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Alberto Herreros-de-Tejada
- Gastroenterology Department, Research Institute Segovia de Arana, Puerta de Hierro University Hospital, Autonomous University of Madrid, Madrid, Spain
| | | | - G Oliver Patrón
- Hospital Manacor and Hospital Parque Llevant, Palma de Mallorca, Spain
| | | | - Eduardo Redondo-Cerezo
- Endoscopy Unit, Department of Gastroenterology and Hepatology, "Virgen de Las Nieves" University Hospital, Granada, Spain
| | | | - Maria Daca
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | - Mónica Enguita
- Methodology Unit,. Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Sheyla Montori
- Gastrointestinal Endoscopy Research Unit, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra (HUN), Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
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14
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Zimmermann-Fraedrich K, Rösch T. Artificial intelligence and the push for small adenomas: all we need? Endoscopy 2023; 55:320-323. [PMID: 36882088 DOI: 10.1055/a-2038-7078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy University Hospital Hamburg-Eppendorf, Hamburg, Germany
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15
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Jackson K, Samaddar S, Markiewicz MA, Bansal A. Vaccination-Based Immunoprevention of Colorectal Tumors: A Primer for the Clinician. J Clin Gastroenterol 2023; 57:246-252. [PMID: 36730670 PMCID: PMC9911105 DOI: 10.1097/mcg.0000000000001808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colorectal cancer (CRC) continues to be a significant public health problem worldwide. CRC screening programs have reduced the incidence rates of CRCs but still suffer from the problems of missed lesions and interval cancers. Chemopreventive strategies against CRC would benefit high-risk populations but trials testing synthetic and naturally occurring compounds have not yielded a front runner. Immune mechanisms promoting cancer have been modulated to develop immunotherapy for cancer treatment that has revolutionized cancer management, but could also be applied to cancer interception, that is, cancer immunoprevention. Cancer immunoprevention refers to approaches that can enhance the immune system, either directly or by removing natural breaks such as immune checkpoints, to survey and destroy tumor cells. In this primer, we aim to explain the concepts behind vaccine-based cancer immunoprevention. Multiple cancer vaccines have been tried in advanced cancer populations, but most have failed primarily because of an immunosuppressive environment that accompanies advanced cancers. Preventive vaccines in immunocompetent hosts may have a better clinical response compared with therapeutic vaccines in immunosuppressed hosts. The first randomized controlled trial testing the mucin1 vaccine against CRC in the prevention setting has been successfully completed. For the benefit of the clinician, we briefly discuss important concepts related to the workings of preventive vaccines. Prevention with vaccines is a highly attractive approach because of the potential for highly targeted therapy with minimal side effects that could theoretically provide lifelong protection.
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Affiliation(s)
- Katy Jackson
- Department of Medicine, The University of Kansas Health System
| | | | - Mary A. Markiewicz
- Department of Microbiology, Molecular Genetics and Immunology, The University of Kansas Medical Center
| | - Ajay Bansal
- Division of Gastroenterology and Hepatology
- The University of Kansas Cancer Center, Kansas City, KS
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16
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Ma X, Yang L, Leung J, Sheng J, He Y. Reply. Clin Gastroenterol Hepatol 2023; 21:854-855. [PMID: 35811049 DOI: 10.1016/j.cgh.2022.05.052] [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: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Xianzong Ma
- Medical School of Chinese PLA, Beijing, China; Department of Gastroenterology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lang Yang
- Department of Gastroenterology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China; Senior Department of Gastroenterology, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Joseph Leung
- Section of Gastroenterology, Sacramento VA Medical Center, Mather, California
| | - Jianqiu Sheng
- Department of Gastroenterology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yuqi He
- Department of Gastroenterology, Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
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17
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Xu H, Tang RSY, Lam TYT, Zhao G, Lau JYW, Liu Y, Wu Q, Rong L, Xu W, Li X, Wong SH, Cai S, Wang J, Liu G, Ma T, Liang X, Mak JWY, Xu H, Yuan P, Cao T, Li F, Ye Z, Shutian Z, Sung JJY. Artificial Intelligence-Assisted Colonoscopy for Colorectal Cancer Screening: A Multicenter Randomized Controlled Trial. Clin Gastroenterol Hepatol 2023; 21:337-346.e3. [PMID: 35863686 DOI: 10.1016/j.cgh.2022.07.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Artificial intelligence (AI)-assisted colonoscopy improves polyp detection and characterization in colonoscopy. However, data from large-scale multicenter randomized controlled trials (RCT) in an asymptomatic population are lacking. METHODS This multicenter RCT aimed to compare AI-assisted colonoscopy with conventional colonoscopy for adenoma detection in an asymptomatic population. Asymptomatic subjects 45-75 years of age undergoing colorectal cancer screening by direct colonoscopy or fecal immunochemical test were recruited in 6 referral centers in Hong Kong, Jilin, Inner Mongolia, Xiamen, and Beijing. In the AI-assisted colonoscopy, an AI polyp detection system (Eagle-Eye) with real-time notification on the same monitor of the endoscopy system was used. The primary outcome was overall adenoma detection rate (ADR). Secondary outcomes were mean number of adenomas per colonoscopy, ADR according to endoscopist's experience, and colonoscopy withdrawal time. This study received Institutional Review Board approval (CRE-2019.393). RESULTS From November 2019 to August 2021, 3059 subjects were randomized to AI-assisted colonoscopy (n = 1519) and conventional colonoscopy (n = 1540). Baseline characteristics and bowel preparation quality between the 2 groups were similar. The overall ADR (39.9% vs 32.4%; P < .001), advanced ADR (6.6% vs 4.9%; P = .041), ADR of expert (42.3% vs 32.8%; P < .001) and nonexpert endoscopists (37.5% vs 32.1%; P = .023), and adenomas per colonoscopy (0.59 ± 0.97 vs 0.45 ± 0.81; P < .001) were all significantly higher in the AI-assisted colonoscopy. The median withdrawal time (8.3 minutes vs 7.8 minutes; P = .004) was slightly longer in the AI-assisted colonoscopy group. CONCLUSIONS In this multicenter RCT in asymptomatic patients, AI-assisted colonoscopy improved overall ADR, advanced ADR, and ADR of both expert and nonexpert attending endoscopists. (ClinicalTrials.gov, Number: NCT04422548).
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Affiliation(s)
- Hong Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Raymond S Y Tang
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Guijun Zhao
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - James Y W Lau
- Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Department of Surgery, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yunpeng Liu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Long Rong
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Weiran Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Xue Li
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shuntian Cai
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Jing Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Guanyi Liu
- Endoscopy Center, Peking University First Hospital, Beijing, China
| | - Tantan Ma
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Xiong Liang
- Department of Endoscopy Center, Inner Mongolia Key Laboratory of Endoscopic Digestive Diseases, Inner Mongolia People's Hospital, Hohhot, China
| | - Joyce W Y Mak
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hongzhi Xu
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Peng Yuan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tingting Cao
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Fudong Li
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Zhenshi Ye
- Department of Gastroenterology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Zhang Shutian
- Department of Gastroenterology and Hepatology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Joseph J Y Sung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China; Stanley Ho Big Data Decision Analytics Research Centre, Chinese University of Hong Kong, Hong Kong SAR, China; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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18
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Low compliance with the United States Multi-Society Task Force on Colorectal Cancer postpolypectomy guidelines. Gastrointest Endosc 2023; 97:357-360. [PMID: 36567203 DOI: 10.1016/j.gie.2022.10.019] [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: 09/27/2022] [Accepted: 10/09/2022] [Indexed: 12/27/2022]
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19
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Li X, Zhu H, Li F, Li R, Xu H. Different endoscopic treatments for small colorectal polyps: A systematic review, pair-wise, and network meta-analysis. Front Med (Lausanne) 2023; 10:1154411. [PMID: 37089613 PMCID: PMC10117900 DOI: 10.3389/fmed.2023.1154411] [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: 01/30/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Background and study aims In recent years, cold snare polypectomy (CSP) has been increasingly used for small polyps (<10 mm) instead of hot snare polypectomy (HSP). However, evidence-based research regarding the effectiveness and safety of CSP and HSP are still lacking. Additionally, for 4-10 -mm non-pedunculated polyps, the polyp removal method is still controversial. Therefore, it is clinically significant to conduct pair-wise and network meta-analyses to assess such resection methods. Methods We searched PubMed, Embase, and the Cochrane library for randomized controlled trials (RCTs). Only studies that involved the resection of polyps <10 mm were included. Outcomes included the complete resection rate, polyp retrieval rate, procedure-related complications, and procedure times. Results Overall, 23 RCTs (5,352 patients) were identified. In meta-analysis compared CSP versus HSP for polyps <10 mm, CSP showed lower complete resection rate than HSP although with no statistically significant difference [odds ratio (OR): 0.77, 95% confidence interval (CI): 0.56-1.06]. CSP showed a lower risk of major post-polypectomy complications compared to HSP (OR: 0.28, 95% CI: 0.11-0.73). In the network meta-analysis for 4-10 mm non-pedunculated polyps, HSP, and endoscopic mucosal resection (EMR) showed a higher complete resection rate than CSP (OR: 2.7, 95% CI: 1.3-9.2 vs. OR: 2.6, 95% CI: 1.0-10) but a significantly longer time than CSP (WMD: 16.55 s, 95% CI [7.48 s, 25.25 s], p < 0.001), (WMD: 48.00 s, 95% CI [16.54 s, 79.46 s], p = 0.003). Underwater CSP ranked third for complete resection with no complications. Conclusion For <10 mm polyps, CSP is safer than HSP, especially for patients taking antithrombotic drugs. For 4-10 mm non-pedunculated polyps, HSP, and EMR have higher complete resection rates than CSP. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022315575.
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Affiliation(s)
- Xuanhan Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - He Zhu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Fudong Li
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ri Li
- Department of Library, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, Changchun, Jilin, China
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20
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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21
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Giri S, Jearth V, Darak H, Sundaram S. Outcomes of thin versus thick-wire snares for cold snare polypectomy: a systematic review and meta-analysis. Clin Endosc 2022; 55:742-750. [PMID: 36347525 PMCID: PMC9726435 DOI: 10.5946/ce.2022.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND/AIMS Cold snare polypectomy (CSP) is commonly used for the resection of colorectal polyps ≤10 mm. Data regarding the influence of snare type on CSP effectiveness are conflicting. Hence, this meta-analysis aimed to compare the outcomes and safety of thin- and thick-wire snares for CSP. METHODS A comprehensive search of the literature published between 2000 and 2021 was performed of various databases for comparative studies evaluating the outcomes of thin- versus thick-wire snares for CSP. RESULTS Five studies with data on 1,425 polyps were included in the analysis. The thick-wire snare was comparable to the thin-wire snare with respect to complete histological resection (risk ratio [RR], 1.03; 95% confidence interval [CI], 0.97-1.09), overall bleeding (RR, 0.98; 95% CI, 0.40-2.40), polyp retrieval (RR, 1.01; 95% CI, 0.97-1.04), and involvement of submucosa in the resection specimen (RR, 1.28; 95% CI, 0.72-2.28). There was no publication bias and a small study effect, and the relative effects remained the same in the sensitivity analysis. CONCLUSION CSP using a thin-wire snare has no additional benefit over thick-wire snares in small colorectal polyps. Factors other than snare design may play a role in improving CSP outcomes.
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Affiliation(s)
| | - Vaneet Jearth
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Darak
- Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, TATA Memorial Hospital, Mumbai, India,Correspondence: Sridhar Sundaram Department of Digestive Diseases and Clinical Nutrition, TATA Memorial Hospital, Homi Bhabha National Institute, Dr. E Borges Road, Parel, Mumbai 400012, India E-mail:
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22
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Dominitz JA, Robertson DJ. Understanding the Results of a Randomized Trial of Screening Colonoscopy. N Engl J Med 2022; 387:1609-1611. [PMID: 36214591 DOI: 10.1056/nejme2211595] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason A Dominitz
- From the National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, DC (J.A.D.); the Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle (J.A.D.); White River Junction Veterans Affairs Medical Center, White River Junction, VT (D.J.R.); and the Geisel School of Medicine at Dartmouth and the Dartmouth Institute, Hanover, NH (D.J.R.)
| | - Douglas J Robertson
- From the National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, DC (J.A.D.); the Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle (J.A.D.); White River Junction Veterans Affairs Medical Center, White River Junction, VT (D.J.R.); and the Geisel School of Medicine at Dartmouth and the Dartmouth Institute, Hanover, NH (D.J.R.)
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23
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Rotermund C, Djinbachian R, Taghiakbari M, Enderle MD, Eickhoff A, von Renteln D. Recurrence rates after endoscopic resection of large colorectal polyps: A systematic review and meta-analysis. World J Gastroenterol 2022; 28:4007-4018. [PMID: 36157546 PMCID: PMC9367239 DOI: 10.3748/wjg.v28.i29.4007] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complete polyp resection is the main goal of endoscopic removal of large colonic polyps. Resection techniques have evolved in recent years and endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR) with margin ablation, cold snare polypectomy (CSP), cold EMR, and underwater EMR have been introduced. Yet, efficacy of these techniques with regard to local recurrence rates (LRRs) vs traditional hot snare polypectomy and standard EMR remains unclear.
AIM To analyze LRR of large colonic polyps in a systematic review and meta-analysis.
METHODS MEDLINE, EMBASE, EBM Reviews, and CINAHL were searched for prospective studies reporting LRR or incomplete resection rate (IRR) after colonic polypectomy of polyps ≥ 10 mm, published between January 2011 and July 2021. Primary outcome was LRR for polyps ≥ 10 mm.
RESULTS Six thousand nine hundred and twenty-eight publications were identified, of which 34 prospective studies were included. LRR for polyps ≥ 10 mm at up to 12 mo’ follow-up was 11.0% (95%CI, 7.1%-14.8%; 15 studies; 4904 polyps). ESD (1.7%; 95%CI, 0%-3.4%; 3 studies, 221 polyps) and endoscopic mucosal resection with margin ablation (3.3%; 95%CI, 2.2%-4.5%; 2 studies, 947 polyps) significantly reduced LRR vs standard EMR without (15.2%; 95%CI, 12.5%-18.0%; 4 studies, 650 polyps) or with unsystematic margin ablation (16.5%; 95%CI, 15.2%-17.8%; 6 studies, 3031 polyps).
CONCLUSION LRR is significantly lower after ESD or EMR with routine margin ablation; thus, these techniques should be considered standard for endoscopic removal of large colorectal polyps. Other techniques, such as CSP, cold EMR, and underwater EMR require further evaluation in prospective studies before their routine implementation in clinical practice can be recommended.
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Affiliation(s)
- Carola Rotermund
- Research and Basic Technologies, ERBE Elektromedizin GmbH, Tuebingen 72072, Germany
| | - Roupen Djinbachian
- Division of Internal Medicine, Montreal University Hospital Center, Montreal QC H2X 3E4, Canada
| | - Mahsa Taghiakbari
- Montreal University Hospital Research Center, Montreal University Hospital Center, Montreal QC H2X 3E4, Canada
| | - Markus D Enderle
- Research and Basic Technologies, ERBE Elektromedizin GmbH, Tuebingen 72072, Germany
| | - Axel Eickhoff
- Department of Internal Medicine II, Klinikum Hanau, Hanau 63450, Germany
| | - Daniel von Renteln
- Montreal University Hospital Research Center, Montreal University Hospital Center, Montreal QC H2X 3E4, Canada
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24
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Snare Wire Diameter for the Efficacy of Cold Polypectomy: Are Our Conclusions Robust to Variations in the Judging Criteria? Am J Gastroenterol 2022; 117:1329. [PMID: 35435885 DOI: 10.14309/ajg.0000000000001796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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25
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Choosing the Best Resection Tool for Polyps ≤3 mm: Is Forceps an Acceptable Alternative to Cold Snare? Am J Gastroenterol 2022; 117:1244-1245. [PMID: 35926492 DOI: 10.14309/ajg.0000000000001854] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 12/11/2022]
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26
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Sachdev R, Valori RM, Anderson JC. Improving outcomes in polypectomy. Gastrointest Endosc 2022; 96:298-300. [PMID: 35701260 DOI: 10.1016/j.gie.2022.04.009] [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: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Rishabh Sachdev
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Roland M Valori
- Gloucestershire Hospitals, National Health Service Foundation Trust, Gloucester, UK
| | - Joseph C Anderson
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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27
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Bourke MJ. Top tips for cold snare polypectomy (with video). Gastrointest Endosc 2022; 95:1226-1232. [PMID: 35007545 DOI: 10.1016/j.gie.2021.12.036] [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: 10/07/2021] [Accepted: 12/29/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
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28
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Helsingen LM, Kalager M. Colorectal Cancer Screening - Approach, Evidence, and Future Directions. NEJM EVIDENCE 2022; 1:EVIDra2100035. [PMID: 38319175 DOI: 10.1056/evidra2100035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Colorectal Cancer ScreeningScreening for colorectal cancer is widespread and successful but screening programs across the globe differ in their recommendations. In this article, Helsingen and Kalager review the evidence for different approaches to colorectal cancer screening and propose a framework for the evaluation of screening programs going forward.
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Affiliation(s)
- Lise M Helsingen
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo
| | - Mette Kalager
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo
- Clinical Effectiveness Research Group, Oslo University Hospital, Oslo
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29
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Rutter CM, Nascimento de Lima P, Lee JK, Ozik J. Too Good to Be True? Evaluation of Colonoscopy Sensitivity Assumptions Used in Policy Models. Cancer Epidemiol Biomarkers Prev 2021; 31:775-782. [PMID: 34906968 DOI: 10.1158/1055-9965.epi-21-1001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/13/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Models can help guide colorectal cancer (CRC) screening policy. While models are carefully calibrated and validated, there is less scrutiny of assumptions about test performance. METHODS We examined the validity of the CRC-SPIN model and colonoscopy sensitivity assumptions. Standard sensitivity assumptions, consistent with published decision analyses, assume sensitivity equal to 0.75 for diminutive adenomas (<6mm), 0.85 for small adenomas (6-10mm), 0.95 for large adenomas ( {greater than or equal to} 10mm), and 0.95 for preclinical cancer. We also selected adenoma sensitivity that resulted in more accurate predictions. Targets were drawn from the Wheat Bran Fiber study. We examined how well the model predicted outcomes measured over a three-year follow-up period, including: the number of adenomas detected, the size of the largest adenoma detected, and incident CRC. RESULTS Using standard sensitivity assumptions, the model predicted adenoma prevalence that was too low (42.5% versus 48.9% observed, with 95% confidence interval 45.3%-50.7%) and detection of too few large adenomas (5.1% versus 14.% observed, with 95% confidence interval 11.8%-17.4%). Predictions were close to targets when we set sensitivities to 0.20 for diminutive adenomas, 0.60 for small adenomas, 0.80 for 10-20mm adenomas, and 0.98 for adenomas 20mm and larger. CONCLUSIONS Colonoscopy may be less accurate than currently assumed, especially for diminutive adenomas. Alternatively, the CRC-SPIN model may not accurately simulate onset and progression of adenomas in higher-risk populations. IMPACT Misspecification of either colonoscopy sensitivity or disease progression in high-risk populations may impact the predicted effectiveness of CRC screening. When possible, decision analyses used to inform policy should address these uncertainties.
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Affiliation(s)
| | | | - Jeffrey K Lee
- Division of Research, Kaiser Permanente Northern California
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory
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