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Hansen LØ, Fürst MB, Bjørsum-Meyer T, Schelde-Olesen B, Deding U, Kaalby L. Factors associated with negative colonoscopy in participants with a positive faecal immunochemical test from the Danish Colorectal Cancer Screening Program - a population-based study. Colorectal Dis 2024; 26:476-485. [PMID: 38297072 DOI: 10.1111/codi.16886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/19/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024]
Abstract
AIM In the Danish Colorectal Cancer Screening Program (DCCSP), 37% of participants undergoing colonoscopy have a negative result with no obvious findings that can be attributed to a positive faecal immunochemical test (FIT). The aim of this work was to identify predictors for a negative colonoscopy in DCCSP participants with a positive FIT. METHOD We included 73 655 FIT-positive DCCSP participants using the Danish Colorectal Cancer Screening Database and linked their screening results with data from several other national health registers. We stratified participants by all predictors, and compared them using multivariate logistic regression analysis. Results are reported as odds ratios (ORs). RESULTS We found that having a condition linked to gastrointestinal bleeding, for example fissures, haemorrhoids and inflammatory bowel disease, was strongly associated with the probability of having a negative colonoscopy [OR 2.77 (95% CI 2.59, 2.96)]. FIT concentration was inversely related to the probability of a negative colonoscopy, the OR decreased steadily from 0.79 (95% CI 0.75, 0.83) in the 40-59 μg/g group, to 0.44 (95% CI 0.42, 0.46) in the ≥200 μg/g group. Women had a 1.64 (95% CI 1.59, 1.70) times higher probability of a negative colonoscopy than men. CONCLUSION Our findings indicate that baseline conditions linked to gastrointestinal bleeding are an associating factor with having a negative colonoscopy. The same is true for low FIT concentration and female sex. Further studies with similar findings could suggest that an incorporation of these factors into a personalized screening approach by differentiating between diagnostic modalities could improve the process for the participant while alleviating the health care system.
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Affiliation(s)
| | | | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Benedicte Schelde-Olesen
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrik Deding
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lasse Kaalby
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Maas MHJ, Neumann H, Shirin H, Katz LH, Benson AA, Kahloon A, Soons E, Hazzan R, Landsman MJ, Lebwohl B, Lewis SK, Sivanathan V, Ngamruengphong S, Jacob H, Siersema PD. A computer-aided polyp detection system in screening and surveillance colonoscopy: an international, multicentre, randomised, tandem trial. Lancet Digit Health 2024; 6:e157-e165. [PMID: 38395537 DOI: 10.1016/s2589-7500(23)00242-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND Studies on the effect of computer-aided detection (CAD) in a daily clinical screening and surveillance colonoscopy population practice are scarce. The aim of this study was to evaluate a novel CAD system in a screening and surveillance colonoscopy population. METHODS This multicentre, randomised, controlled trial was done in ten hospitals in Europe, the USA, and Israel by 31 endoscopists. Patients referred for non-immunochemical faecal occult blood test (iFOBT) screening or surveillance colonoscopy were included. Patients were randomomly assigned to CAD-assisted colonoscopy or conventional colonoscopy; a subset was further randomly assigned to undergo tandem colonoscopy: CAD followed by conventional colonoscopy or conventional colonoscopy followed by CAD. Primary objectives included adenoma per colonoscopy (APC) and adenoma per extraction (APE). Secondary objectives included adenoma miss rate (AMR) in the tandem colonoscopies. The study was registered at ClinicalTrials.gov, NCT04640792. FINDINGS A total of 916 patients were included in the modified intention-to-treat analysis: 449 in the CAD group and 467 in the conventional colonoscopy group. APC was higher with CAD compared with conventional colonoscopy (0·70 vs 0·51, p=0·015; 314 adenomas per 449 colonoscopies vs 238 adenomas per 467 colonoscopies; poisson effect ratio 1·372 [95% CI 1·068-1·769]), while showing non-inferiority of APE compared with conventional colonoscopy (0·59 vs 0·66; p<0·001 for non-inferiority; 314 of 536 extractions vs 238 of 360 extractions). AMR in the 127 (61 with CAD first, 66 with conventional colonoscopy first) patients completing tandem colonoscopy was 19% (11 of 59 detected during the second pass) in the CAD first group and 36% (16 of 45 detected during the second pass) in the conventional colonoscopy first group (p=0·024). INTERPRETATION CAD increased adenoma detection in non-iFOBT screening and surveillance colonoscopies and reduced adenoma miss rates compared with conventional colonoscopy, without an increase in the resection of non-adenomatous lesions. FUNDING Magentiq Eye.
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Affiliation(s)
- Michiel H J Maas
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Helmut Neumann
- University Medical Center Mainz, Interventional Endoscopy Center, I Medizinische Klinik und Poliklinik, Mainz, Germany
| | - Haim Shirin
- Institute of Gastroenterology and Liver Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Lior H Katz
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Institute of Gastroenterology and Liver Diseases, Jerusalem, Israel
| | - Ariel A Benson
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Institute of Gastroenterology and Liver Diseases, Jerusalem, Israel
| | - Arslan Kahloon
- College of Medicine, Division of Gastroenterology, University of Tennessee, Chattanooga, TN, USA
| | - Elsa Soons
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rawi Hazzan
- Assuta Centers, Haifa Gastroenterology Institute, Haifa, Israel
| | - Marc J Landsman
- Department of Gastroenterology, MetroHealth Medical Center, Cleveland, OH, USA
| | - Benjamin Lebwohl
- Department of Gastroenterology, Columbia University Irving Medical Center, New York, NY, USA
| | - Suzanne K Lewis
- Department of Gastroenterology, Columbia University Irving Medical Center, New York, NY, USA
| | - Visvakanth Sivanathan
- University Medical Center Mainz, Interventional Endoscopy Center, I Medizinische Klinik und Poliklinik, Mainz, Germany
| | | | - Harold Jacob
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Institute of Gastroenterology and Liver Diseases, Jerusalem, Israel
| | - Peter D Siersema
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, Netherlands; Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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3
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Desai M, Ausk K, Brannan D, Chhabra R, Chan W, Chiorean M, Gross SA, Girotra M, Haber G, Hogan RB, Jacob B, Jonnalagadda S, Iles-Shih L, Kumar N, Law J, Lee L, Lin O, Mizrahi M, Pacheco P, Parasa S, Phan J, Reeves V, Sethi A, Snell D, Underwood J, Venu N, Visrodia K, Wong A, Winn J, Wright CH, Sharma P. Use of a Novel Artificial Intelligence System Leads to the Detection of Significantly Higher Number of Adenomas During Screening and Surveillance Colonoscopy: Results From a Large, Prospective, US Multicenter, Randomized Clinical Trial. Am J Gastroenterol 2024:00000434-990000000-00980. [PMID: 38235741 DOI: 10.14309/ajg.0000000000002664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/14/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Adenoma per colonoscopy (APC) has recently been proposed as a quality measure for colonoscopy. We evaluated the impact of a novel artificial intelligence (AI) system, compared with standard high-definition colonoscopy, for APC measurement. METHODS This was a US-based, multicenter, prospective randomized trial examining a novel AI detection system (EW10-EC02) that enables a real-time colorectal polyp detection enabled with the colonoscope (CAD-EYE). Eligible average-risk subjects (45 years or older) undergoing screening or surveillance colonoscopy were randomized to undergo either CAD-EYE-assisted colonoscopy (CAC) or conventional colonoscopy (CC). Modified intention-to-treat analysis was performed for all patients who completed colonoscopy with the primary outcome of APC. Secondary outcomes included positive predictive value (total number of adenomas divided by total polyps removed) and adenoma detection rate. RESULTS In modified intention-to-treat analysis, of 1,031 subjects (age: 59.1 ± 9.8 years; 49.9% male), 510 underwent CAC vs 523 underwent CC with no significant differences in age, gender, ethnicity, or colonoscopy indication between the 2 groups. CAC led to a significantly higher APC compared with CC: 0.99 ± 1.6 vs 0.85 ± 1.5, P = 0.02, incidence rate ratio 1.17 (1.03-1.33, P = 0.02) with no significant difference in the withdrawal time: 11.28 ± 4.59 minutes vs 10.8 ± 4.81 minutes; P = 0.11 between the 2 groups. Difference in positive predictive value of a polyp being an adenoma among CAC and CC was less than 10% threshold established: 48.6% vs 54%, 95% CI -9.56% to -1.48%. There were no significant differences in adenoma detection rate (46.9% vs 42.8%), advanced adenoma (6.5% vs 6.3%), sessile serrated lesion detection rate (12.9% vs 10.1%), and polyp detection rate (63.9% vs 59.3%) between the 2 groups. There was a higher polyp per colonoscopy with CAC compared with CC: 1.68 ± 2.1 vs 1.33 ± 1.8 (incidence rate ratio 1.27; 1.15-1.4; P < 0.01). DISCUSSION Use of a novel AI detection system showed to a significantly higher number of adenomas per colonoscopy compared with conventional high-definition colonoscopy without any increase in colonoscopy withdrawal time, thus supporting the use of AI-assisted colonoscopy to improve colonoscopy quality ( ClinicalTrials.gov NCT04979962).
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Karlee Ausk
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Donald Brannan
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Rajiv Chhabra
- Department of Gastroenterology, Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Walter Chan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Chiorean
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Seth A Gross
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - Mohit Girotra
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Gregory Haber
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - Reed B Hogan
- GI Associates and Endoscopy Center, Jackson, Mississippi, USA
| | - Bobby Jacob
- Gastroenterology, Largo Medical Center, Largo, Florida, USA
| | - Sreeni Jonnalagadda
- Department of Gastroenterology, Saint Luke's Hospital of Kansas City, Kansas City, Missouri, USA
| | - Lulu Iles-Shih
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Navin Kumar
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Joanna Law
- Gastroenterology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Linda Lee
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Otto Lin
- Gastroenterology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Meir Mizrahi
- Gastroenterology, Largo Medical Center, Largo, Florida, USA
| | - Paulo Pacheco
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - Sravanthi Parasa
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Jennifer Phan
- Departement of Gastroenterology, Keck Medicine University of Southern California, Los Angeles, California, USA
| | - Vonda Reeves
- GI Associates and Endoscopy Center, Jackson, Mississippi, USA
| | - Amrita Sethi
- Department of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - David Snell
- Gastroenterology, New York University Langone Health, New York, New York, USA
| | - James Underwood
- GI Associates and Endoscopy Center, Jackson, Mississippi, USA
| | - Nanda Venu
- Gastroenterology, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Kavel Visrodia
- Department of Gastroenterology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alina Wong
- Gastroenterology, Swedish Health and Swedish Medical Center, Seattle, Washington, USA
| | - Jessica Winn
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | | | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
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Tonini V, Zanni M. Why is early detection of colon cancer still not possible in 2023? World J Gastroenterol 2024; 30:211-224. [PMID: 38314134 PMCID: PMC10835528 DOI: 10.3748/wjg.v30.i3.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/30/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
Colorectal cancer (CRC) screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal cancers. Over the years, screening, particularly in those settings where it is well organized, has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to them. Despite considerable advancements in screening technologies and strategies, the effectiveness of CRC screening programs remains less than optimal. This paper examined the multifaceted reasons behind the persistent lack of effectiveness in CRC screening initiatives. Through a critical analysis of current methodologies, technological limitations, patient-related factors, and systemic challenges, we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality rates. While acknowledging the advancements that have improved aspects of screening, we emphasized the necessity of addressing the identified barriers comprehensively. This study aimed to raise awareness of how important CRC screening is in reducing costs for this disease. Screening and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced stage. Spending more sooner can mean saving money later.
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Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
| | - Manuel Zanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna 40138, Italy
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Kim BS, Cho M, Chung GE, Lee J, Kang HY, Yoon D, Cho WS, Lee JC, Bae JH, Kong HJ, Kim S. Density clustering-based automatic anatomical section recognition in colonoscopy video using deep learning. Sci Rep 2024; 14:872. [PMID: 38195632 PMCID: PMC10776865 DOI: 10.1038/s41598-023-51056-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Abstract
Recognizing anatomical sections during colonoscopy is crucial for diagnosing colonic diseases and generating accurate reports. While recent studies have endeavored to identify anatomical regions of the colon using deep learning, the deformable anatomical characteristics of the colon pose challenges for establishing a reliable localization system. This study presents a system utilizing 100 colonoscopy videos, combining density clustering and deep learning. Cascaded CNN models are employed to estimate the appendix orifice (AO), flexures, and "outside of the body," sequentially. Subsequently, DBSCAN algorithm is applied to identify anatomical sections. Clustering-based analysis integrates clinical knowledge and context based on the anatomical section within the model. We address challenges posed by colonoscopy images through non-informative removal preprocessing. The image data is labeled by clinicians, and the system deduces section correspondence stochastically. The model categorizes the colon into three sections: right (cecum and ascending colon), middle (transverse colon), and left (descending colon, sigmoid colon, rectum). We estimated the appearance time of anatomical boundaries with an average error of 6.31 s for AO, 9.79 s for HF, 27.69 s for SF, and 3.26 s for outside of the body. The proposed method can facilitate future advancements towards AI-based automatic reporting, offering time-saving efficacy and standardization.
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Grants
- 1711179421, RS-2021-KD000006 the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, and the Ministry of Food and Drug Safety)
- 1711179421, RS-2021-KD000006 the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, and the Ministry of Food and Drug Safety)
- 1711179421, RS-2021-KD000006 the Korea Medical Device Development Fund grant funded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, and the Ministry of Food and Drug Safety)
- IITP-2023-2018-0-01833 the Ministry of Science and ICT, Korea under the Information Technology Research Center (ITRC) support program
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Affiliation(s)
- Byeong Soo Kim
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Minwoo Cho
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, 03080, Korea
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, 03080, Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Goh Eun Chung
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea
| | - Jooyoung Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea
| | - Hae Yeon Kang
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea
| | - Dan Yoon
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Woo Sang Cho
- Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, 08826, Korea
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080, Korea
- Institute of Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, 03080, Korea
| | - Jung Ho Bae
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, 06236, Korea.
| | - Hyoun-Joong Kong
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, 03080, Korea.
- Department of Transdisciplinary Medicine, Seoul National University Hospital, Seoul, 03080, Korea.
- Department of Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.
- Medical Big Data Research Center, Seoul National University College of Medicine, Seoul, 03087, Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080, Korea.
- Institute of Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea.
- Artificial Intelligence Institute, Seoul National University, Research Park Building 942, 2 Fl., Seoul, 08826, Korea.
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Li Z, Wang D, Zhang W, Shi H, Zhu M. Novel PBMC LncRNA signatures as diagnostic biomarkers for colorectal cancer. Pathol Res Pract 2024; 253:154985. [PMID: 38039742 DOI: 10.1016/j.prp.2023.154985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/20/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
The expression of long non-coding RNAs (LncRNAs) in peripheral blood mononuclear cell (PBMC) and its clinical relevance in colorectal cancer (CRC) remains largely uncharacterized. To address these gaps, we investigated the expression profiles of lncRNAs in PBMC from CRC and healthy controls (HC) by RNA sequencing. The expression level of differentially expressed lncRNAs (DElncRNAs) were evaluated by quantitative PCR in PBMC samples from CRC patients and HC. A total of 447 DElncRNAs were identified, with 178 elevated lncRNAs and 269 decreased lncRNAs in PBMC from CRC patients as compared with that from HC. RT-PCR results supported a significant elevation of NEAT1:11, lnc-PDZD8-1:5 and LINC00910:16 in 98 CRC patients and 82 HC. The clinical implication of NEAT1:11, lnc-PDZD8-1:5 and LINC00910:16 as CRC diagnostic biomarker were determined by receiver operating characteristic (ROC) curve, showing sensitivity 74.5% and specificity 84.5% for joint detection the three lncRNAs. Notably, NEAT1:11 was closely related with the size and extent of primary tumor, with higher relative expression of NEAT1:11 in higher T stage (P = 0.0047). Moreover, NEAT1:11 was related with grade (P = 0.012). Collectively, PBMC from patients with CRC show significantly variable expression profiles of lncRNAs, and detection of these differential expression lncRNAs may provide useful information for basic and clinical research.
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Affiliation(s)
- Zhaosheng Li
- Department of Clinical Laboratory, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Dongfeng Wang
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Wenjun Zhang
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Huina Shi
- Department of Clinical Laboratory, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - Mingchen Zhu
- Department of Clinical Laboratory, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.
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Pattarajierapan S, Tipmanee P, Supasiri T, Wisedopas N, Khomvilai S. Texture and color enhancement imaging (TXI) plus endocuff vision versus TXI alone for colorectal adenoma detection: a randomized controlled trial. Surg Endosc 2023; 37:8340-8348. [PMID: 37697119 DOI: 10.1007/s00464-023-10396-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/13/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND AIMS Increasing the adenoma detection rate (ADR) helps reduce the risk of post-colonoscopy colorectal cancer. Texture and Color Enhancement Imaging (TXI) improves ADR by enhancing the brightness and contrast of endoscopic images. Endocuff Vision (ECV) is a mucosal exposure device that helps flatten the colonic folds. The benefit of combining TXI with ECV has not been studied previously. Thus, we aimed to compare the ADR between using TXI combined with ECV and TXI alone. METHODS We conducted a prospective randomized controlled trial recruiting patients aged ≥ 40 years who underwent colonoscopy for colorectal cancer screening or gastrointestinal symptoms. The participants were randomized in a 1:1 ratio into the TXI with ECV (TXI + ECV) and the TXI groups. Experienced endoscopists with ≥ 40% ADR performed all colonoscopies. The primary outcome was ADR. RESULTS We had 189 and 192 patients in the TXI + ECV and TXI groups, respectively. The baseline characteristics of both groups were comparable. The ADR was significantly higher in the TXI + ECV group than in the TXI group (65.6% vs. 52.1%, P = 0.007). Adenoma per colonoscopy (APC) was significantly greater in the TXI + ECV group than in the TXI group (1.6 vs. 1.2, P = 0.021), prominently proximal (1.0 vs. 0.7, P = 0.031), non-pedunculated (1.4 vs. 1.1, P = 0.035), and diminutive (1.3 vs. 1, P = 0.045) adenomas. Serrated lesion detection rate, insertion time, and withdrawal time did not differ between the groups. CONCLUSION Adding ECV to TXI significantly improves ADR and APC compared to using TXI alone. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20220507004.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Phadungkiat Tipmanee
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
| | - Thanan Supasiri
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Naruemon Wisedopas
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
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Nishimoto S, Kudo T, Horiuchi I, Yabe K, Kurasawa S, Horiuchi A. Cap-assisted colonoscopy can increase the rate of sessile serrated lesion detection at the left lateral decubitus position: A retrospective case-control study. Medicine (Baltimore) 2023; 102:e35264. [PMID: 37746993 PMCID: PMC10519449 DOI: 10.1097/md.0000000000035264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/01/2023] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
We investigated the effectiveness of cap-assisted colonoscopy conducted with the patient in the left lateral decubitus position at both the colonoscope's insertion and withdrawal timepoints compared to the effectiveness of colonoscopy without a cap conducted in the supine position at withdrawal. This was a case-control study, based on historical comparisons of patients over 2 time periods. The first group of patients underwent colonoscopies with a transparent cap and the patient was in the left lateral decubitus position at both the insertion and withdrawal timepoints from April to June 2019. The subsequent group underwent colonoscopies without a cap and with the patient in the supine position at withdrawal from July to September 2019. The rates of successful intubation, cecal intubation time, and number, size, shape, and location of the detected adenomas and sessile serrated lesions were compared between the 2 groups. Data from 644 colonoscopies (cap-assisted colonoscopy + left lateral decubitus position, n=320; other colonoscopies, n=324) were analyzed. The demographic characteristics and technical performances were similar. The SSL detection rate was significantly higher with cap-assisted colonoscopy and the left lateral decubitus position than with other colonoscopies (3.4% vs 0.93%, P=.029). The adenoma detection rates in the 2 groups were similar (31% and 28%, respectively, P=.43).Cap-assisted colonoscopy in the left lateral decubitus position may increase the detection rate of sessile serrated lesions compared to colonoscopy without a cap and supine position at withdrawal.
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Affiliation(s)
- Satomi Nishimoto
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Ichitaro Horiuchi
- Department of Gastroenterology, Shinshu University Hospital, Matsumoto, Japan
| | - Kiyoaki Yabe
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
| | - Shingo Kurasawa
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
- Department of Pediatrics, Shinshu University Hospital, Matsumoto, Japan
| | - Akira Horiuchi
- Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan
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9
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Zhao X, Wang S, Yuan Z, Yan S, Pang W, Liu X, Wang W, Yi B, Han Q, Zhang Q, Zhang X, Zhang C. Colonoscopy compliance and diagnostic yield in a large population-based colorectal cancer screening programme. Int J Colorectal Dis 2023; 38:227. [PMID: 37700205 PMCID: PMC10497689 DOI: 10.1007/s00384-023-04517-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES With the intention of providing a reference for secondary prevention, our study provides some insight on diagnostic yield of factors influencing compliance with colonoscopy and the presence of advanced adenomas (AA). METHODS We conducted large-scale CRC screening among local Tianjin residents aged 40-75 years between 2012 and 2019. A high-risk factor questionnaire (HRFQ) was distributed to each participant, followed by the performance of a fecal immunochemical test (FIT). Participants who tested positively for any of these items were advised to undergo a colonoscopy. Relevant basic information was collected from participants during CRC screening, and the screening data were sorted and analysed. RESULTS A total of 5,670,924 people participated in CRC screening by the end of 2019, including 275,708 people in the high-risk group, and 74,685 (27.1%) people who underwent colonoscopy. The results of the logistic regression model demonstrated that participants with a history of mucous bloody stool (OR = 8.20, 95% CI: 7.92, 8.50, p < 0.001), chronic diarrhea (OR = 5.73, 95% CI: 5.57, 5.89, p < 0.001), and higher level of education (OR = 1.87, 95% CI: 1.80, 1.93, p < 0.001) were more likely to comply with a colonoscopy. Several factors including age (70-75 years old:OR = 3.72, 95% CI: 2.71, 5.10, p < 0.001), and FIT( +) (OR = 1.65, 95% CI: 1.42,1.90, p < 0.001) were identified to be associated with the presence of AA. CONCLUSIONS Increased compliance with colonoscopy is urgently needed. Our findings can inform the design of future effective large-scale population-based CRC screening programmes.
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Grants
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 19YFZCSY00420 Key R&D Projects in the Tianjin Science and Technology Pillar Program
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- 21JCZDJC00060, 21JCYBJC00180 and 21JCYBJC00340 Natural Science Foundation of Tianjin
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- TJYXZDXK-044A Tianjin Key Medical Discipline (Specialty) Construction Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- 2019ZZ07 Tianjin Hospital Association Hospital Management Research Project
- Key R&D Projects in the Tianjin Science and Technology Pillar Program
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Affiliation(s)
- Xinzhu Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Shuyuan Wang
- School of Medicine, Nankai University, Tianjin, China
| | - Zhen Yuan
- School of Medicine, Nankai University, Tianjin, China
| | - Suying Yan
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wenwen Pang
- Department of Clinical Laboratory, Tianjin Union Medical Center, Tianjin, China
| | - Xinyu Liu
- Tianjin Medical University, Tianjin, China
| | - Wanting Wang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ben Yi
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qiurong Han
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qinghuai Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China
- Tianjin Institute of Coloproctology, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
| | - Chunze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.
- The Institute of Translational Medicine, Tianjin Union Medical Center, Tianjin, China.
- Tianjin Institute of Coloproctology, Tianjin, China.
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10
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Adigun AO, Adebile TM, Okoye C, Ogundipe TI, Ajekigbe OR, Mbaezue RN, Okobi OE. Causes and Prevention of Early-Onset Colorectal Cancer. Cureus 2023; 15:e45095. [PMID: 37842356 PMCID: PMC10569084 DOI: 10.7759/cureus.45095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Sporadic colorectal cancer (CRC) has historically been considered a disease of the elderly. However, early-onset colorectal cancer (eoCRC) incidence and prevalence have steadily increased over the last few decades, highlighting the critical need for a comprehensive understanding of its causes and prevention. This research examines the numerous factors contributing to the increasing incidence of eoCRC. These factors include a combination of genetic predispositions and environmental effects. We also investigate the impact of modifiable lifestyle factors like obesity, physical inactivity, and an unhealthy diet on eoCRC risk. Understanding these factors is critical in developing future diagnostic, prognostic, disease monitoring, and therapy planning strategies in managing eoCRC and will help optimize guidelines for CRC screening.
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Affiliation(s)
- Aisha O Adigun
- Infectious Diseases, University of Louisville, Louisville, USA
| | - Temitayo M Adebile
- Public Health, Georgia Southern University, Statesboro, USA
- Nephrology, Boston Medical Center, Boston, USA
| | - Chiugo Okoye
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Omolola R Ajekigbe
- Family Medicine, Ladoke Akintola University of Technology, Ogbomoso, NGA
| | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
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11
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Diedrich L, Brinkmann M, Dreier M, Rossol S, Schramm W, Krauth C. Is there a place for sigmoidoscopy in colorectal cancer screening? A systematic review and critical appraisal of cost-effectiveness models. PLoS One 2023; 18:e0290353. [PMID: 37594967 PMCID: PMC10438011 DOI: 10.1371/journal.pone.0290353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/05/2023] [Indexed: 08/20/2023] Open
Abstract
INTRODUCTION Screening for colorectal cancer (CRC) is effective in reducing both incidence and mortality. Colonoscopy and stool tests are most frequently used for this purpose. Sigmoidoscopy is an alternative screening measure with a strong evidence base. Due to its distinct characteristics, it might be preferred by subgroups. The aim of this systematic review is to analyze the cost-effectiveness of sigmoidoscopy for CRC screening compared to other screening methods and to identify influencing parameters. METHODS A systematic literature search for the time frame 01/2010-01/2023 was conducted using the databases MEDLINE, Embase, EconLit, Web of Science, NHS EED, as well as the Cost-Effectiveness Registry. Full economic analyses examining sigmoidoscopy as a screening measure for the general population at average risk for CRC were included. Incremental cost-effectiveness ratios were calculated. All included studies were critically assessed based on a questionnaire for modelling studies. RESULTS Twenty-five studies are included in the review. Compared to no screening, sigmoidoscopy is a cost-effective screening strategy for CRC. When modelled as a single measure strategy, sigmoidoscopy is mostly dominated by colonoscopy or modern stool tests. When combined with annual stool testing, sigmoidoscopy in 5-year intervals is more effective and less costly than the respective strategies alone. The results of the studies are influenced by varying assumptions on adherence, costs, and test characteristics. CONCLUSION The combination of sigmoidoscopy and stool testing represents a cost-effective screening strategy that has not received much attention in current guidelines. Further research is needed that goes beyond a narrow focus on screening technology and models different, preference-based participation behavior in subgroups.
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Affiliation(s)
- Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Siegbert Rossol
- Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany
| | - Wendelin Schramm
- GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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12
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Gomes V, Wiese D, Stroup A, Henry KA. Ethnic enclaves and colon cancer stage at diagnosis among New Jersey Hispanics. Soc Sci Med 2023; 328:115977. [PMID: 37301107 DOI: 10.1016/j.socscimed.2023.115977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/08/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
Ethnic enclaves are neighborhoods with high concentrations of individuals of the same ethnic origin. Researchers have hypothesized that residence in ethnic enclaves may contribute to cancer outcomes through detrimental or protective pathways. A limitation of previous work, however, is their cross-sectional approach whereby an individual's residence at the time of diagnosis was used to capture residence in an ethnic enclave at a single point in time. This study addresses this limitation by adopting a longitudinal approach to investigating the association between the duration of residence in an ethnic enclave and the colon cancer (CC) stage at diagnosis. Colon cancer incidence cases diagnosed between 2006 and 2014, for Hispanics aged 18 years and older from the New Jersey State Cancer Registry (NJSCR) were linked to residential histories obtained from a commercial database LexisNexis, Inc. We examined associations between residence in an enclave and stage at diagnosis using binary and multinomial logistic regression, adjusted for age, sex, primary payer, and marital status. Among the 1076 Hispanics diagnosed with invasive colon cancer in New Jersey from 2006 to 2014, 48.4% lived in a Hispanic enclave at the time of diagnosis. Over the ten years preceding CC diagnosis, 32.6% lived in an enclave for the entire period. We found that Hispanics living in an ethnic enclave at diagnosis had significantly lower odds of distant-stage CC than Hispanics not living in an enclave at the time of diagnosis. Additionally, we found a significant association between living in an enclave for an extended period (e.g., over ten years) and lower odds of being diagnosed with distant stage CC. Integrating residential histories opens research possibilities to examine how minorities' residential mobility and residence in enclaves affect cancer diagnosis over time.
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Affiliation(s)
- Veronica Gomes
- Temple University, Department of Geography, Philadelphia, PA, USA
| | - Daniel Wiese
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Antoinette Stroup
- New Jersey State Cancer Registry, Trenton, NJ, USA; Rutgers Cancer Institute of New Jersey, Rutgers University School of Public Health, New Brunswick, NJ, USA
| | - Kevin A Henry
- Temple University, Department of Geography, Philadelphia, PA, USA; Division of Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, PA, USA.
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13
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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14
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Jiang W, Xin L, Zhu S, Liu Z, Wu J, Ji F, Yu C, Shen Z. Risk Factors Related to Polyp Miss Rate of Short-Term Repeated Colonoscopy. Dig Dis Sci 2023; 68:2040-2049. [PMID: 37017819 DOI: 10.1007/s10620-023-07848-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/25/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Colonoscopy is regarded as the gold standard for colorectal cancer screening and surveillance. However, previous studies have reported large numbers of polyps were missed during routine colonoscopy. AIMS To evaluate polyp miss rate in short-term repeated colonoscopy and explore the related risk factors. METHODS A total of 3695 patients and 12,412 polyps were included in our studies. We calculated the miss rate for polyps of different sizes, pathologies, morphologies and locations, and patients of different characteristics. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors related to miss rate. RESULTS The polyp miss rate was 26.3% and the adenoma miss rate was 22.4% in our study. The advanced adenoma miss rate was 11.0% and the proportion of missed advanced adenomas in missed adenomas sized > 5 mm was up to 22.8%. Polyps sized < 5 mm had a significantly higher miss rate. The miss rate of pedunculated polyps was lower than that of flat or sessile polyps. Polyps in the right colon were prone to be missed than that in the left colon. For older men, current smokers, individuals with multiple polyps detected in the first colonoscopy, the risk of missing polyps was significantly higher. CONCLUSION Nearly a quarter of polyps were missed during routine colonoscopy. Diminutive, flat, sessile, and right-side colon polyps were at higher risk of missing. The risk of missing polyps was higher in older men, current smokers, and individuals with multiple polyps detected in the first colonoscopy than their counterparts.
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Affiliation(s)
- Wenxi Jiang
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Linying Xin
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Shefeng Zhu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhaoxue Liu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jiali Wu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Feng Ji
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Zhe Shen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China.
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15
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Abstract
Modern endoscopy relies on digital technology, from high-resolution imaging sensors and displays to electronics connecting configurable illumination and actuation systems for robotic articulation. In addition to enabling more effective diagnostic and therapeutic interventions, the digitization of the procedural toolset enables video data capture of the internal human anatomy at unprecedented levels. Interventional video data encapsulate functional and structural information about a patient's anatomy as well as events, activity and action logs about the surgical process. This detailed but difficult-to-interpret record from endoscopic procedures can be linked to preoperative and postoperative records or patient imaging information. Rapid advances in artificial intelligence, especially in supervised deep learning, can utilize data from endoscopic procedures to develop systems for assisting procedures leading to computer-assisted interventions that can enable better navigation during procedures, automation of image interpretation and robotically assisted tool manipulation. In this Perspective, we summarize state-of-the-art artificial intelligence for computer-assisted interventions in gastroenterology and surgery.
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Affiliation(s)
- François Chadebecq
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Laurence B Lovat
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Danail Stoyanov
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK.
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16
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Hamada Y, Tanaka K, Horiki N, Tsuboi J, Yamada R, Nakamura M, Tamaru S, Yamada T, Nakagawa H. Negative effect of prolonged cecal intubation time on adenoma detection in female patients. JGH Open 2023; 7:128-134. [PMID: 36852143 PMCID: PMC9958335 DOI: 10.1002/jgh3.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/17/2022] [Accepted: 01/01/2023] [Indexed: 01/25/2023]
Abstract
Background and Aim Withdrawal time of the colonoscope is associated with adenoma detection. However, the association between cecal intubation time and adenoma detection remains unclear. This study aimed to evaluate the association between cecal intubation time and adenoma detection. Methods This retrospective study analyzed prospectively collected data from a randomized controlled trial on female patients who underwent colonoscopy in an academic hospital. The primary outcome was the mean number of all adenomas detected per patient. Secondary outcomes included the mean number of advanced, diminutive, small/large, right-sided colonic, and left-sided colonic adenomas detected per patient. Furthermore, the detection rates of all categories of adenoma were evaluated. Results The analysis included 216 female patients aged ≥20 years. The correlation analysis did not reveal a significant relationship (P = 0.473) between cecal intubation and withdrawal times. The mean number of all adenomas detected per patient declined by approximately 30% (1.05-0.70) from the fastest to the slowest insertion time quartile. Adjusted regression analysis showed a significant decrease in the mean number of all adenomas detected per patient with increased intubation time (relative risk, RR = 0.87; 95% confidence interval, 0.76-0.99, P = 0.045), whereas the mean number of other categories of adenomas detected per patient and the detection rates of all categories of adenoma were not associated with the cecal intubation time. Conclusions This study showed a significant association between prolonged cecal intubation time and decreased adenoma detection. The cecal intubation time may be a significant quality indicator for colonoscopy.
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Affiliation(s)
- Yasuhiko Hamada
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Kyosuke Tanaka
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Noriyuki Horiki
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Junya Tsuboi
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Reiko Yamada
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Misaki Nakamura
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
| | - Satoshi Tamaru
- Clinical Research Support CenterMie University HospitalTsuJapan
| | - Tomomi Yamada
- Department of Medical InnovationOsaka University HospitalSuitaJapan
| | - Hayato Nakagawa
- Department of Gastroenterology and HepatologyMie University HospitalTsuJapan
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17
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Knapp ST, Revette A, Underhill-Blazey M, Stopfer JE, Ukaegbu CI, Poulin C, Parenteau M, Syngal S, Bae E, Bickmore T, Hampel H, Idos GE, Parmigiani G, Yurgelun MB, Braun D. MyLynch: A Patient-Facing Clinical Decision Support Tool for Genetically-Guided Personalized Medicine in Lynch Syndrome. Cancers (Basel) 2023; 15. [PMID: 36672340 DOI: 10.3390/cancers15020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
Lynch syndrome (LS) is a hereditary cancer susceptibility condition associated with varying cancer risks depending on which of the five causative genes harbors a pathogenic variant; however, lifestyle and medical interventions provide options to lower those risks. We developed MyLynch, a patient-facing clinical decision support (CDS) web application that applies genetically-guided personalized medicine (GPM) for individuals with LS. The tool was developed in R Shiny through a patient-focused iterative design process. The knowledge base used to estimate patient-specific risk leveraged a rigorously curated literature review. MyLynch informs LS patients of their personal cancer risks, educates patients on relevant interventions, and provides patients with adjusted risk estimates, depending on the interventions they choose to pursue. MyLynch can improve risk communication between patients and providers while also encouraging communication among relatives with the goal of increasing cascade testing. As genetic panel testing becomes more widely available, GPM will play an increasingly important role in patient care, and CDS tools offer patients and providers tailored information to inform decision-making. MyLynch provides personalized cancer risk estimates and interventions to lower these risks for patients with LS.
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18
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Sakamoto T, Ikematsu H, Tamai N, Mizuguchi Y, Takamaru H, Murano T, Shinmura K, Sasabe M, Furuhashi H, Sumiyama K, Saito Y. Detection of colorectal adenomas with texture and color enhancement imaging: Multicenter observational study. Dig Endosc 2022; 35:529-537. [PMID: 36398944 DOI: 10.1111/den.14480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to evaluate the efficacy of texture and color enhancement imaging (TXI), which allows the acquisition of brighter images with enhanced color and surface structure in colorectal polyp detection compared to white light imaging. METHODS Patients who underwent colonoscopy with repeated ascending colon observation using TXI and white light imaging between August 2020 and January 2021 were identified in three institutions. The outcomes included the mean number of adenomas detected per procedure (MAP), adenoma detection rate (ADR), and ascending colonic adenoma miss rate (Ac-AMR). Logistic regression was used to determine the effects of the variables on the outcomes. RESULTS We included 1043 lesions from 470 patients in the analysis. The MAP, ADR, flat polyp detection rate, and Ac-AMR in TXI and white light imaging were 1.5% (95% confidence interval 1.3-1.6%) vs. 1.0% (0.9-1.1%), 58.2% (51.7-64.6%) vs. 46.8% (40.2-53.4%), 66.2% (59.8-72.2%) vs. 49.8% (43.2-56.4%), and 17.9% (12.1-25.2%) vs. 28.2% (20.0-37.6%), respectively. TXI, age, withdrawal time, and endoscopy type were identified as significant factors affecting the MAP and the ADR using multivariate regression analysis. CONCLUSIONS Our study indicates that TXI improve the detection of colorectal neoplastic lesions. However, prospective randomized trials are required to confirm these findings.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, National Cancer Center Hospital East, Chiba, Japan.,Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Naoto Tamai
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Maasa Sasabe
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuki Sumiyama
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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19
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Murakami T, Kamba E, Nomura K, Kurosawa T, Haga K, Fukushima H, Takeda T, Shibuya T, Yao T, Nagahara A. Linked color imaging improves visibility of colorectal serrated lesion by high color contrast to surrounding mucosa. Dig Endosc 2022; 34:1422-1432. [PMID: 35689542 DOI: 10.1111/den.14374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/08/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aimed to objectively evaluate the efficacy of linked color imaging (LCI) in diagnosing colorectal serrated lesions by utilizing visibility scores and color differences. METHODS We examined 89 serrated lesions, including 36 hyperplastic polyps (HPs), 47 sessile serrated lesions (SSLs), and six traditional serrated adenomas (TSAs). Visibility changes were scored by six endoscopists as follows: 4, excellent; 3, good; 2, fair; and 1, poor. Furthermore, images obtained by white-light imaging (WLI) or LCI were assessed using the CIELAB color space in the lesion and adjacent mucosa. We calculated the mean color values (L*, a*, and b*) measured at five regions of interest of the sample lesion and surrounding mucosa and derived the color difference (ΔE*). RESULTS The visibility scores of both HPs and SSLs in LCI were significantly higher than that in WLI (HPs, 3.67/2.89, P < 0.001; SSLs, 3.07/2.36, P < 0.001). Furthermore, SSLs showed a significantly higher L* value and significantly lower a* and b* values in LCI than the adjacent mucosae (L*, 61.76/58.23, P = 0.016; a*, 14.91/17.58, P = 0.019; b*, 20.42/24.21, P = 0.007), while WLI produced no significant difference in any color value. A similar trend was apparent in HPs. In all serrated groups, LCI revealed significantly greater ΔE* values between the lesion and adjacent mucosa than WLI (HPs, 11.54/6.12; SSLs, 13.43/7.67; TSAs, 35.00/22.48). CONCLUSION Linked color imaging showed higher color contrast between serrated lesions and the surrounding mucosae compared with WLI, indicating improved visibility of colorectal serrated lesion using LCI.
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Affiliation(s)
- Takashi Murakami
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Eiji Kamba
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kei Nomura
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Taro Kurosawa
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Keiichi Haga
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirofumi Fukushima
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeda
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoyoshi Shibuya
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Departments of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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20
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Weissman S, Mehta TI, Stein DJ, Tripathi K, Rosenwald N, Kolli S, Aziz M, Feuerstein JD. Comparative Efficacy of Endoscopic Assist Devices on Colonic Adenoma Detection: A Systematic Review With Network Meta-analysis. J Clin Gastroenterol 2022; 56:889-894. [PMID: 35324485 DOI: 10.1097/mcg.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/18/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Numerous endoscopic assist devices exist, yet data surrounding their comparative efficacy is lacking. We conducted a systematic review with network meta-analysis to determine the comparative efficacy of endoscopic assist devices on colonic adenoma detection. METHODS A systematic search was performed using multiple electronic databases through July 2020, to identify all randomized controlled trials and dual-arm observational studies compared with either other endoscopic assist devices and/or standard colonoscopy. The primary outcome was adenoma detection rate (ADR). Secondary outcomes included polyp detection rate (PDR), serrated adenoma detection rate (SADR), right-sided adenoma detection rate (RADR), and proximal adenoma detection rate (PADR). RESULTS Fifty-seven studies (31,051 patients) met inclusion criteria and were analyzed. Network meta-analysis identified an enhanced ADR among (clear) cap [odds ratio (OR): 2.69, 95% confidence interval (CI): 1.45-4.99], endocuff, (OR: 4.95, 95% CI: 3.15-7.78), and endoring (OR: 3.68, 95% CI: 1.47-9.20)-with no significant difference amongst any particular device. Similar findings for PDR were also seen. Enhanced SADR was identified for endocuff (OR: 9.43) and endoring (OR: 4.06) compared with standard colonoscopy. Enhanced RADR (OR: 5.36) and PADR (OR: 3.78) were only identified for endocuff. Endocuff comparatively demonstrated the greatest ADR, PDR, and SADR, but this was not significant when compared with the other assist devices. Subgroup analysis of randomized controlled trials identified enhanced PDR and ADR for both cap and endocuff. CONCLUSIONS Endoscopic assist devices displayed increased ADR and PDR as compared with standard colonoscopy and thus should be widely adopted. A nonsignificant trend was seen toward higher efficacy for the endocuff device.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Tej I Mehta
- Department of Medicine, Medical College of Wisconsin, Madison, WI
| | | | - Kartikeya Tripathi
- Department of Gastroenterology and Hepatology, University of Massachusetts Medical School-Baystate Campus, Springfield, MA
| | | | - Sindhura Kolli
- Department of Medicine, NYU Langone Medical Center, New York, NY
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston
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21
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Kamal F, Khan MA, Lee-Smith W, Sharma S, Acharya A, Imam Z, Farooq U, Hanson J, Pulous V, Aziz M, Chandan S, Kouanda A, Dai SC, Munroe CA, Howden CW. Second exam of right colon improves adenoma detection rate: Systematic review and meta-analysis of randomized controlled trials. Endosc Int Open 2022; 10:E1391-E1398. [PMID: 36262512 PMCID: PMC9576333 DOI: 10.1055/a-1896-4499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background and study aims A second examination of the right colon, either as a second forward view (SFV) or as retroflexion (RF) in the cecum, can increase adenoma detection rate (ADR) in the right colon. In this meta-analysis, we have evaluated the role of a second examination of the right colon in improving ADR. Methods We reviewed several databases to identify randomized controlled trials that compared right colon SFV with no SFV, and RCTs that compared SFV with RF in the right colon, and reported data on ADR. Our outcomes of interest were ADR and polyp detection rate (PDR) with SFV vs no SFV, right colon and total withdrawal times, and additional ADR and PDR with SFV vs RF. For categorical variables, we calculated pooled risk ratios (RRs) with 95 % confidence intervals (CIs); for continuous variables, we calculated standardized mean difference (SMD) with 95 % CI. Data were analyzed using random effects model. Results We included six studies with 3901 patients. Comparing SFV with no SFV, right colon ADR and PDR were significantly higher in the SFV group: ADR (RR [95 % CI] 1.39 [1.22,1.58]) and PDR (RR [95 % CI] 1.47 [1.30, 1.65]). We found no significant difference in right colon withdrawal time (SMD [95 % CI] 1.54 [-0.20,3.28]) or total withdrawal time (SMD (95 % CI) 0.37 [-0.39,1.13]) with and without SFV. We found no significant difference in additional ADR between SFV and RF. Conclusions SFV of the right colon significantly increases right-sided and overall ADR.
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Affiliation(s)
- Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Muhammad Ali Khan
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas MD
| | - Wade Lee-Smith
- Mulford Health Sciences Library, University of Toledo, Toledo, Ohio, United States
| | - Sachit Sharma
- Department of Medicine, University of Toledo, Toledo, Ohio, United States,Division of Gastroenterology, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Ashu Acharya
- Department of Medicine, University of Toledo, Toledo, Ohio, United States
| | - Zaid Imam
- Division of Gastroenterology, William Beaumont Hospital, Royal Oak, Michigan, United States
| | - Umer Farooq
- Department of Medicine, Loyola Medicine/MacNeal Hospital, Berwyn, Illinois, United States
| | - John Hanson
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
| | - Vian Pulous
- Department of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo, Toledo, Ohio, United States
| | - Saurabh Chandan
- Division of Gastroenterology, Creighton University Medical Center, Omaha, Nebraska, United States
| | - Abdul Kouanda
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Sun-Chuan Dai
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Craig A. Munroe
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Colin W. Howden
- Division of Gastroenterology, University of Tennessee Health Sciences Center, Memphis, Tennessee, United States
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22
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Park YE, Jeong SJ, Lee J, Park J, Yu SJ, Jee SR, Kim TO. Multi-center study of residual gastric volume and bowel preparation after the usage of 1L and 2L polyethylene glycol in Korea. Medicine (Baltimore) 2022; 101:e30795. [PMID: 36197218 PMCID: PMC9509098 DOI: 10.1097/md.0000000000030795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In colonoscopy, good bowel preparation is an important factor in determining the quality of colonoscopy. However, an increase in residual gastric volume (RGV) can lead to a higher risk of aspiration pneumonia. Therefore, the purpose of this study was to investigate the factors related to an increase in RGV with the usage of 1L polyethylene glycol (PEG). METHODS We prospectively analyzed 268 patients who underwent both gastroscopy and colonoscopy at 2 hospitals from May to October 2021. Bowel preparation was performed using 1L in 127 patients (47.4%) and 2L PEG in 141 patients (52.6%). We investigated the time taken for bowel preparation solutions, the last water intake, total water intake, and RGV, and conducted a survey on taking compliance and satisfaction. RESULTS The level of RGV was significantly increased in the 1L PEG group when compared to the 2L PEG group (1L, 52.26 ± 65.33 vs 2L, 23.55 ± 22.99; P < .001). There was no difference between the 2 groups in the degree of bowel preparation, but there were more bubbles formed in the 1L group (1L, 1.91 ± 2.74 vs 2L, 1.10 ± 2.02; P = .007). In the case of RGV ≥ 50 mL, in multivariate analysis, the risk was higher in water intake within 5 hours and the patients who think the dose is too high (all P < .05). CONCLUSION Therefore, since RGV is higher in 1L PEG than in 2L PEG, it is necessary to be careful not to take water for at least 5 hours before the test.
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Affiliation(s)
- Yong Eun Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Su Jin Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Jongha Park
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
| | - Seung Jung Yu
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Sam Ryong Jee
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Republic of Korea
| | - Tae Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Republic of Korea
- *Correspondence: Tae Oh Kim, Department of Internal Medicine, Inje University College of Medicine, 875 Haeundae-ro, Haeundae-gu, Busan 48108, Republic of Korea (e-mail: )
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23
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Shaukat A, Lichtenstein DR, Somers SC, Chung DC, Perdue DG, Gopal M, Colucci DR, Phillips SA, Marka NA, Church TR, Brugge WR. Computer-Aided Detection Improves Adenomas per Colonoscopy for Screening and Surveillance Colonoscopy: A Randomized Trial. Gastroenterology 2022; 163:732-741. [PMID: 35643173 DOI: 10.1053/j.gastro.2022.05.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Colonoscopy for colorectal cancer screening is endoscopist dependent, and colonoscopy quality improvement programs aim to improve efficacy. This study evaluated the clinical benefit and safety of using a computer-aided detection (CADe) device in colonoscopy procedures. METHODS This randomized study prospectively evaluated the use of a CADe device at 5 academic and community centers by US board-certified gastroenterologists (n = 22). Participants aged ≥40 scheduled for screening or surveillance (≥3 years) colonoscopy were included; exclusion criteria included incomplete procedure, diagnostic indication, inflammatory bowel disease, and familial adenomatous polyposis. Patients were randomized by endoscopist to the standard or CADe colonoscopy arm using computer-generated, random-block method. The 2 primary endpoints were adenomas per colonoscopy (APC), the total number of adenomas resected divided by the total number of colonoscopies; and true histology rate (THR), the proportion of resections with clinically significant histology divided by the total number of polyp resections. The primary analysis used a modified intention-to-treat approach. RESULTS Between January and September 2021, 1440 participants were enrolled to be randomized. After exclusion of participants who did not meet the eligibility criteria, 677 in the standard arm and 682 in the CADe arm were included in a modified intention-to-treat analysis. APC increased significantly with use of the CADe device (standard vs CADe: 0.83 vs 1.05, P = .002; total number of adenomas, 562 vs 719). There was no decrease in THR with use of the CADe device (standard vs CADe: 71.7% vs 67.4%, P for noninferiority < .001; total number of non-neoplastic lesions, 284 vs 375). Adenoma detection rate was 43.9% and 47.8% in the standard and CADe arms, respectively (P = .065). CONCLUSIONS For experienced endoscopists performing screening and surveillance colonoscopies in the United States, the CADe device statistically improved overall adenoma detection (APC) without a concomitant increase in resection of non-neoplastic lesions (THR). CLINICALTRIALS gov registration: NCT04754347.
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Affiliation(s)
- Aasma Shaukat
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Grossman School of Medicine, New York, New York; Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota.
| | - David R Lichtenstein
- Division of Gastroenterology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Samuel C Somers
- Concord Hospital Gastroenterology/Concord Endoscopy Center, Concord, New Hampshire
| | - Daniel C Chung
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Nicholas A Marka
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Timothy R Church
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - William R Brugge
- Division of Gastroenterology, Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
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24
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Azab MM, Kahl R, Lin E, Kam K, Balagoni H, Pham J, Oh N, Piper MS, Wright AP. The Cost of Guideline Adherence: A Multicenter Analysis of the Financial Implications of Adopting the US Multi-Society Task Force Polypectomy Guidelines. J Clin Gastroenterol 2022; 56:597-600. [PMID: 34267104 DOI: 10.1097/MCG.0000000000001582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/01/2021] [Indexed: 12/10/2022]
Abstract
GOAL The goal of this study was to determine the financial impact of adopting the US Multi-Society Task Force (USMSTF) polypectomy guidelines on physician reimbursement and disposable equipment costs for gastroenterologists in the academic medical center and community practice settings. BACKGROUND In 2020, USMSTF guidelines on polypectomy were introduced with a strong recommendation for cold snare rather than cold forceps technique for removing diminutive and small polyps. Polypectomy with snare technique reimburses physicians at a higher rate compared with cold forceps and also requires different disposable equipment. The financial implications of adopting these guidelines is unknown. MATERIALS AND METHODS Patients that underwent screening colonoscopy where polypectomy was performed at an academic medical center (Loma Linda University Medical Center) and community practice medical center (Ascension Providence Hospital) between July 2018 and July 2019 were identified. The polypectomy technique performed during each procedure was determined (forceps alone, snare alone, forceps plus snare) along with the number and size of polyps as well as disposable equipment. Actual and projected provider reimbursement and disposable equipment costs were determined based on applying the new polypectomy guidelines. RESULTS A total of 1167 patients underwent colonoscopy with polypectomy. Adhering to new guidelines would increase estimated physician reimbursement by 5.6% and 12.5% at academic and community practice sites, respectively. The mean increase in physician reimbursement per procedure was significantly higher at community practice compared with the academic setting ($29.50 vs. $14.13, P <0.00001). The mean increase in disposable equipment cost per procedure was significantly higher at the community practice setting ($6.11 vs. $1.97, P <0.00001). CONCLUSION Adopting new polypectomy guidelines will increase physician reimbursement and equipment costs when colonoscopy with polypectomy is performed.
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25
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Zhang M, Zhao L, Zhang Y, Jing H, Wei L, Li Z, Zhang H, Zhang Y, Zhu S, Zhang S, Zhang X. Colorectal Cancer Screening With High Risk-Factor Questionnaire and Fecal Immunochemical Tests Among 5, 947, 986 Asymptomatic Population: A Population-Based Study. Front Oncol 2022; 12:893183. [PMID: 35712520 PMCID: PMC9195590 DOI: 10.3389/fonc.2022.893183] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
Background The recent uptrend in colorectal cancer (CRC) incidence in China is causing an increasingly overwhelming social burden. And its occurrence can be effectively reduced by sensitizing CRC screening for early diagnosis and treatment. However, a large number of people in China do not undergo screening due to multiple factors. To address this issue, since 2012, a CRC screening program has been initiated in Tianjin. Methods Residents aged 40-74 years were eligible for CRC screening. The first was to complete the high-risk factor questionnaire (HRFQ) and undergo fecal immunochemical test (FIT). Then those with a positive result in any of the two screening methods were recommended for a free colonoscopy. Results The detection rate of intestinal diseases increased with age, had a male predominance, and was higher in residents from central urban areas and those with primary school above education level. The sensitivity of predicting CRC after colonoscopy in the high-risk group was 76.02%; the specificity was 25.33%.A significant decrease in the detection rate of intestinal disease, CRC and advanced adenoma was observed from positive FIT, the high-risk group and positive HRFQ, 47.13%, 44.79%, 42.30%; 3.15%, 2.44%, 1.76%; 7.72%, 6.42%, 5.08%, in that order, while no inter-group difference was found for the detection of polyps. In addition, the different combinations of HRFQ and FIT can enroll more high-risk population than FIT or (and) HRFQ only, and thus detect more intestinal diseases (include CRC/AA/Polyp). Conclusion The superimposition of different screening method for HRFQ and FIT is an effective strategy for the detection of CRC, AA, and Polyp, compared to HRFQ or FIT alone. However, further improvements in screening and interventions are needed to promote colonoscopy compliance.
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Affiliation(s)
- Mingqing Zhang
- Nankai University School of Medicine, Nankai University, Tianjin, China.,Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Lianbo Wei
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Zhixuan Li
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Haixiang Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Yong Zhang
- Center for Applied Mathematics, Tianjin University, Tianjin, China
| | - Siwei Zhu
- Nankai University School of Medicine, Nankai University, Tianjin, China.,Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Shiwu Zhang
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China.,Department of Pathology, Tianjin Union Medical Center, Tianjin, China
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China.,Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China.,The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
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26
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Tang CP, Lin TL, Hsieh YH, Hsieh CH, Tseng CW, Leung FW. Polyp detection and false-positive rates by computer-aided analysis of withdrawal-phase videos of colonoscopy of the right-sided colon segment in a randomized controlled trial comparing water exchange and air insufflation. Gastrointest Endosc 2022; 95:1198-1206.e6. [PMID: 34973967 DOI: 10.1016/j.gie.2021.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Water exchange (WE) improves lesion detection but misses polyps because of human limitations. Computer-aided detection (CADe) identifies additional polyps overlooked by the colonoscopist. Additional polyp detection rate (APDR) is the proportion of patients with at least 1 additional polyp detected by CADe. The number of false positives (because of feces and air bubble) per colonoscopy (FPPC) is a major CADe limitation, which might be reduced by salvage cleaning with WE. We compared the APDR and FPPC by CADe between videos of WE and air insufflation in the right-sided colon. METHODS CADe used a convolutional neural network with transfer learning. We edited and coded withdrawal-phase videos in a randomized controlled trial that compared right-sided colon findings between air insufflation and WE. Two experienced blinded endoscopists analyzed the CADe-overlaid videos and identified additional polyps by consensus. An artifact triggered by CADe but not considered a polyp by the reviewers was defined as a false positive. The primary outcome was APDR. RESULTS Two hundred forty-five coded videos of colonoscopies inserted with WE (n = 123) and air insufflation (n = 122) methods were analyzed. The APDR in the WE group was significantly higher (37 [30.1%] vs 15 [12.3%], P = .001). The mean [standard deviation] FPPC related to feces (1.78 [1.67] vs 2.09 [2.09], P = .007) and bubbles (.53 [.89] vs 1.25 [2.45], P = .001) in the WE group were significantly lower. CONCLUSIONS CADe showed significantly higher APDR and lower number of FPPC related to feces and bubbles in the WE group. The results support the hypothesis that the strengths of CADe and WE complement the weaknesses of each other in optimizing polyp detection.
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Affiliation(s)
- Chia-Pei Tang
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Tu-Liang Lin
- Department of Management Information Systems, National Chiayi University, Chiayi, Taiwan
| | - Yu-Hsi Hsieh
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Chen-Hung Hsieh
- Department of Management Information Systems, National Chiayi University, Chiayi, Taiwan
| | - Chih-Wei Tseng
- Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien City, Taiwan
| | - Felix W Leung
- Sepulveda Ambulatory Care Center, Veterans Affairs Greater Los Angeles Healthcare System, North Hills, California, USA; David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
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27
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Liao L, Feng J, Fu X, Cao L, Fan M, Huang C, Zhang J, Zhang L, Chen P, You F. Comparison between Traditional Chinese Medicine Constitution and Blood Biochemical Markers Associated with Left and Right Mammary Hyperplasia in Rural Areas of Southwest China. J Healthc Eng 2022; 2022:9274060. [PMID: 35368942 DOI: 10.1155/2022/9274060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022]
Abstract
Background Hyperplasia of mammary glands (HMG) is the breast disease with the highest clinical incidence. Many traditional Chinese medicine (TCM) doctors suggest that the treatment of HMG should be based on the left and right breast pain difference. However, these views are based on case reports, and an objective basis has not been established for treatment according to left-side and right-side differences. Methods We enrolled 150 patients who met the clinical diagnostic criteria of HMG. The incidence bias was determined according to the score difference between bilateral breast pain and mass in patients with HMG. A left group, right group, and bilateral group were included, and TCM constitution was investigated in each group. Blood biochemical indicators were measured for 120 fasting patients. We conducted a network pharmacology study of the key herb qingpi and chenpi, which are used by TCM doctors to treat different lateral HMG. Results In patients with biased onset of HMG, the results showed that the frequency and constitution score of stagnant blood in the L group were higher than those of the R group, and the frequency and constitution score of phlegm-dampness in the R group were higher than those of the L group. Both the L and R groups had high proportion of stagnant Qi. The results indicated that the concentration of coagulation factor VIII (FVIII) was higher in the L group than that in the R group, and the concentration of lipoprotein a (Lp-α) was higher in the R group than that in the L group. The results showed that sinensetin and neohesperidin contained in qingpi might interfere with platelet activation, thrombogenesis, prolactin signaling pathway, and atherosclerosis process, in removing “blood stasis” and eventually treating the left-leaning group of HMG patients. Sitosterol and citromitin contained in chenpi could regulate lipid metabolism by interfering with regulation of lipolysis in adipocytes, salivary secretion, estrogen signaling pathway, and thyroid hormone signaling pathway. Chenpi could eliminate “phlegm turbidity” and treat HMG patients in the right-leaning group. Conclusions We preliminarily confirmed that the clinical pathogenesis of HMG is not a left-right equilibrium and TCM constitution, coagulation function, and lipid metabolism may be used as the objective basis for the difference between the left and right in HMG pathogenesis. For left-sided HMG patients, the doctor can consider qingpi, herb of activating blood and removing stasis, to treat HMG. However, for right-sided HMG, we think doctors should apply herb of activating Qi and eliminating phlegm, such as chenpi.
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Ikematsu H, Murano T, Shinmura K. Detection of colorectal lesions during colonoscopy. DEN open 2022; 2:e68. [PMID: 35310752 PMCID: PMC8828173 DOI: 10.1002/deo2.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/11/2022]
Abstract
Owing to its high mortality rate, the prevention of colorectal cancer is of particular importance. The resection of colorectal polyps is reported to drastically reduce colorectal cancer mortality, and examination by endoscopists who had a high adenoma detection rate was found to lower the risk of colorectal cancer, highlighting the importance of identifying lesions. Various devices, imaging techniques, and diagnostic tools aimed at reducing the rate of missed lesions have therefore been developed to improve detection. The distal attachments and devices for improving the endoscopic view angle are intended to help avoid missing blind spots such as folds and flexures in the colon, whereas the imaging techniques represented by image‐enhanced endoscopy contribute to improving lesion visibility. Recent advances in artificial intelligence‐supported detection systems are expected to supplement an endoscopist's eye through the instant diagnosis of the lesions displayed on the monitor. In this review, we provide an outline of each tool and assess its impact on the reduction in the incidence of missed colorectal polyps by summarizing previous clinical research and meta‐analyses. Although useful, the many devices, image‐enhanced endoscopy, and artificial intelligence tools exhibited various limitations. Integrating these tools can improve their shortcomings. Combining artificial intelligence‐based diagnoses with wide‐angle image‐enhanced endoscopy may be particularly useful. Thus, we hope that such tools will be available in the near future.
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Affiliation(s)
- Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy Exploratory Oncology Research & Clinical Trial Center National Cancer Center Chiba Japan.,Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy National Cancer Center Hospital East Chiba Japan
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Tang RSY, Lee JWJ, Chang LC, Ong DEH, Chiu HM, Matsuda T, Kim HS, Sekiguchi M, Leong RW, Ho AMY, Lam TYT, Tse YK, Lin L, Yeoh KG, Lau JYW, Sung JJY. Two vs One Forward View Examination of Right Colon on Adenoma Detection: An International Multicenter Randomized Trial. Clin Gastroenterol Hepatol 2022; 20:372-380.e2. [PMID: 33065307 DOI: 10.1016/j.cgh.2020.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Second forward view (SFV) examination of the right colon (RC) in colonoscopy was suggested to improve the adenoma detection rate (ADR), but multicenter data to inform its routine use remain limited. We performed an international multicenter randomized trial comparing SFV vs a standard single forward view examination of the RC on adenoma detection. METHODS Asymptomatic individuals undergoing screening or surveillance colonoscopies from 6 Asia Pacific regions were invited for study. A forward view examination of the RC was first performed in all patients, followed by randomization at the hepatic flexure to either SFV examination of the RC and standard withdrawal examination from the hepatic flexure to rectum, or a standard withdrawal colonoscopy (SWC) examination from the hepatic flexure to rectum. The primary outcome was RC ADR. RESULTS Between 2016 and 2019, there were 1011 patients randomized (SFV group, 502 patients; SWC group, 509 patients). Forty-five endoscopists performed the colonoscopies. The RC ADR was significantly higher in the SFV group than in the SWC group (27.1% vs 21.6%; P = .042). The whole-colon ADR was high in both groups (49.0% vs 45.0%; P =.201). The SFV examination identified 58 additional adenomas in 49 patients (9.8%), leading to a change in surveillance recommendations in 15 patients (3.0%). The median overall withdrawal time was 1.5 minutes longer in the SFV group (12.0 vs 10.5 min; P < .001). Older age, male sex, ever smoking, and longer RC withdrawal time were independent predictors of right-sided adenoma detection. CONCLUSIONS In this multicenter trial, SFV examination significantly increased the RC ADR in screening and surveillance colonoscopies. Routine RC SFV examination should be considered. ClinicalTrials.gov ID: NCT03121495.
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Affiliation(s)
- Raymond S Y Tang
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan W J Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University of Singapore, Singapore
| | - Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - David E H Ong
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University of Singapore, Singapore
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Takahisa Matsuda
- Cancer Screening Center, Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hyun-Soo Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Seoul, Korea
| | - Masau Sekiguchi
- Cancer Screening Center, Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Rupert W Leong
- Department of Gastroenterology, Concord Hospital, Sydney, Australia; Faculty of Medicine and Health, Macquarie University Hospital, Macquarie University, Sydney, Australia
| | - Andrew M Y Ho
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Yee Kit Tse
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - Lucy Lin
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Khay-Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, National University of Singapore, Singapore
| | - James Y W Lau
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
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Jafarpour S, Saberi F, Yazdi M, Nedaeinia R, Amini G, Ferns GA, Salehi R. Association between colorectal cancer and the degree of ITGA4 promoter methylation in peripheral blood mononuclear cells. Gene Reports 2022. [DOI: 10.1016/j.genrep.2022.101580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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31
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Ahmad A, Dhillon A, Saunders BP, Kabir M, Thomas-Gibson S. Validation of post-colonoscopy colorectal cancer (PCCRC) cases reported at national level following local root cause analysis: REFLECT study. Frontline Gastroenterol 2022; 13:374-380. [PMID: 36051952 PMCID: PMC9380767 DOI: 10.1136/flgastro-2021-102016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Our aim was to determine aetiology of post-colonoscopy colorectal cancers (PCCRCs) identified from population-based data through local root cause analysis at a high-volume mixed secondary and tertiary referral centre. DESIGN/METHOD A subset of national cancer registration data, collected by the National Cancer Registration and Analysis Service, was used to determine PCCRCs diagnosed between 2005 and 2013 at our centre.Root cause analysis was performed for each identified PCCRC, using World Endoscopy Organisation recommendations, to validate it and assess most plausible explanation. We also assessed whether patient, clinician and/or service factors were primarily responsible. RESULTS Of 107 'PCCRC' cases provided from the national dataset, 20 were excluded (16 missing data, 4 duplicates). 87 'PCCRC' cases were included of which 58 were true PCCRCs and 29 false PCCRCs.False PCCRCs comprised 17 detected cancers (cancer diagnosed within 6 months of negative colonoscopy) and 12 cases did not meet PCCRC criteria. Inflammatory bowel disease was the most common risk factor (18/58) and the most common site was rectum (19/58). The most common explanation was 'possible missed lesion, prior examination negative but inadequate' (23/58) and clinician factors were primarily responsible for PCCRC occurrence in most cases (37/58). CONCLUSION Our single-centre study shows, after local analysis, there was misclassification of PCCRCs identified from a population-based registry. The degree of such error will vary between registries. Most PCCRCs occurred in cases of sub-optimal examination as indicated by poor photodocumentation. Effective mechanisms to feedback root cause analyses are critical for quality improvement.
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Affiliation(s)
- Ahmir Ahmad
- St Mark's Hospital, Wolfson Unit for Endoscopy, London, UK
| | - Angad Dhillon
- St Mark's Hospital, Wolfson Unit for Endoscopy, London, UK
| | | | - Misha Kabir
- St Mark's Hospital, Wolfson Unit for Endoscopy, London, UK
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32
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Rumpold H, Hackl M, Petzer A, Wolf D. Improvement in colorectal cancer outcomes over time is limited to patients with left-sided disease. J Cancer Res Clin Oncol 2022; 148:3007-3014. [PMID: 34977964 DOI: 10.1007/s00432-021-03868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Incidence and mortality of colorectal cancer (CRC) declined over the last decades. However, survival depends on the primary tumor location. It is unknown if all progress in outcomes vary depending on left-sided (LCRC) versus right-sided (RCC) colorectal cancer. We compare incidence and mortality rates over time according to the primary tumor location. METHODS Data from the Austrian National Cancer Registry spanning from 1983 to 2018 were used to calculate annual incidence and mortality rates and survival stratified by primary tumor localization and stage. Joinpoint regression with linear regression models were used on different subgroups to identify significant changes of incidence- and mortality slopes. RESULTS A total of 168,260 (incidence dataset) and 87,355 cases (mortality dataset) were identified. Survival of disseminated RCC was worse compared to LCRC (HR 1.14; CI 1.106-1.169). Total and LCRC incidence and mortality rates declined steadily over time, whereas the rates of RCC did not. Incidence of disseminated RCC declined significantly less (slope - 0.07; CI - 0.086; - 0.055) than in LCRC (slope - 0.159; CI - 0.183; - 0.136); mortality rate of RCC was unchanged over time. Incidence and mortality of localized RCC remained unchanged over time, whereas both rates declined independently of stage in LCRC. CONCLUSION Colorectal cancer outcomes during the last 35 years have preferentially improved in LCRC but not in RCC, indicating that the progress made is limited to LCRC. It is necessary to define RCC as a distinct form of CRC and to focus on specific strategies for its early detection and treatment.
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Affiliation(s)
- Holger Rumpold
- Gastrointestinal Cancer Center, Ordensklinikum Linz, Seilerstaette 4, 4010, Linz, Austria. .,Medical Faculty, Johannes Kepler University, Linz, Austria.
| | - M Hackl
- National Cancer Registry, Statistics Austria, Vienna, Austria
| | - A Petzer
- Department of Medical Oncology and Hematology, Ordensklinikum Linz, Linz, Austria
| | - D Wolf
- Internal Medicine 5, Department of Hematology and Oncology, Medical University Innsbruck, Innsbruck, Austria
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Jaiswal S, Joshi B, Chen J, Wang F, Dame MK, Spence JR, Newsome GM, Katz EL, Shah YM, Ramakrishnan SK, Li G, Lee M, Appelman HD, Kuick R, Wang TD. Membrane Bound Peroxiredoxin-1 Serves as a Biomarker for In Vivo Detection of Sessile Serrated Adenomas. Antioxid Redox Signal 2022; 36:39-56. [PMID: 34409853 PMCID: PMC8792500 DOI: 10.1089/ars.2020.8244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim: Sessile serrated adenomas (SSAs) are premalignant lesions driven by the BRAFV600E mutation to give rise to colorectal cancers (CRCs). They are often missed during white light colonoscopy because of their subtle appearance. Previously, a fluorescently labeled 7mer peptide KCCFPAQ was shown to detect SSAs in vivo. We aim to identify the target of this peptide. Results: Peroxiredoxin-1 (Prdx1) was identified as the binding partner of the peptide ligand. In vitro binding assays and immunofluorescence staining of human colon specimens ex vivo supported this result. Prdx1 was overexpressed on the membrane of cells with the BRAFV600E mutation, and this effect was dependent on oxidative stress. RKO cells harboring the BRAFV600E mutation and human SSA specimens showed higher oxidative stress as well as elevated levels of Prdx1 on the cell membrane. Innovation and Conclusion: These results suggest that Prdx1 is overexpressed on the cell surface in the presence of oxidative stress and can serve as an imaging biomarker for in vivo detection of SSAs. Antioxid. Redox Signal. 36, 39-56.
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Affiliation(s)
- Sangeeta Jaiswal
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Bishnu Joshi
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jing Chen
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Fa Wang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael K Dame
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason R Spence
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Cell and Developmental Biology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gina M Newsome
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Erica L Katz
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yatrik M Shah
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Sadeesh K Ramakrishnan
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gaoming Li
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Miki Lee
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Henry D Appelman
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Rork Kuick
- Department of Biostatistics, and University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas D Wang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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Vemulapalli KC, Lahr RE, Lee CJ, Abdullah N, Rex DK. Yield of a second right colon examination during colonoscopy after a first examination using a mucosal exposure device. Gastrointest Endosc 2022; 95:149-154.e1. [PMID: 34284026 DOI: 10.1016/j.gie.2021.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/08/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Double right colon examination during colonoscopy has been advocated to reduce the risk of interval cancer in the right colon. Whether 2 examinations are necessary when the first examination is performed with a mucosal exposure device is uncertain. We documented the rates of missed adenomas, sessile serrated lesions, and hyperplastic polyps after an initial right colon examination by a high-level detector using a mucosal exposure device. METHODS At a single tertiary hospital outpatient practice, we prospectively collected data on the yield of a second examination of the right colon after an initial examination by a single high-detecting colonoscopist using a mucosal exposure device. RESULTS During the study period, 1331 eligible consecutive patients underwent colonoscopy. Right colon adenoma, sessile serrated lesion, and hyperplastic polyp miss rates were 15.8%, 14.1%, and 16.7%, respectively. Four percent of patients had adenomas detected in the right colon only with a second examination. CONCLUSIONS A second examination of the right colon is warranted, even when using a distal mucosal exposure device to perform colonoscopy.
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Affiliation(s)
- Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Rachel E Lahr
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Christopher J Lee
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Noor Abdullah
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Lall V, Ismail AGM, Ayonrinde OT. Disparate age and sex distribution of sessile serrated lesions and conventional adenomas in an outpatient colonoscopy population-implications for colorectal cancer screening? Int J Colorectal Dis 2022; 37:1569-1579. [PMID: 35660947 PMCID: PMC9262786 DOI: 10.1007/s00384-022-04191-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Colorectal cancer (CRC) is increasingly diagnosed in individuals aged < 50 years, resulting in advocacy of screening from age 45 years. Despite existing knowledge associating CRC with conventional adenomas, the significance of sessile serrated lesions (SSLs) on the burden of CRC is less detailed. We aimed to provide contemporary estimates for SSL prevalence and examine patient and procedure factors associated with SSL detection. METHODS Retrospective observational study examining associations between SSL and conventional adenoma detection, polyp histopathology, patient, and procedure characteristics in an outpatient colonoscopy unit over 12 months. RESULTS From 2097 colonoscopies, SSL detection was 13.8% overall and 12.5% in patients < 50 years. SSLs were mostly proximal in location (64%), and SSL detection was significantly higher in females compared with males (16.2% vs. 11.7%, p = 0.003), particularly in those < 50 years (16.8% vs. 8.6%, p < 0.001). In multivariable analysis, SSL detection was associated with female sex (adjusted odds ratio [aOR] 1.48, 95% confidence interval [CI] 1.15-1.91), synchronous conventional adenoma detection (aOR 1.36, 95% CI 1.04-1.78) and BMI ≥ 25 kg/m2 (aOR 1.34, 95% CI 1.02-1.77). Conventional adenoma detection was 33.6% and associated with age ≥ 50 years (aOR 3.57, 95% CI 2.84-4.47) and synchronous SSL detection (aOR 1.36, 95% CI 1.03-1.79). CONCLUSIONS We observed age and sex disparities in polyp types and prevalence in this outpatient colonoscopy population. SSLs were most prevalent in females aged < 50 years, suggesting a potential increased susceptibility of young females to SSLs and CRC. Our findings may have implications for the design of CRC screening programs.
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Affiliation(s)
- Vidit Lall
- Sir Charles Gairdner Hospital, Nedlands, Australia ,Medical School, The University of Western Australia, Nedlands, Australia
| | - Ali Galalah Mostafa Ismail
- Royal Perth Hospital, Perth, Australia ,Medical School, The University of Western Australia, Nedlands, Australia
| | - Oyekoya Taiwo Ayonrinde
- Medical School, The University of Western Australia, Nedlands, Australia ,Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, Australia ,Faculty of Health Sciences, Curtin University, Bentley, Australia
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Lv XH, Lu Q, Sun YN, Deng K, Yang JL. Retroflexed view for reexamination of the right colon after forward view examination: Systematic review and meta-analysis. Dig Endosc 2022; 34:33-42. [PMID: 34075629 DOI: 10.1111/den.14052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/15/2021] [Accepted: 05/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The effect of retroflexed view (RV) for the reexamination of the right colon after forward view (FV) examination has not been fully understood. METHODS We searched multiple databases including PubMed, Embase, and the Cochrane Library for prospective studies exploring the role of RV for reexamination of the right colon. A meta-analysis was performed on outcomes including lesion detection rates, lesion miss rates, and withdrawal time. RESULTS Four randomized controlled trials aimed to compare the impact of the second withdrawal from the right colon in RV vs. FV following a standard colonoscopy. Both the additional adenoma detection rate (AADR) and additional polyp detection rate (APDR) of the right colon were lower in the RV group compared with the FV group (risk ratio [RR] 0.73 for AADR; RR 0.76 for APDR); similar results were noted in comparisons of the adenoma miss rate and polyp miss rate. Six prospective cohort studies aimed to describe the effect of the RV examination of the right colon after one or two rounds of FV examination. Both the adenoma detection rate (ADR) and polyp detection rate (PDR) of the right colon were slightly higher in combined examinations with RV examination than single FV examination (RR 1.11 for ADR; RR 1.16 for PDR) or two FV examinations (RR 1.21 for ADR; RR 1.22 for PDR). CONCLUSIONS FV may detect more adenomas and polyps than RV during the second withdrawal from the right colon. RV may detect additional adenomas and polyps in the right colon after two FV examinations.
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Affiliation(s)
- Xiu-He Lv
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Qing Lu
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Yi-Ning Sun
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Deng
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology,, West China Hospital of Sichuan University, Chengdu, China.,Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, China
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Abstract
Despite strong evidence of effectiveness, colorectal cancer (CRC) screening remains underused. Currently, there are several options for CRC screening, each with its own performance characteristics and considerations for practice. This Review aims to cover current CRC screening guidelines and highlight future blood-based and imaging-based options for screening. In current practice, the leading non-invasive option is the faecal immunochemical test (FIT) based on its high specificity, good sensitivity, low cost and ease of use in mailed outreach programmes. There are currently five blood-based CRC screening tests in varying stages of evaluation, including one that is currently sold in the USA as a laboratory-developed test. There are ongoing studies on the diagnostic accuracy and longitudinal performance of blood tests and they have the potential to disrupt the CRC screening landscape. Imaging-based options, including the colon capsule, MR colonography and the CT capsule, are also being tested in active studies. As the world attempts to recover from the COVID-19 pandemic and adapts to the start of CRC screening among people at average risk starting at age 45 years, non-invasive options will become increasingly important.
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Madureira CM, Roda R, Rocha LCM, Leite FAV, Coelho DL, Lima Junior GF. IMPACT OF RETROFLEXED VIEW ON THE DETECTION OF LESIONS IN THE PROXIMAL COLON: ASSESSMENT OF 393 PATIENTS IN A PRIVATE TERTIARY HOSPITAL. Arq Gastroenterol 2021; 58:359-363. [PMID: 34705971 DOI: 10.1590/s0004-2803.202100000-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The gold standard test for colorectal cancer screening the colonoscopy. Although this is the test of choice, colonoscopy misses a significant number of lesions, mainly in the proximal colon. With the purpose of reducing the number of lesions missed, new techniques have been studied, amongst them, retroflexed view in the right side of the colon and the second direct forward view. OBJECTIVE Assessing the safety of the retroview in the proximal colon (cecum and ascending colon), its impact on the detection of lesions in the proximal colon and its advantage over the double right forward view using adenoma detection rate and adenoma miss rate. METHODS Three hundred and ninety-three patients who came to Hospital Mater Dei to undergo colonoscopy from March to July 2017, prospectively. Out of these, 372 were included in the study based on the following exclusion criteria: being under 18 years of age, inadequate bowel preparations (Boston scale <7), history of colectomy, inflammatory bowel disease or polypoid diseases. First, an endoscopist inserted the colonoscope into the cecum and examine the cecum and the ascending colon with a forward view twice. In the third insertion into the cecum, retroflexed view was performed, cecal mucosa was examined until the hepatic flexure in search of polyps missed on forward view. All lesions found were resected and sent for histological analysis. RESULTS In 334 (89.8%) patients, retroflexed view was performed successfully, 65.8% of failures were attributed to the loops of the device which prevented the maneuver. The direct view identified 175 polyps in the proximal colon in 102 people. Retroflexed view detected 26 polyps missed by the direct view in 24 (6.5%) people, with a missing rate of 12.9% in the test with only the forward view. Out of the 26 polyps found in retroview, 21 (80.76%) were adenomas, one of them with a high-grade dysplasia. Eleven patients had polyps seen only in retroflexed view. Retroview has increased the polyp detection rate from 27.41% to 31.72% and the adenoma detection rate from 21.77% to 25%. The adenoma miss rate by the double direct view was 12.8%. Without the retroview, one polyp in every 13.91 colonoscopies would be missed (number needed to treat - NNT=13.91). There was no adverse event. CONCLUSION The retroflexed view technique in the proximal colon was shown to be safe, fast and feasible in most cases. It increased the adenoma detection rate and was shown to be advantageous in this study wit benefit beyond the double direct view.
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Affiliation(s)
| | - Rodrigo Roda
- Hospital Mater Dei, Departamento de Endoscopia Digestiva, Belo Horizonte, MG, Brasil.,Universidade Federal de Minas Gerais, Hospital das Clínicas, Instituto Alfa de Gastroenterologia, Belo Horizonte, MG, Brasil
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Chang LC, Hsu YC, Chiu HM, Ueda K, Wu MS, Kao CH, Shen TL. Exploration of the Proteomic Landscape of Small Extracellular Vesicles in Serum as Biomarkers for Early Detection of Colorectal Neoplasia. Front Oncol 2021; 11:732743. [PMID: 34589434 PMCID: PMC8473825 DOI: 10.3389/fonc.2021.732743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background Patient participation in colorectal cancer (CRC) screening via a stool test and colonoscopy is suboptimal, but participation can be improved by the development of a blood test. However, the suboptimal detection abilities of blood tests for advanced neoplasia, including advanced adenoma (AA) and CRC, limit their application. We aimed to investigate the proteomic landscape of small extracellular vesicles (sEVs) from the serum of patients with colorectal neoplasia and identify specific sEV proteins that could serve as biomarkers for early diagnosis. Materials and Methods We enrolled 100 patients including 13 healthy subjects, 12 non-AAs, 13 AAs, and 16 stage-I, 15 stage-II, 16 stage-III, and 15 stage-IV CRCs. These patients were classified as normal control, early neoplasia, and advanced neoplasia. The sEV proteome was explored by liquid chromatography-tandem mass spectrometry. Generalized association plots were used to integrate the clustering methods, visualize the data matrix, and analyze the relationship. The specific sEV biomarkers were identified by a decision tree via Orange3 software. Functional enrichment analysis was conducted by using the Ingenuity Pathway Analysis platform. Results The sEV protein matrix was identified from the serum of 100 patients and contained 3353 proteins, of which 1921 proteins from 98 patients were finally analyzed. Compared with the normal control, subjects with early and advanced neoplasia exhibited a distinct proteomic distribution in the data matrix plot. Six sEV proteins were identified, namely, GCLM, KEL, APOF, CFB, PDE5A, and ATIC, which properly distinguished normal control, early neoplasia, and advanced neoplasia patients from each other. Functional enrichment analysis revealed that APOF+ and CFB+ sEV associated with clathrin-mediated endocytosis signaling and the complement system, which have critical implications for CRC carcinogenesis. Conclusion Patients with colorectal neoplasia had a distinct sEV proteome expression pattern in serum compared with those patients who were healthy and did not have neoplasms. Moreover, the six identified specific sEV proteins had the potential to discriminate colorectal neoplasia between early-stage and advanced neoplasia. Collectively, our study provided a six-sEV protein biomarker panel for CRC diagnosis at early or advanced stages. Furthermore, the implication of the sEV proteome in CRC carcinogenesis via specific signaling pathways was explored.
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Affiliation(s)
- Li-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chiung Hsu
- Department of Biomedical Science and Engineering, National Central University, Taoyuan, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Health Management Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Koji Ueda
- Cancer Precision Medicine Center, Japanese Foundation of Cancer Research, Tokyo, Japan
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiun-How Kao
- Department of Statistics, Tamkang University, New Taipei City, Taiwan
| | - Tang-Long Shen
- Department of Plant Pathology and Microbiology, National Taiwan University, Taipei, Taiwan.,Center for Biotechnology, National Taiwan University, Taipei, Taiwan.,Genome and Systems Biology Degree Program, National Taiwan University, Taipei, Taiwan
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Peled N, Fuchs V, Kestenbaum EH, Oscar E, Bitran R. An Update on the Use of Exhaled Breath Analysis for the Early Detection of Lung Cancer. Lung Cancer (Auckl) 2021; 12:81-92. [PMID: 34429674 PMCID: PMC8378913 DOI: 10.2147/lctt.s320493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/17/2021] [Indexed: 12/18/2022]
Abstract
Lung cancer has historically been the main responsible for cancer associated deaths. Owing to this is our current inability to screen for and diagnose early pathological findings, preventing us from a timely intervention when cure is still achievable. Over the last decade, together with the extraordinary progress in therapeutical alternatives in the field, there has been an ongoing search for a biomarker that would allow for this. Numerous technologies have been developed but their clinical application is yet to come. In this review, we provide an update on volatile organic compounds, a non-invasive method that can hold the key for detecting early metabolic pathway changes in carcinogenesis. For its compilation, web-based search engines of scientific literature such as PubMed were explored and reviewed, using articles, research, and papers deemed meaningful by authors discretion. After a brief description, we depict how this technique can complement current methods and present the value of electronic noses in the identification of the “breathprint”. Lastly, we bring some of the latest updates in the field together with the current limitations and final remarks.
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Affiliation(s)
- Nir Peled
- Shaare Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Vered Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Emily H Kestenbaum
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Elron Oscar
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Raul Bitran
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center, Beer-Sheva, Israel
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Guarner-Argente C, Ikematsu H, Osera S, Fraile M, Ibañez B, Marra-López C, Jerusalén-Gargallo C, Alonso Aguirre PA, Martinez-Ares D, Soto S, Ramos Zabala F, Alvarez-Gonzalez MA, Rodriguez Sánchez J, Múgica F, Nogales Rincon O, Herreros de Tejada A, Redondo-Cerezo E, Martínez-Cara J, López-Rosés L, Rodriguez-Tellez M, Garcia-Bosch O, de la Peña J, Pellisé M, Rivero-Sanchez L, Saperas E, Pérez-Roldán F, Lopez Viedma B, González-Santiago JM, Álvarez Delgado A, Cobian C, Pardeiro R, Valdivielso Cortázar E, Colan-Hernandez J, Gordillo J, Kaneko K, Albéniz E. Location, morphology and invasiveness of lateral spreading tumors in the colorectum differ between two large cohorts from an eastern and western country. Gastroenterol Hepatol 2021; 45:440-449. [PMID: 34400187 DOI: 10.1016/j.gastrohep.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/30/2021] [Accepted: 07/16/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND STUDY AIMS Data from Japanese series show that surface morphology of laterally spreading tumors (LST) in the colon identifies lesions with different incidence and pattern of submucosal invasion. Such data from western countries are scarce. We compared clinical and histological features of LST in a western country and an eastern country, with special interest on mucosal invasiveness of LST, and investigated the effect of clinical factors on invasiveness in both countries. PATIENTS AND METHODS Patients with LST lesions ≥20mm were included from a multicenter prospective registry in Spain and from a retrospective registry from the National Cancer Center Hospital East, Japan. The primary outcome was the presence of submucosal invasion in LST. The secondary outcome was the presence of high-risk histology, defined as high-grade dysplasia or submucosal invasion. RESULTS We evaluated 1102 patients in Spain and 663 in Japan. Morphological and histological characteristics differed. The prevalence of submucosal invasion in Japan was six-fold the prevalence in Spain (Prevalence Ratio PR=5.66; 95%CI: 3.96, 8.08), and the prevalence of high-risk histology was 1.5 higher (PR=1.44; 95%CI: 1.31, 1.58). Compared to the granular homogeneous type and adjusted by clinical features, granular mixed, flat elevated, and pseudo-depressed types were associated with higher odds of submucosal invasion in Japan, whereas only the pseudo-depressed type showed higher risk in Spain. Regarding high-risk histology, both granular mixed and pseudo-depressed were associated with higher odds in Japan, compared with only the granular mixed type in Spain. CONCLUSION This study reveals differences in location, morphology and invasiveness of LST in an eastern and a western cohort.
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Affiliation(s)
| | - Hiroaki Ikematsu
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - Shozo Osera
- Gastroenterology Department, Saku Central Hospital Advanced Care Center, Japan
| | - Maria Fraile
- Gastroenterology Department, Hospital de San Pedro, Logroño, Spain
| | - Berta Ibañez
- Statistics, NavarraBiomed-Fundación Miguel Servet-IDISNA, Pamplona, Spain
| | - Carlos Marra-López
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | | | | | - David Martinez-Ares
- Gastroenterology Department, Complejo Hospitalario de Vigo Hospital Xeral, Spain
| | - Santiago Soto
- Gastroenterology Department, Complexo Hospitalario de Ourense, Spain
| | - Felipe Ramos Zabala
- Gastroenterology Department, HM Monteprincipe University Hospital, Madrid, Spain
| | | | | | - Fernando Múgica
- Gastroenterology Department, Hospital Universitario de Donostia, Spain
| | - Oscar Nogales Rincon
- Department of Gastroenterology and Hepatology, HGU Gregorio Marañon, Madrid, Spain
| | | | | | - Juan Martínez-Cara
- Gastroenterology Department, Virgen de las Nieves Hospital, Granada, Spain
| | | | | | - Orlando Garcia-Bosch
- Gastroenterology Department, Hospital Sant Joan Despi Moises Broggi, Barcelona, Spain
| | | | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Liseth Rivero-Sanchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Esteve Saperas
- Gastroenterology Department, Hospital General de Catalunya, Barcelona, Spain
| | | | | | | | | | - Carol Cobian
- Gastroenterology Department, Hospital Universitario de Donostia, Spain
| | | | | | - Juan Colan-Hernandez
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Gordillo
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Kazuhiro Kaneko
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - Eduardo Albéniz
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Navarrabiomed, Universidad Pública de Navarra, IdiSNa, Pamplona, Spain.
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Keswani RN, Kahi CJ, Benson M, Gawron AJ, Kaltenbach TR, Yadlapati RH, Gregory DL, Duloy A. Cecal retroflexion is infrequently performed in routine practice and the retroflexed view is of poor quality. BMC Gastroenterol 2021; 21:307. [PMID: 34332538 PMCID: PMC8325794 DOI: 10.1186/s12876-021-01877-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/06/2021] [Indexed: 01/16/2023] Open
Abstract
Background As right colon polyps are challenging to detect, a retroflexed view of right colon (RV) may be useful. However, cecal retroflexion (CR) without a RV to the hepatic flexure (HF) is inadequate. We aimed to determine the frequency of CR and quality of the RV in routine practice. Methods This prospective observational study performed at an academic medical center assessed colonoscopy inspection technique of endoscopists who had performed ≥ 100 annual screening colonoscopies. We video recorded ≥ 28 screening/surveillance colonoscopies per endoscopist and randomly evaluated 7 videos per endoscopist. Six gastroenterologists blindly reviewed the videos to determine if CR was performed and HF withdrawal time (cecum to HF time, excluding ileal/polypectomy time). Results Reviewers assessed 119 colonoscopies performed by 17 endoscopists. The median HF withdrawal time was 3 min and 46 s. CR was performed in 31% of colonoscopies. CR frequency varied between endoscopists with 9 never performing CR and 2 performing CR in all colonoscopies. When performed, nearly half (43%) of RVs did not extend to the HF with median RV duration of 16 s (IQR 9–30 s). Three polyps were identified in the RV (polyp detection rate of 8.1%), all identified prior to a forward view. Conclusions CR is performed infrequently in routine practice. When CR is performed, the RV is of low quality with a very short inspection duration and insufficient ascending colon examination. Further education is required to educate endoscopists in optimal technique to improve overall colonoscopy quality.
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Affiliation(s)
- Rajesh N Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA.
| | - Charles J Kahi
- Department of Gastroenterology, Indiana University Medical Center, Indianapolis, USA
| | - Mark Benson
- Department of Gastroenterology and Hepatology, School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Andrew J Gawron
- Department of Gastroenterology, University of Utah, Salt Lake City, USA
| | - Tonya R Kaltenbach
- Department of Gastroenterology, University of California, San Francisco, USA
| | - Rena H Yadlapati
- Division of Gastroenterology, University of California, San Diego School of Medicine, La Jolla, USA
| | - Dyanna L Gregory
- Department of Gastroenterology and Hepatology, Northwestern University, 676 N. St. Clair, Suite 1400, Chicago, IL, 60611, USA
| | - Anna Duloy
- Department of Gastroenterology, University of Colorado, Boulder, USA
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Alkhizzi B, Khan MI, Al-Ghafari A, Choudhry H. Upregulation of circular and linear METTL3 and USP3 in colorectal cancer. Oncol Lett 2021; 22:675. [PMID: 34345300 DOI: 10.3892/ol.2021.12936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/11/2021] [Indexed: 02/06/2023] Open
Abstract
Several screening methods are currently used to detect colorectal cancer (CRC). However, these are either under-utilized due to their invasive nature or are limited in terms of their diagnostic ability. Numerous reports have investigated messenger and circular RNA as non-invasive biomarkers, but the majority of gene expression studies using RT-qPCR involve critical errors that often lead to irreproducible findings. In the present study, several of these issues were addressed. To the best of our knowledge, this study reports for the first time the upregulation of both the circular and the linear isoform of USP3 and METTL3 in leukocytes from patients with CRC. The linear transcripts of USP3 and METTL3 exhibited 2.3- and 2-fold increases on average in CRC samples (n=42 CRC) compared with the respective healthy controls (n=32), whereas their circular isoforms showed 1.6- and 1.7-fold increases, respectively. Moreover, a strong positive correlation was observed between the circular and linear isoforms of USP3 in the CRC cohort (P<0.0001), but not in the control group (P>0.05). In addition, the linear USP3 assay had excellent sensitivity (79%), specificity (75%), positive predictive value (81%), negative predictive value (73%) and area under the curve (AUC, 0.8534; P-value <0.0001). The circular (AUC, 0.6946; P-value =0.0043) and linear (AUC, 0.7202; P-value =0.0012) METTL3 assays also showed potential; however, this was not the case for the circular USP3 assay (P-value >0.05). Taken together, this stringent RT-qPCR approach provides evidence for the viability of using circular and linear RNA molecules as disease biomarkers and may help shed light on the regulatory pathways of CRC.
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Affiliation(s)
- Bilal Alkhizzi
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Mohammad Imran Khan
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Center for Artificial Intelligence in Precision Medicines, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ayat Al-Ghafari
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Scientific Research Center, Dar Al-Hekma University, Jeddah 22246, Saudi Arabia.,Cancer and Mutagenesis Unit, King Fahd Medical Research Centre, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hani Choudhry
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia.,Center for Artificial Intelligence in Precision Medicines, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Tanaka H, Urabe Y, Oka S, Shimohara Y, Nishimura T, Inagaki K, Okamoto Y, Matsumoto K, Yamashita K, Sumimoto K, Ninomiya Y, Yuge R, Tanaka S, Chayama K. Clinical Features and Genomic Characterization of Post-Colonoscopy Colorectal Cancer. Clin Transl Gastroenterol 2020; 11:e00246. [PMID: 33031197 DOI: 10.14309/ctg.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Some colorectal cancers (CRCs) may be missed during colonoscopies. We aimed to determine the clinicopathological, biological, and genomic characteristics of post-colonoscopy CRCs (PCCRCs). METHODS Of the 1,619 consecutive patients with 1,765 CRCs detected between 2008 and 2016, 63 patients with 67 PCCRCs, when colonoscopies were performed 6-60 months before diagnosis, were recruited. After excluding patients with inflammatory bowel disease, familial polyposis syndrome, CRCs that developed from diminutive adenomatous polyps, and recurrent CRCs after endoscopic resection, 32 patients with 34 PCCRCs were enrolled. The lesions' clinicopathological features, mismatch repair proteins (MMRs), and genomic alterations were investigated. RESULTS The overall PCCRC-5y rate, rate of intramucosal (Tis) lesions, and rate of T1 or more deeply invasive cancers were 3.7% (66/1,764), 3.9% (32/820), and 3.6% (34/944), respectively. Thirty-three patients' MMRs were investigated; 7 (21%) exhibited deficient MMRs (dMMRs), comprising 4 with T2 or more deeply invasive cancers and 5 whose lesions were in the proximal colon. Twenty-three tumors' genomic mutations were investigated; PIK3CA had mutated in 5 of 6 T2 or more deeply invasive cancers, of which, 4 were located in the proximal colon. Two patients with dMMRs and BRAF mutations had poor prognoses. Sixty-one percent (17/28) of the macroscopic type 0 lesions were superficial. All superficial Tis and T1 PCCRCs were detected <24 months after the negative colonoscopies. They were distributed throughout the colon and rectum. DISCUSSION PCCRCs may be invasive cancers in the proximal colon that exhibit dMMRs and/or PIK3CA mutations or missed early CRCs especially superficial lesions.
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Qian C, Cai R, Zhang W, Wang J, Hu X, Zhang Y, Jiang B, Yuan H, Liu F. Neutrophil-Lymphocyte Ratio and Circulating Tumor Cells Counts Predict Prognosis in Gastrointestinal Cancer Patients. Front Oncol 2021; 11:710704. [PMID: 34307180 PMCID: PMC8293392 DOI: 10.3389/fonc.2021.710704] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose The purpose of this study is to explore the prognostic value of associating pre-treatment neutrophil–lymphocyte ratio (NLR) with circulating tumor cells counts (CTCs) in patients with gastrointestinal cancer. Materials and Methods We collected the related data of 72 patients with gastric cancer (GC) and colorectal cancer (CRC) who received different therapies from August 2016 to October 2020, including age, gender, primary tumor location, TNM stage, tumor-differentiation, NLR, CTCs, disease-free survival (DFS) and overall survival (OS). We chose the optimal cut-off value of NLR >3.21 or NLR ≤3.21 and CTC >1 or CTC ≤1 by obtaining receiver operating characteristic (ROC) curve. The Kaplan–Meier survival analysis and Cox regression analysis were used to analyze DFS and OS. To clarify the role of the combination of NLR and CTCs counts in predicting the prognosis, we analyzed the DFS and OS when associated NLR and CTCs counts. Results A high NLR (>3.21) was associated with shorter DFS (P <0.0001) and OS (P <0.0001). Patients with high CTCs level (>1) had shorter DFS (P = 0.001) and OS (P = 0.0007) than patients with low CTCs level. Furthermore, patients who had both higher NLR and higher CTCs counts had obvious shorter DFS (P <0.0001) and OS (P <0.0001). Conclusions Patients with higher NLR and more CTCs respectively tended to have poor prognosis with shorter DFS and OS, which might be regarded as predictors of gastrointestinal cancer. In particular, associating NLR and CTCs counts might be a reliable predictor in patients with gastrointestinal cancer.
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Affiliation(s)
- Chengcheng Qian
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renjie Cai
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenying Zhang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiongyi Wang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaohua Hu
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanjie Zhang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Jiang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haihua Yuan
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feng Liu
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sehgal M, Ladabaum U, Mithal A, Singh H, Desai M, Singh G. Colorectal Cancer Incidence After Colonoscopy at Ages 45-49 or 50-54 Years. Gastroenterology 2021; 160:2018-2028.e13. [PMID: 33577872 DOI: 10.1053/j.gastro.2021.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) incidence at ages younger than 50 years is increasing, leading to proposals to lower the CRC screening initiation age to 45 years. Data on the effectiveness of CRC screening at ages 45-49 years are lacking. METHODS We studied the association between undergoing colonoscopy at ages 45-49 or 50-54 years and CRC incidence in a retrospective population-based cohort study using Florida's linked Healthcare Cost and Utilization Project databases with mandated reporting from 2005 to 2017 and Cox models extended for time-varying exposure. RESULTS Among 195,600 persons with and 2.6 million without exposure to colonoscopy at ages 45-49 years, 276 and 4844 developed CRC, resulting in CRC incidence rates of 20.8 (95% CI, 18.5-23.4) and 30.6 (95% CI, 29.8-31.5) per 100,000 person-years, respectively. Among 660,248 persons with and 2.4 million without exposure to colonoscopy at ages 50-54 years, 798 and 6757 developed CRC, resulting in CRC incidence rates of 19.0 (95% CI, 17.7-20.4) and 51.9 (95% CI, 50.7-53.1) per 100,000 person-years, respectively. The adjusted hazard ratios for incident CRC after undergoing compared with not undergoing colonoscopy were 0.50 (95% CI, 0.44-0.56) at ages 45-49 years and 0.32 (95% CI, 0.29-0.34) at ages 50-54 years. The results were similar for women and men (hazard ratio, 0.48; 95% CI, 0.40-0.57 and hazard ratio, 0.52; 95% CI, 0.43-0.62 at ages 45-49 years, and hazard ratio, 0.35; 95% CI, 0.31-0.39 and hazard ratio, 0.29; 95% CI, 0.26-0.32 at ages 50-54 years, respectively). CONCLUSIONS Colonoscopy at ages 45-49 or 50-54 years was associated with substantial decreases in subsequent CRC incidence. These findings can inform screening guidelines.
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Affiliation(s)
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
| | - Alka Mithal
- Institute of Clinical Outcomes Research and Education, Woodside, California
| | - Harminder Singh
- Section of Gastroenterology, University of Manitoba, Winnipeg, Canada
| | - Manisha Desai
- Division of Bioinformatics Research, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Gurkirpal Singh
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California; Institute of Clinical Outcomes Research and Education, Woodside, California
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Redwood DG, Dinh TA, Kisiel JB, Borah BJ, Moriarty JP, Provost EM, Sacco FD, Tiesinga JJ, Ahlquist DA. Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People. Mayo Clin Proc 2021; 96:1203-1217. [PMID: 33840520 DOI: 10.1016/j.mayocp.2020.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/17/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults. PATIENTS AND METHODS A Markov model was used to evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence and mortality, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The study incorporated updated evidence on screening test performance and adherence and was conducted from December 15, 2016, through November 6, 2019. RESULTS With perfect adherence, CRC incidence was reduced by 52% (95% CI, 46% to 56%) using colonoscopy, 61% (95% CI, 57% to 64%) using annual FIT, and 66% (95% CI, 63% to 68%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15, 0.17, and 0.19 QALYs per person with colonoscopy, FIT, and MT-sDNA, respectively. Colonoscopy is the most expensive strategy: approximately $110 million more than MT-sDNA and $127 million more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs per person vs 0.05 and 0.06 QALYs per person by FIT and colonoscopy, respectively. Probabilistic sensitivity analyses supported the base-case analysis. Under varied adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs, $1740-$75,868 per QALY saved) compared with FIT and colonoscopy. CONCLUSION Each strategy reduced costs and increased QALYs compared with no screening. Screening by MT-sDNA results in the largest QALY savings. In Markov model analysis, screening by MT-sDNA in the Alaska Native population was cost-effective compared with screening by colonoscopy and FIT for a wide range of adherence scenarios.
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Veettil SK, Kew ST, Lim KG, Phisalprapa P, Kumar S, Lee YY, Chaiyakunapruk N. Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis. BMC Gastroenterol 2021; 21:130. [PMID: 33743605 PMCID: PMC7981989 DOI: 10.1186/s12876-021-01715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/10/2021] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC). METHODS Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk-benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained. RESULTS According to NMA, the risk-benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective. CONCLUSION ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacotherapy, College of Pharmacy, The University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA.,Department of Pharmacy Practice, School of Pharmacy, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Siang Tong Kew
- Department of Internal Medicine, School of Medicine, International Medical University, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Kean Ghee Lim
- Department of Surgery, International Medical University, Negeri Sembilan, Jalan Rasah, 70300, Seremban, Malaysia
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Suresh Kumar
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,Gut Research Group, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, The University of Utah, 30 2000 E, Salt Lake City, UT, 84112, USA. .,School of Pharmacy, Monash University Malaysia, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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Yang SY, Quan SY, Friedland S, Pan JY. Predictive factors for adenoma detection rates: a video study of endoscopist practices. Endosc Int Open 2021; 9:E216-E223. [PMID: 33553584 PMCID: PMC7857972 DOI: 10.1055/a-1321-0990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background and study aims In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) and American College of Gastroenterology (ACG) Task Force on Quality in Endoscopy deemed adenoma detection rate (ADR) the most important quality measure for colonoscopy. There has been much interest in factors that can increase ADR. To date, however, few studies have looked at what intra-procedural endoscopist practices are associated with improving ADR. We conducted a retrospective review of colonoscopy videos to evaluate intra-procedural practices that could be associated with ADR. Methods Videos were recorded of colonoscopies performed between September and December 2017 at the Palo Alto Veterans Affairs Health Care System. Colonoscopies for screening and surveillance were included for video review. Factors assessed included withdrawal time, intra-procedural cleaning, inspection technique, and other variables (colon distention, removal of equivocal/hyperplastic polyps). A series of multiple regression analyses was conducted on variables of interest before running a final model of significant predictors. Results A total of 130 videos were reviewed from nine endoscopists whose ADRs ranged between 37.5 % and 73.7 %. The final regression model was significant (F = 15.35, df = 2, P = 0.0044), R 2 = 0.8365) with close inspection of behind folds and quality of cecal inspection being the factors highly correlated with predicting ADR. Withdrawal and inspection times, colonic wall distention, removal of equivocal/hyperplastic polyps, quality of rectal inspection, suctioning, and washing were factors moderately correlated with predicting ADR. Conclusions We found that behind-fold inspection and a meticulous cecal inspection technique were predictive of a high ADR.
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Affiliation(s)
- Sun Young Yang
- Division of Gastroenterology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Susan Y. Quan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shai Friedland
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jennifer Y. Pan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, United States,Division of Gastroenterology & Hepatology, Stanford University School of Medicine, Palo Alto, California, United States
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50
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Xue Y, Li PD, Tang XM, Yan ZH, Xia SS, Tian HP, Liu ZL, Zhou T, Tang XG, Zhang GJ. Cytochrome C Oxidase Assembly Factor 1 Homolog Predicts Poor Prognosis and Promotes Cell Proliferation in Colorectal Cancer by Regulating PI3K/AKT Signaling. Onco Targets Ther 2020; 13:11505-11516. [PMID: 33204105 PMCID: PMC7667209 DOI: 10.2147/ott.s279024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/22/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose Colorectal cancer (CRC) is one of the most common malignancies in the world. The prognosis of advanced CRC is still poor. The purpose of this study was to identify a gene expression profile associated with CRC that may contribute to the early diagnosis of CRC and improve patient prognosis. Patients and Methods Five pairs of CRC tissues and paracancerous tissues were used to identify causative genes using microarray assays. The prognostic value of Cytochrome C Oxidase Assembly Factor 1 Homolog (COA1) in CRC was assessed in 90 CRC patients. Loss-of-function assays, cell proliferation assays using Celigo and MTT, colony formation assays, a subcutaneous xenograft mouse model, and apoptosis assays were used to define the effects of downregulation of COA1 in CRC cells in vitro and in vivo. The underlying molecular mechanisms of COA1 in CRC were also investigated. Results The causative gene COA1 was identified through microarray analysis. COA1 expression in CRC was notably associated with pathologic differentiation, tumor size, and tumor depth. COA1 expression may act as an independent prognostic factor for overall survival of CRC. Knockdown of COA1 inhibited the proliferation of CRC cells in vitro and the tumorigenicity of CRC cells in vivo. Decreased COA1 expression induced apoptosis of CRC cells. Based on the microarray assay results comparing HCT116 cells transfected with lentivirus encoding anti-COA1 shRNA or negative control shRNA, ingenuity pathway analysis (IPA) revealed that the PI3K/AKT signaling pathway was significantly enriched. Moreover, CCND1, mTOR, AKT1, and MDM2 were identified as the downstream genes of COA1. Conclusion These findings demonstrate that COA1 promotes CRC cell proliferation and inhibits apoptosis by regulating the PI3K/AKT signaling pathway. Our results implicate COA1 as a potential oncogene involved in tumor growth and progression of CRC.
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Affiliation(s)
- Yuan Xue
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Pei-Dong Li
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Xue-Mei Tang
- Department of Ultrasound, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Zai-Hua Yan
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Shu-Sen Xia
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Hong-Peng Tian
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Zuo-Liang Liu
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Tong Zhou
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Xue-Gui Tang
- Anorectal Department of Integrated Traditional Chinese and Western Medicine, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
| | - Guang-Jun Zhang
- The Second Department of Gastrointestinal Surgery, The Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China.,Institute of Hepatobiliary, Pancreatic and Intestinal Disease, North Sichuan Medical College, Nanchong, Sichuan, People's Republic of China
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