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Engel C, Ahadova A, Seppälä TT, Aretz S, Bigirwamungu-Bargeman M, Bläker H, Bucksch K, Büttner R, de Vos Tot Nederveen Cappel WT, Endris V, Holinski-Feder E, Holzapfel S, Hüneburg R, Jacobs MAJM, Koornstra JJ, Langers AM, Lepistö A, Morak M, Möslein G, Peltomäki P, Pylvänäinen K, Rahner N, Renkonen-Sinisalo L, Schulmann K, Steinke-Lange V, Stenzinger A, Strassburg CP, van de Meeberg PC, van Kouwen M, van Leerdam M, Vangala DB, Vecht J, Verhulst ML, von Knebel Doeberitz M, Weitz J, Zachariae S, Loeffler M, Mecklin JP, Kloor M, Vasen HF. Associations of Pathogenic Variants in MLH1, MSH2, and MSH6 With Risk of Colorectal Adenomas and Tumors and With Somatic Mutations in Patients With Lynch Syndrome. Gastroenterology 2020; 158:1326-1333. [PMID: 31926173 DOI: 10.1053/j.gastro.2019.12.032] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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: 08/18/2019] [Revised: 12/05/2019] [Accepted: 12/24/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Lynch syndrome is caused by variants in DNA mismatch repair (MMR) genes and associated with an increased risk of colorectal cancer (CRC). In patients with Lynch syndrome, CRCs can develop via different pathways. We studied associations between Lynch syndrome-associated variants in MMR genes and risks of adenoma and CRC and somatic mutations in APC and CTNNB1 in tumors in an international cohort of patients. METHODS We combined clinical and molecular data from 3 studies. We obtained clinical data from 2747 patients with Lynch syndrome associated with variants in MLH1, MSH2, or MSH6 from Germany, the Netherlands, and Finland who received at least 2 surveillance colonoscopies and were followed for a median time of 7.8 years for development of adenomas or CRC. We performed DNA sequence analyses of 48 colorectal tumors (from 16 patients with mutations in MLH1, 29 patients with mutations in MSH2, and 3 with mutations in MSH6) for somatic mutations in APC and CTNNB1. RESULTS Risk of advanced adenoma in 10 years was 17.8% in patients with pathogenic variants in MSH2 vs 7.7% in MLH1 (P < .001). Higher proportions of patients with pathogenic variants in MLH1 or MSH2 developed CRC in 10 years (11.3% and 11.4%) than patients with pathogenic variants in MSH6 (4.7%) (P = .001 and P = .003 for MLH1 and MSH2 vs MSH6, respectively). Somatic mutations in APC were found in 75% of tumors from patients with pathogenic variants in MSH2 vs 11% in MLH1 (P = .015). Somatic mutations in CTNNB1 were found in 50% of tumors from patients with pathogenic variants in MLH1 vs 7% in MSH2 (P = .002). None of the 3 tumors with pathogenic variants in MSH6 had a mutation in CTNNB1, but all had mutations in APC. CONCLUSIONS In an analysis of clinical and DNA sequence data from patients with Lynch syndrome from 3 countries, we associated pathogenic variants in MMR genes with risk of adenoma and CRC, and somatic mutations in APC and CTNNB1 in colorectal tumors. If these findings are confirmed, surveillance guidelines might be adjusted based on MMR gene variants.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
| | - Aysel Ahadova
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Toni T Seppälä
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; University of Helsinki, Helsinki, Finland; Johns Hopkins University, Surgical Oncology, Baltimore, Maryland
| | - Stefan Aretz
- Institute of Human Genetics, University of Bonn, Bonn, Germany; National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | | | - Hendrik Bläker
- Institute of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | | | - Volker Endris
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Elke Holinski-Feder
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Stefanie Holzapfel
- Institute of Human Genetics, University of Bonn, Bonn, Germany; National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Robert Hüneburg
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Maarten A J M Jacobs
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan J Koornstra
- Department of Gastroenterology & Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Alexandra M Langers
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna Lepistö
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland
| | - Monika Morak
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Gabriela Möslein
- Center for Hereditary Tumors, HELIOS Klinikum Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Päivi Peltomäki
- Department of Medical and Clinical Genetics, University of Helsinki, Helsinki, Finland
| | - Kirsi Pylvänäinen
- Department of Education and Science, Central Finland Hospital District, Jyväskylä, Finland
| | - Nils Rahner
- Institute of Human Genetics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Laura Renkonen-Sinisalo
- Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland; Research Programs Unit, Genome-Scale Biology, University of Helsinki, Helsinki, Finland
| | - Karsten Schulmann
- Department of Hematology and Oncology, Klinikum Hochsauerland, Meschede, Germany; MVZ Arnsberg, Medical Practice for Hematology and Oncology, Arnsberg, Germany
| | - Verena Steinke-Lange
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Albrecht Stenzinger
- Department of General Pathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian P Strassburg
- National Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Paul C van de Meeberg
- Department of Gastroenterology & Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Mariette van Kouwen
- Department of Gastroenterology & Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monique van Leerdam
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Deepak B Vangala
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Juda Vecht
- Department of Gastroenterology & Hepatology, Isala Zwolle, Zwolle, The Netherlands
| | - Marie-Louise Verhulst
- Department of Gastroenterology & Hepatology, Maxima Medical Centre, Eindhoven, The Netherlands
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus of the Technical University Dresden, Dresden, Germany
| | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jukka-Pekka Mecklin
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hans F Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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2
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Engel C, Vasen HF, Seppälä T, Aretz S, Bigirwamungu-Bargeman M, de Boer SY, Bucksch K, Büttner R, Holinski-Feder E, Holzapfel S, Hüneburg R, Jacobs MAJM, Järvinen H, Kloor M, von Knebel Doeberitz M, Koornstra JJ, van Kouwen M, Langers AM, van de Meeberg PC, Morak M, Möslein G, Nagengast FM, Pylvänäinen K, Rahner N, Renkonen-Sinisalo L, Sanduleanu S, Schackert HK, Schmiegel W, Schulmann K, Steinke-Lange V, Strassburg CP, Vecht J, Verhulst ML, de Vos Tot Nederveen Cappel W, Zachariae S, Mecklin JP, Loeffler M. No Difference in Colorectal Cancer Incidence or Stage at Detection by Colonoscopy Among 3 Countries With Different Lynch Syndrome Surveillance Policies. Gastroenterology 2018; 155:1400-1409.e2. [PMID: 30063918 DOI: 10.1053/j.gastro.2018.07.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 01/21/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Patients with Lynch syndrome are at high risk for developing colorectal cancer (CRC). Regular colonoscopic surveillance is recommended, but there is no international consensus on the appropriate interval. We investigated whether shorter intervals are associated with lower CRC incidence and detection at earlier stages by comparing the surveillance policies in Germany, which evaluates patients by colonoscopy annually, in the Netherlands (patients evaluated at 1-2-year intervals), and Finland (patients evaluated at 2-3-year intervals). METHODS We collected data from 16,327 colonoscopic examinations (conducted from 1984 through 2015) of 2747 patients with Lynch syndrome (pathogenic variants in the MLH1, MSH2, or MSH6 genes) from the German HNPCC Consortium, the Dutch Lynch Syndrome Registry, and the Finnish Lynch Syndrome Registry. Our analysis included 23,309 person-years of cumulative observation time. Time from the index colonoscopy to incident CRC or adenoma was analyzed using the Kaplan-Meier method; groups were compared using the log-rank test. We performed multivariable Cox regression analyses to identify factors associated with CRC risk (diagnosis of CRC before the index colonoscopy, sex, mutation, age, and presence of adenoma at the index colonoscopy). RESULTS The 10-year cumulative CRC incidence ranged from 4.1% to 18.4% in patients with low- and high-risk profiles, respectively, and varied with age, sex, mutation, and prior detection of CRC or adenoma. Observed colonoscopy intervals were largely in accordance with the country-specific recommendations. We found no significant differences in cumulative CRC incidence or CRC stage at detection among countries. There was no significant association between CRC stage and time since last colonoscopy. CONCLUSIONS We did not find a significant reduction in CRC incidence or stage of detection in Germany (annual colonoscopic surveillance) than in countries with longer surveillance intervals (the Netherlands, with 1-2-year intervals, and Finland, with 2-3-year intervals). Overall, we did not find a significant association of the interval with CRC risk, although age, sex, mutation, and prior neoplasia were used to individually modify colonoscopy intervals. Studies are needed to develop and validate risk-adapted surveillance strategies and to identify patients who benefit from shorter surveillance intervals.
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Affiliation(s)
- Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany.
| | - Hans F Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Toni Seppälä
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Stefan Aretz
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | | | - Sybrand Y de Boer
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Karolin Bucksch
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Elke Holinski-Feder
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Stefanie Holzapfel
- Institute of Human Genetics, University of Bonn, Bonn, Germany; Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany
| | - Robert Hüneburg
- Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology, Free University Medical Centre, Amsterdam, The Netherlands
| | - Heikki Järvinen
- Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Matthias Kloor
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Magnus von Knebel Doeberitz
- Department of Applied Tumour Biology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Cooperation Unit Applied Tumour Biology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jan J Koornstra
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariette van Kouwen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alexandra M Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Paul C van de Meeberg
- Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Monika Morak
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Gabriela Möslein
- Center for Hereditary Tumors, HELIOS Klinikum Wuppertal, University Witten-Herdecke, Wuppertal, Germany
| | - Fokko M Nagengast
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kirsi Pylvänäinen
- Department of Education and Research, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Nils Rahner
- Institute of Human Genetics, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Silvia Sanduleanu
- Department of Gastroenterology and Hepatology, University Medical Centre Maastricht, Maastricht, The Netherlands
| | - Hans K Schackert
- Department of Surgical Research, Technische Universität Dresden, Dresden, Germany
| | - Wolff Schmiegel
- Department of Medicine, Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Karsten Schulmann
- Department of Internal Medicine, Hematology and Oncology, Klinikum Arnsberg, Arnsberg, Germany
| | - Verena Steinke-Lange
- Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany; Center of Medical Genetics, Munich, Germany
| | - Christian P Strassburg
- Center for Hereditary Tumor Syndromes, University Hospital Bonn, Bonn, Germany; Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Juda Vecht
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
| | - Marie-Louise Verhulst
- Department of Gastroenterology and Hepatology, Maxima Medical Centre, Eindhoven, The Netherlands
| | | | - Silke Zachariae
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Jukka-Pekka Mecklin
- Departments of Education and Research and Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland; Sports and Health Sciences, Jyväskylä University, Jyväskylä, Finland
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
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3
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Nissen LHC, Derikx LAAP, Jacobs AME, van Herpen CM, Kievit W, Verhoeven R, van den Broek E, Bekers E, van den Heuvel T, Pierik M, Rahamat-Langendoen J, Takes RP, Melchers WJG, Nagtegaal ID, Hoentjen F, Peutz-Kootstra C, Roelofs JJTH, Willems SM, Willig AP, van Bodegraven AA, Tan ACITL, Meeuse JJ, van der Meulen–de Jong AE, Oldenburg B, Loffeld BCAJ, Durfeld BM, van der Woude CJ, Cahen DL, D’Haens G, Janik D, Mares WGM, Gilissen LPL, Wolters FL, Dijkstra G, Erkelens GW, Tang TJ, Breumelhof R, Smalbraak HJT, Thijs JC, Voskuil JH, Kuyvenhoven JP, Vecht J, Rijk MCM, Janssen JM, Sarneel JT, Tjhie-Wensing JWM, Lai JYL, Vlasveld LT, Oostenbrug LE, Gerretsen M, Van Herwaarden MA, Mahmmod N, Russel MGVM, Grubben MJAL, Vu MK, Verhulst ML, Dewint P, Stokkers PCF, Bus PJ, Wismans PJ, van der Haeck PWE, Stuyt RJL, Zeijen RNM, Dahlmans RPM, Vandebosch S, Romkens TEH, Moolenaar W, ten Hove WR, Boot H, van der Linde K, Wahab P, de Boer SY, Thurnau K, Thijs WJ, Josemanders DFGM, West RL, Pierik MJ, Depla ACTM, Keulen ETP, de Boer WA, Naber AHJ, Vermeijden JR, Mallant-Hent RC, Beukers R, Ter Borg PCJ, Halet ECR, Bruin KF, Linskens RK, Bruins Slot W. Risk Factors and Clinical Outcomes of Head and Neck Cancer in Inflammatory Bowel Disease: A Nationwide Cohort Study. Inflamm Bowel Dis 2018; 24:2015-2026. [PMID: 30759216 DOI: 10.1093/ibd/izy096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 09/18/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immunosuppressed inflammatory bowel disease (IBD) patients are at increased risk to develop extra-intestinal malignancies. Immunosuppressed transplant patients show increased incidence of head and neck cancer with impaired survival. This study aims to identify risk factors for oral cavity (OCC) and pharyngeal carcinoma (PC) development in IBD, to compare clinical characteristics in IBD with the general population, and to assess the influence of immunosuppressive medication on survival. METHODS We retrospectively searched the Dutch Pathology Database to identify all IBD patients with OCC and PC between 1993 and 2011. Two case-control studies were performed: We compared cases with the general IBD population to identify risk factors, and we compared cases with non-IBD cancer patients for outcome analyses. RESULTS We included 66 IBD patients and 2141 controls with OCC, 31 IBD patients and 1552 controls with PC, and 1800 IBD controls. Age at IBD diagnosis was a risk factor for OCC development, Crohn's disease (CD; odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.07), and ulcerative colitis (UC; OR, 1.03; 95% CI, 1.01-1.06). For PC, this applied to UC (OR, 1.05; 95% CI, 1.01-1.06). IBD OCC cases showed impaired survival (P = 0.018); in PC, survival was similar. There was no effect of immunosuppression on survival. Human papillomavirus (HPV) testing of IBD cases revealed 52.2% (12/23) HPV-positive oropharyngeal carcinomas (OPCs). CONCLUSION This study shows that IBD is associated with impaired OCC survival. Higher age at IBD diagnosis is a risk factor for OCC development. We found no influence of immunosuppression on survival; 52.2% of OPC in IBD contained HPV.
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Affiliation(s)
- Loes H C Nissen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology.,Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands
| | | | - Anouk M E Jacobs
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology
| | - Carla M van Herpen
- Department of Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rob Verhoeven
- Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organization
| | | | - Elise Bekers
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tim van den Heuvel
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marieke Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Robert P Takes
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Centre, Department of Gastroenterology and Hepatology
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Argillander TE, Koornstra JJ, van Kouwen M, Langers AM, Nagengast FM, Vecht J, de Vos Tot Nederveen Cappel WH, Dekker E, van Duijvendijk P, Vasen HF. Features of incident colorectal cancer in Lynch syndrome. United European Gastroenterol J 2018; 6:1215-1222. [PMID: 30288284 DOI: 10.1177/2050640618783554] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/09/2018] [Accepted: 05/24/2018] [Indexed: 12/30/2022] Open
Abstract
Background and objective Despite intensive colonoscopic surveillance, a substantial proportion of Lynch syndrome (LS) patients develop colorectal cancer (CRC). The aim of this study was to characterize incident CRC in LS patients. Methods All patients diagnosed with incident CRC after start of colonoscopic surveillance were identified in the Dutch LS Registry of 905 patients. A retrospective analysis of patient records was carried out for patient characteristics, survival, CRC characteristics and findings of previous colonoscopy. Results Seventy-one patients (7.8%) were diagnosed with incident CRC. Median interval between incident CRC diagnosis and previous colonoscopy was 23.8 (range 6.7-45.6) months. Median tumor diameter was 2.5 cm, and 17% of the tumors were sessile or flat. Most patients (83%) had no lymph node metastases. There was no association between tumor size and colonoscopy interval or lymph node status. Most patients (65%) had no adenomas during previous colonoscopy. Two patients (2.8%) eventually died from metastatic CRC. Conclusion The high frequency of incident CRC in LS likely results from several factors. Our findings lend support to the hypothesis of fast conversion of adenomas to CRC, as 65% of patients had no report of polyps during previous colonoscopy. High-quality colonoscopies are essential, especially as tumors and adenomas are difficult to detect because of their frequent non-polypoid appearance. Early detection due to surveillance as well as the indolent growth of CRC, as demonstrated by the lack of lymph node metastases, contributes to the excellent survival observed.
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Affiliation(s)
- Tanja E Argillander
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan J Koornstra
- Department of Gastroenterology & Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariette van Kouwen
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexandra Mj Langers
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fokko M Nagengast
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juda Vecht
- Department of Gastroenterology & Hepatology, Isala Clinics, Zwolle, The Netherlands
| | | | - Evelien Dekker
- Department of Gastroenterology & Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Hans Fa Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Soer E, de Vos Tot Nederveen Cappel WH, Ligtenberg MJL, Moll F, Pierik RG, Vecht J, Vasen HFA, Flierman A. Massive gastric polyposis associated with a germline SMAD4 gene mutation. Fam Cancer 2016; 14:569-73. [PMID: 26159157 DOI: 10.1007/s10689-015-9822-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Juvenile polyposis syndrome (JPS) is a rare autosomal dominant disorder characterized by the development of multiple hamartomatous polyps in the gastrointestinal tract. Polyps are most common in the colorectum (98% of patients) and the stomach (14%). Causative mutations for JPS have been identified in two genes to date, SMAD4 and BMPR1A. SMAD4 mutations are associated with a higher incidence of gastric polyposis. In this case report, we describe two patients with massive gastric polyposis associated with a SMAD4 mutation. Both presented with anaemia and both had colonic polyps. Initial endoscopic findings revealed giant rugal folds suggestive of Ménétrier disease. However, as other possible gastropathies could not be differentiated on the basis of histology, a definitive diagnosis of JPS required additional mutation analysis. In patients with polyposis predominant in or limited to the stomach, establishing a diagnosis based solely on the pathological features of polyps can be challenging due to difficulties in differentiating JPS from other hypertrophic gastropathies. Mutation analysis should be considered early in the diagnostic process in cases of suspected juvenile polyposis, thus facilitating rapid diagnosis and adequate follow-up.
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Affiliation(s)
- Eline Soer
- Department of Gastroenterology and Hepatology, Isala Clinics, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands.
| | | | | | - Freek Moll
- Department of Pathology, Isala Clinics, Zwolle, The Netherlands
| | - Robert G Pierik
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
| | - Juda Vecht
- Department of Gastroenterology and Hepatology, Isala Clinics, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
| | - Hans F A Vasen
- The Netherlands Foundation for the Detection of Hereditary Tumors, Leiden, The Netherlands
| | - Antoine Flierman
- Department of Gastroenterology and Hepatology, Isala Clinics, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands
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Hennink SD, van der Meulen-de Jong AE, Wolterbeek R, Crobach ASLP, Becx MCJM, Crobach WFSJ, van Haastert M, Ten Hove WR, Kleibeuker JH, Meijssen MAC, Nagengast FM, Rijk MCM, Salemans JMJI, Stronkhorst A, Tuynman HARE, Vecht J, Verhulst ML, de Vos Tot Nederveen Cappel WH, Walinga H, Weinhardt OK, Westerveld D, Witte AMC, Wolters HJ, Cats A, Veenendaal RA, Morreau H, Vasen HFA. Randomized Comparison of Surveillance Intervals in Familial Colorectal Cancer. J Clin Oncol 2015; 33:4188-93. [PMID: 26527788 DOI: 10.1200/jco.2015.62.2035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Colonoscopic surveillance is recommended for individuals with familial colorectal cancer (CRC). However, the appropriate screening interval has not yet been determined. The aim of this randomized trial was to compare a 3-year with a 6-year screening interval. PATIENTS AND METHODS Individuals between ages 45 and 65 years with one first-degree relative with CRC age < 50 years or two first-degree relatives with CRC were selected. Patients with zero to two adenomas at baseline were randomly assigned to one of two groups: group A (colonoscopy at 6 years) or group B (colonoscopy at 3 and 6 years). The primary outcome measure was advanced adenomatous polyps (AAPs). Risk factors studied included sex, age, type of family history, and baseline endoscopic findings. RESULTS A total of 528 patients were randomly assigned (group A, n = 262; group B, n = 266). Intention-to-treat analysis showed no significant difference in the proportion of patients with AAPs at the first follow-up examination at 6 years in group A (6.9%) versus 3 years in group B (3.5%). Also, the proportion of patients with AAPs at the final follow-up examination at 6 years in group A (6.9%) versus 6 years in group B (3.4%) was not significantly different. Only AAPs at baseline was a significant predictor for the presence of AAPs at first follow-up. After correction for the difference in AAPs at baseline, differences between the groups in the rate of AAPs at first follow-up and at the final examination were statistically significant. CONCLUSION In view of the relatively low rate of AAPs at 6 years and the absence of CRC in group A, we consider a 6-year surveillance interval appropriate. A surveillance interval of 3 years might be considered in patients with AAPs and patients with ≥ three adenomas.
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Affiliation(s)
- Simone D Hennink
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Andrea E van der Meulen-de Jong
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Ron Wolterbeek
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - A Stijn L P Crobach
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Marco C J M Becx
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Wiet F S J Crobach
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Michiel van Haastert
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - W Rogier Ten Hove
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Jan H Kleibeuker
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Maarten A C Meijssen
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Fokko M Nagengast
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Marno C M Rijk
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Jan M J I Salemans
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Arnold Stronkhorst
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Hans A R E Tuynman
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Juda Vecht
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Marie-Louise Verhulst
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Wouter H de Vos Tot Nederveen Cappel
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Herman Walinga
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Olaf K Weinhardt
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Dik Westerveld
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Anne M C Witte
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Hugo J Wolters
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Annemieke Cats
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Roeland A Veenendaal
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Hans Morreau
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands
| | - Hans F A Vasen
- Simone D. Hennink, Andrea E. van der Meulen-de Jong, Ron Wolterbeek, A. Stijn L.P. Crobach, Roeland A. Veenendaal, Hans Morreau, and Hans F.A. Vasen, Leiden University Medical Center; Wiet F.S.J. Crobach, W. Rogier ten Hove, and Anne M.C. Witte, Diaconessenhuis, Leiden; Marco C.J.M. Becx, St Antonius Hospital, Nieuwegein; Michiel van Haastert and Hugo J. Wolters, Martini Hospital; Jan H. Kleibeuker, University Medical Center Groningen, Groningen; Maarten A.C. Meijssen, Juda Vecht, Wouter H. de Vos tot Nederveen Cappel, and Dik Westerveld, Isala Clinics, Zwolle; Fokko M. Nagengast, Radboud University Medical Center, Nijmegen; Marno C.M. Rijk, Amphia Hospital, Breda; Jan M.J.I. Salemans and Marie-Louise Verhulst, Máxima Medical Center; Arnold Stronkhorst, Catharina Hospital, Eindhoven; Hans A.R.E. Tuynman, Medical Center Alkmaar, Alkmaar; Herman Walinga, Reinier de Graaf Gasthuis, Delft; Olaf K. Weinhardt, Scheper Hospital, Emmen; and Annemieke Cats, National Cancer Institute, Amsterdam, the Netherlands.
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7
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van Heijningen EMB, Lansdorp-Vogelaar I, Steyerberg EW, Goede SL, Dekker E, Lesterhuis W, ter Borg F, Vecht J, Spoelstra P, Engels L, Bolwerk CJM, Timmer R, Kleibeuker JH, Koornstra JJ, de Koning HJ, Kuipers EJ, van Ballegooijen M. Adherence to surveillance guidelines after removal of colorectal adenomas: a large, community-based study. Gut 2015; 64:1584-92. [PMID: 25586057 PMCID: PMC4602240 DOI: 10.1136/gutjnl-2013-306453] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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] [Received: 11/16/2013] [Revised: 09/29/2014] [Accepted: 10/18/2014] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine adherence to recommended surveillance intervals in clinical practice. DESIGN 2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within ± 3 months of a 1-year recommended interval and ± 6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing. RESULTS Surveillance was inappropriate in 76% and 89% of patients diagnosed before 2002 and in 2002, respectively. Patients eligible under the pre-2002 guideline mainly received surveillance too late or were absent (57% of cases). For patients eligible under the 2002 guideline surveillance occurred mainly too early (48%). The rate of advanced neoplasia at surveillance was higher in patients with delayed surveillance compared with those with too early or appropriate timed surveillance (8% vs 4-5%, p<0.01). CONCLUSIONS There is much room for improving surveillance practice. Less than 25% of patients with adenoma receive appropriate surveillance. Such practice seriously hampers the effectiveness and efficiency of surveillance, as too early surveillance poses a considerable burden on available resources while delayed surveillance is associated with an increased rate of advanced adenoma and especially colorectal cancer.
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Affiliation(s)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - S Lucas Goede
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Wilco Lesterhuis
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands Department of Gastroenterology, Albert Schweitzer hospital, Dordrecht, the Netherlands
| | - Frank ter Borg
- Department of Gastroenterology and Hepatology, Deventer Hospital, Deventer, the Netherlands
| | - Juda Vecht
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
| | - Pieter Spoelstra
- Department of Gastroenterology and Hepatology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Leopold Engels
- Department of Gastroenterology and Hepatology, Orbis Medical Centre, Sittard, the Netherlands
| | - Clemens J M Bolwerk
- Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Robin Timmer
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jan H Kleibeuker
- Department of Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jan J Koornstra
- Department of Gastroenterology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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8
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Gardenbroek TJ, Pinkney TD, Sahami S, Morton DG, Buskens CJ, Ponsioen CY, Tanis PJ, Löwenberg M, van den Brink GR, Broeders IA, Pullens PH, Seerden T, Boom MJ, Mallant-Hent RC, Pierik RE, Vecht J, Sosef MN, van Nunen AB, van Wagensveld BA, Stokkers PC, Gerhards MF, Jansen JM, Acherman Y, Depla AC, Mannaerts GH, West R, Iqbal T, Pathmakanthan S, Howard R, Magill L, Singh B, Htun Oo Y, Negpodiev D, Dijkgraaf MG, Ram D'Haens G, Bemelman WA. The ACCURE-trial: the effect of appendectomy on the clinical course of ulcerative colitis, a randomised international multicenter trial (NTR2883) and the ACCURE-UK trial: a randomised external pilot trial (ISRCTN56523019). BMC Surg 2015; 15:30. [PMID: 25887789 PMCID: PMC4393565 DOI: 10.1186/s12893-015-0017-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/26/2015] [Indexed: 12/18/2022] Open
Abstract
Background Over the past 20 years evidence has accumulated confirming the immunomodulatory role of the appendix in ulcerative colitis (UC). This led to the idea that appendectomy might alter the clinical course of established UC. The objective of this body of research is to evaluate the short-term and medium-term efficacy of appendectomy to maintain remission in patients with UC, and to establish the acceptability and cost-effectiveness of the intervention compared to standard treatment. Methods/Design These paired phase III multicenter prospective randomised studies will include patients over 18 years of age with an established diagnosis of ulcerative colitis and a disease relapse within 12 months prior to randomisation. Patients need to have been medically treated until complete clinical (Mayo score <3) and endoscopic (Mayo score 0 or 1) remission. Patients will then be randomised 1:1 to a control group (maintenance 5-ASA treatment, no appendectomy) or elective laparoscopic appendectomy plus maintenance treatment. The primary outcome measure is the one year cumulative UC relapse rate - defined both clinically and endoscopically as a total Mayo-score ≥5 with endoscopic subscore of 2 or 3. Secondary outcomes that will be assessed include the number of relapses per patient at 12 months, the time to first relapse, health related quality of life and treatment costs, and number of colectomies in each arm. Discussion The ACCURE and ACCURE-UK trials will provide evidence on the role and acceptability of appendectomy in the treatment of ulcerative colitis and the effects of appendectomy on the disease course. Trial registration NTR2883; ISRCTN56523019
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Affiliation(s)
- Tjibbe J Gardenbroek
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Thomas D Pinkney
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Saloomeh Sahami
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Dion G Morton
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Christianne J Buskens
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Gijs R van den Brink
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ivo Amj Broeders
- Department of Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - Paul Hjm Pullens
- Department of Gastroenterology, Meander Medical Center, Amersfoort, The Netherlands
| | - Tom Seerden
- Department of Gastroenterology, Amphia Hospital, Breda, The Netherlands
| | - Maarten J Boom
- Department of Surgery, Flevo Hospital, Almere, The Netherlands
| | | | | | - Juda Vecht
- Department of Gastroenterology, Isala Hospital, Zwolle, The Netherlands
| | - Meindert N Sosef
- Department of Surgery, Atrium Medical Center, Heerlen, The Netherlands
| | - Annick B van Nunen
- Department of Gastroenterology, Atrium Medical Center, Heerlen, The Netherlands
| | | | - Pieter Cf Stokkers
- Department of Gastroenterology, Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology, Onze Lieve Vrouwe Hospital, Amsterdam, The Netherlands
| | - Yair Acherman
- Department of Surgery, Slotervaart Hospital, Amsterdam, The Netherlands
| | | | - Guido Hh Mannaerts
- Department of Surgery, St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Rachel West
- Department of Gastroenterology, St. Franciscus Hospital, Rotterdam, The Netherlands
| | - Tariq Iqbal
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | | | - Rebecca Howard
- Birmingham Clinical Trials Unit, University Hospitals Birmingham, Birmingham, UK
| | - Laura Magill
- Birmingham Clinical Trials Unit, University Hospitals Birmingham, Birmingham, UK
| | - Baljit Singh
- Department of Surgery, University Hospitals Leicester, Leicester, UK
| | - Ye Htun Oo
- School of Immunity and Infection, University of Birmingham, Birmingham, UK
| | - Dmitri Negpodiev
- Department of Surgery, University Hospitals Birmingham, Birmingham, UK
| | | | - Geert Ram D'Haens
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Bakker OJ, van Brunschot S, van Santvoort HC, Besselink MG, Bollen TL, Boermeester MA, Dejong CH, van Goor H, Bosscha K, Ahmed Ali U, Bouwense S, van Grevenstein WM, Heisterkamp J, Houdijk AP, Jansen JM, Karsten TM, Manusama ER, Nieuwenhuijs VB, Schaapherder AF, van der Schelling GP, Schwartz MP, Spanier BWM, Tan A, Vecht J, Weusten BL, Witteman BJ, Akkermans LM, Bruno MJ, Dijkgraaf MG, van Ramshorst B, Gooszen HG. Early versus on-demand nasoenteric tube feeding in acute pancreatitis. N Engl J Med 2014; 371:1983-93. [PMID: 25409371 DOI: 10.1056/nejmoa1404393] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [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] [Indexed: 01/13/2023]
Abstract
BACKGROUND Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis. METHODS We enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter. Patients were randomly assigned to nasoenteric tube feeding within 24 hours after randomization (early group) or to an oral diet initiated 72 hours after presentation (on-demand group), with tube feeding provided if the oral diet was not tolerated. The primary end point was a composite of major infection (infected pancreatic necrosis, bacteremia, or pneumonia) or death during 6 months of follow-up. RESULTS A total of 208 patients were enrolled at 19 Dutch hospitals. The primary end point occurred in 30 of 101 patients (30%) in the early group and in 28 of 104 (27%) in the on-demand group (risk ratio, 1.07; 95% confidence interval, 0.79 to 1.44; P=0.76). There were no significant differences between the early group and the on-demand group in the rate of major infection (25% and 26%, respectively; P=0.87) or death (11% and 7%, respectively; P=0.33). In the on-demand group, 72 patients (69%) tolerated an oral diet and did not require tube feeding. CONCLUSIONS This trial did not show the superiority of early nasoenteric tube feeding, as compared with an oral diet after 72 hours, in reducing the rate of infection or death in patients with acute pancreatitis at high risk for complications. (Funded by the Netherlands Organization for Health Research and Development and others; PYTHON Current Controlled Trials number, ISRCTN18170985.).
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Affiliation(s)
- Olaf J Bakker
- The authors' affiliations are listed in the Appendix
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Bisschop C, Tjalma JJJ, Hospers GAP, Van Geldere D, de Groot JWB, Wiegman EM, Van’t Veer-ten Kate M, Havenith MG, Vecht J, Beukema JC, Kats-Ugurlu G, Mahesh SVK, van Etten B, Havenga K, Burgerhof JGM, de Groot DJA, de Vos tot Nederveen Cappel WH. Consequence of Restaging After Neoadjuvant Treatment for Locally Advanced Rectal Cancer. Ann Surg Oncol 2014; 22:552-6. [DOI: 10.1245/s10434-014-3996-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Indexed: 11/18/2022]
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van Heijningen EMB, Lansdorp-Vogelaar I, Kuipers EJ, Dekker E, Lesterhuis W, Ter Borg F, Vecht J, De Jonge V, Spoelstra P, Engels L, Bolwerk CJM, Timmer R, Kleibeuker JH, Koornstra JJ, van Ballegooijen M, Steyerberg EW. Features of adenoma and colonoscopy associated with recurrent colorectal neoplasia based on a large community-based study. Gastroenterology 2013; 144:1410-8. [PMID: 23499951 DOI: 10.1053/j.gastro.2013.03.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [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: 05/24/2012] [Revised: 02/26/2013] [Accepted: 03/05/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND & AIMS We investigated adenoma and colonoscopy characteristics that are associated with recurrent colorectal neoplasia based on data from community-based surveillance practice. METHODS We analyzed data of 2990 consecutive patients (55% male; mean age 61 years) newly diagnosed with adenomas from 1988 to 2002 at 10 hospitals throughout The Netherlands. Medical records were reviewed until December 1, 2008. We excluded patients with hereditary colorectal cancer (CRC) syndromes, a history of CRC, inflammatory bowel disease, or without surveillance data. We analyzed associations among adenoma number, size, grade of dysplasia, villous histology, and location with recurrence of advanced adenoma (AA) and nonadvanced adenoma (NAA). We performed a multivariable multinomial logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS During the surveillance period, 203 (7%) patients were diagnosed with AA and 954 (32%) patients with NAA. The remaining 1833 (61%) patients had no adenomas during a median follow-up of 48 months. Factors associated with AA during the surveillance period included baseline number of adenomas (ORs ranging from 1.6 for 2 adenomas; 95% CI: 1.1-2.4 to 3.3 for ≥5 adenomas; 95% CI: 1.7-6.6), adenoma size ≥10 mm (OR = 1.7; 95% CI: 1.2-2.3), villous histology (OR = 2.0; 95% CI: 1.2-3.2), proximal location (OR = 1.6; 95% CI: 1.2-2.3), insufficient bowel preparation (OR = 3.4; 95% CI: 1.6-7.4), and only distal colonoscopy reach (OR = 3.2; 95% CI: 1.2-8.5). Adenoma number had the greatest association with NAA. High-grade dysplasia was not associated with AA or NAA. CONCLUSIONS Large size and number, villous histology, proximal location of adenomas, insufficient bowel preparation, and poor colonoscopy reach were associated with detection of AA during surveillance based on data from community-based practice. These characteristics should be used jointly to develop surveillance policies for adenoma patients.
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Bakker OJ, van Santvoort HC, van Brunschot S, Ali UA, Besselink MG, Boermeester MA, Bollen TL, Bosscha K, Brink MA, Dejong CH, van Geenen EJ, van Goor H, Heisterkamp J, Houdijk AP, Jansen JM, Karsten TM, Manusama ER, Nieuwenhuijs VB, van Ramshorst B, Schaapherder AF, van der Schelling GP, Spanier MBM, Tan A, Vecht J, Weusten BL, Witteman BJ, Akkermans LM, Gooszen HG. Pancreatitis, very early compared with normal start of enteral feeding (PYTHON trial): design and rationale of a randomised controlled multicenter trial. Trials 2011; 12:73. [PMID: 21392395 PMCID: PMC3068962 DOI: 10.1186/1745-6215-12-73] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 03/10/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In predicted severe acute pancreatitis, infections have a negative effect on clinical outcome. A start of enteral nutrition (EN) within 24 hours of onset may reduce the number of infections as compared to the current practice of starting an oral diet and EN if necessary at 3-4 days after admission. METHODS/DESIGN The PYTHON trial is a randomised controlled, parallel-group, superiority multicenter trial. Patients with predicted severe acute pancreatitis (Imrie-score ≥ 3 or APACHE-II score ≥ 8 or CRP > 150 mg/L) will be randomised to EN within 24 hours or an oral diet and EN if necessary, after 72 hours after hospital admission.During a 3-year period, 208 patients will be enrolled from 20 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite of mortality or infections (bacteraemia, infected pancreatic or peripancreatic necrosis, pneumonia) during hospital stay or within 6 months following randomisation. Secondary endpoints include other major morbidity (e.g. new onset organ failure, need for intervention), intolerance of enteral feeding and total costs from a societal perspective. DISCUSSION The PYTHON trial is designed to show that a very early (< 24 h) start of EN reduces the combined endpoint of mortality or infections as compared to the current practice of an oral diet and EN if necessary at around 72 hours after admission for predicted severe acute pancreatitis. TRIAL REGISTRATION ISRCTN: ISRCTN18170985.
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Affiliation(s)
- Olaf J Bakker
- Dept. of Surgery, University Medical Center Utrecht, HP G04.228, PO 85500, 3508 GA Utrecht; The Netherlands
| | - Hjalmar C van Santvoort
- Dept. of Surgery, University Medical Center Utrecht, HP G04.228, PO 85500, 3508 GA Utrecht; The Netherlands
| | - Sandra van Brunschot
- Dept. of Surgery, Radboud University Nijmegen Medical Centre, HP 630, PO 9101, 6500 HB Nijmegen; The Netherlands
| | - Usama Ahmed Ali
- Dept. of Surgery, University Medical Center Utrecht, HP G04.228, PO 85500, 3508 GA Utrecht; The Netherlands
| | - Marc G Besselink
- Dept. of Surgery, University Medical Center Utrecht, HP G04.228, PO 85500, 3508 GA Utrecht; The Netherlands
| | - Marja A Boermeester
- Dept. of Surgery, Academic Medical Center Amsterdam, PO 22660, 1100 DD Amsterdam; The Netherlands
| | - Thomas L Bollen
- Dept. of Radiology, St Antonius Hospital Nieuwegein, PO 2500, 3430 EM Nieuwegein; The Netherlands
| | - Koop Bosscha
- Dept. of Surgery, Jeroen Bosch Hospital, PO 90153, 5200 ME Den Bosch; The Netherlands
| | - Menno A Brink
- Dept. of Gastroenterology, Meander Medical Center Amersfoort, PO 1502, 3800 BM, Amersfoort; The Netherlands
| | - Cornelis H Dejong
- Dept. of Surgery, Maastricht University Medical Center, PO 5800, 6202 AZ Maastricht; The Netherlands
| | - Erwin J van Geenen
- Dept. of Gastroenterology, VU Medical Center, PO 7057, 1007 MB Amsterdam; The Netherlands
| | - Harry van Goor
- Dept. of Surgery, Radboud University Nijmegen Medical Centre, HP 630, PO 9101, 6500 HB Nijmegen; The Netherlands
| | - Joos Heisterkamp
- Dept. of Surgery, St.Elisabeth Hospital, PO 90151, 5000 LC Tilburg; The Netherlands
| | - Alexander P Houdijk
- Dept. of Surgery, Medical Center Alkmaar, PO 501, 1800 AM Alkmaar; The Netherlands
| | - Jeroen M Jansen
- Dept. of Gastroenterology, Onze Lieve Vrouwe Gasthuis, PO 95500, 1090 HM Amsterdam; The Netherlands
| | - Thom M Karsten
- Dept. of Surgery, Reinier de Graaf Gasthuis, PO 5011, 2600 GA Delft; The Netherlands
| | - Eric R Manusama
- Dept. of Surgery, Medical Center Leeuwarden, PO 888, 8901 BR Leeuwarden; The Netherlands
| | - Vincent B Nieuwenhuijs
- Dept. of Surgery, University Medical Center Groningen, PO 30001, 9700 RB Groningen; The Netherlands
| | - Bert van Ramshorst
- Dept. of Surgery, St Antonius Hospital Nieuwegein, PO 2500, 3430 EM Nieuwegein; The Netherlands
| | | | | | - Marcel BM Spanier
- Dept. of Gastroenterology, Rijnstate Hospital, PO 9555, 6800 TA Arnhem; The Netherlands
| | - Adriaan Tan
- Dept. of Gastroenterology, Canisius Wilhelmina Hospital, PO 9015, 6500 GS Nijmegen; The Netherlands
| | - Juda Vecht
- Dept. of Gastroenterology, Isala Clinics, PO 10400, 8000 GK, Zwolle; The Netherlands
| | - Bas L Weusten
- Dept. of Gastroenterology, St Antonius Hospital Nieuwegein, PO 2500, 3430 EM Nieuwegein; The Netherlands
| | - Ben J Witteman
- Dept. of Gastroenterology, Hospital Gelderse Vallei Ede, PO 9025, 6710 HN Ede; The Netherlands
| | - Louis M Akkermans
- Dept. of Surgery, University Medical Center Utrecht, HP G04.228, PO 85500, 3508 GA Utrecht; The Netherlands
| | - Hein G Gooszen
- Dept. of OR/Evidence Based Surgery, Radboud University Nijmegen Medical Centre, PO 9101, 6500 HB Nijmegen; The Netherlands
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van der Meulen-de Jong AE, Morreau H, Becx MCJM, Crobach LFSJ, van Haastert M, ten Hove WR, Kleibeuker JH, Meijssen MAC, Nagengast FM, Rijk MCM, Salemans JMJI, Stronkhorst A, Tuynman HARE, Vecht J, Verhulst ML, de Vos tot Nederveen Cappel WH, Walinga H, Weinhardt OK, Westerveld BD, Witte AMC, Wolters HJ, Vasen HFA. High detection rate of adenomas in familial colorectal cancer. Gut 2011; 60:73-6. [PMID: 20833659 DOI: 10.1136/gut.2010.217091] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS Subjects with one first-degree relative (FDR) with colorectal cancer (CRC) <50 years old or two FDRs with CRC have an increased risk for CRC (RR 4-6). Current guidelines recommend colonoscopic surveillance of such families. However, information about the yield of surveillance is limited. The aim of the present study was to evaluate the outcome of surveillance and to identify risk factors for the development of adenomas. PATIENTS AND METHODS Subjects were included if they fulfilled the following criteria: asymptomatic subjects aged between 45 and 65 years, with one FDR with CRC <50 years old (group A) or two FDRs with CRC diagnosed at any age (group B). Subjects with a personal history of inflammatory bowel disease or colorectal surgery were excluded. RESULTS A total of 551 subjects (242 male) met the selection criteria. Ninety-five subjects with a previous colonoscopy were excluded. Two of 456 remaining subjects (0.4%) were found to have a colorectal tumour (one CRC and one carcinoid). Adenomas were detected in 85 (18.6%) and adenomas with advanced pathology in 37 subjects (8.1%). 30 subjects (6.6%) had multiple (>1) adenomas. Men were more often found to have an adenoma than women (24% vs 14.3%; p=0.01). Adenomas were more frequent in group B compared with group A (22.0% vs 15.6%; p=0.09). CONCLUSION The yield of colonoscopic surveillance in familial CRC is substantially higher than the yield of screening reported for the general population.
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14
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Nieuwenhuis MH, Mathus-Vliegen EM, Baeten CG, Nagengast FM, van der Bijl J, van Dalsen AD, Kleibeuker JH, Dekker E, Langers AM, Vecht J, Peters FT, van Dam R, van Gemert WG, Stuifbergen WN, Schouten WR, Gelderblom H, Vasen HFA. Evaluation of management of desmoid tumours associated with familial adenomatous polyposis in Dutch patients. Br J Cancer 2010; 104:37-42. [PMID: 21063417 PMCID: PMC3039799 DOI: 10.1038/sj.bjc.6605997] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The optimal treatment of desmoid tumours is controversial. We evaluated desmoid management in Dutch familial adenomatous polyposis (FAP) patients. METHODS Seventy-eight FAP patients with desmoids were identified from the Dutch Polyposis Registry. Data on desmoid morphology, management, and outcome were analysed retrospectively. Progression-free survival (PFS) rates and final outcome were compared for surgical vs non-surgical treatment, for intra-abdominal and extra-abdominal desmoids separately. Also, pharmacological treatment was evaluated for all desmoids. RESULTS Median follow-up was 8 years. For intra-abdominal desmoids (n=62), PFS rates at 10 years of follow-up were comparable after surgical and non-surgical treatment (33% and 49%, respectively, P=0.163). None of these desmoids could be removed entirely. Eventually, one fifth died from desmoid disease. Most extra-abdominal and abdominal wall desmoids were treated surgically with a PFS rate of 63% and no deaths from desmoid disease. Comparison between NSAID and anti-estrogen treatment showed comparable outcomes. Four of the 10 patients who received chemotherapy had stabilisation of tumour growth, all after doxorubicin combination therapy. CONCLUSION For intra-abdominal desmoids, a conservative approach and surgery showed comparable outcomes. For extra-abdominal and abdominal wall desmoids, surgery seemed appropriate. Different pharmacological therapies showed comparable outcomes. If chemotherapy was given for progressively growing intra-abdominal desmoids, most favourable outcomes occurred after combinations including doxorubicin.
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Affiliation(s)
- M H Nieuwenhuis
- The Netherlands Foundation for the Detection of Hereditary Tumours, Rijnsburgerweg 10, Poortgebouw Zuid, 2333 AA Leiden, The Netherlands.
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15
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Vasen HFA, Abdirahman M, Brohet R, Langers AMJ, Kleibeuker JH, van Kouwen M, Koornstra JJ, Boot H, Cats A, Dekker E, Sanduleanu S, Poley JW, Hardwick JCH, de Vos Tot Nederveen Cappel WH, van der Meulen-de Jong AE, Tan TG, Jacobs MAJM, Mohamed FLA, de Boer SY, van de Meeberg PC, Verhulst ML, Salemans JM, van Bentem N, Westerveld BD, Vecht J, Nagengast FM. One to 2-year surveillance intervals reduce risk of colorectal cancer in families with Lynch syndrome. Gastroenterology 2010; 138:2300-6. [PMID: 20206180 DOI: 10.1053/j.gastro.2010.02.053] [Citation(s) in RCA: 183] [Impact Index Per Article: 13.1] [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: 09/07/2009] [Revised: 02/01/2010] [Accepted: 02/23/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Two percent to 4% of all cases of colorectal cancer (CRC) are associated with Lynch syndrome. Dominant clustering of CRC (non-Lynch syndrome) accounts for 1%-3% of the cases. Because carcinogenesis is accelerated in Lynch syndrome, an intensive colonoscopic surveillance program has been recommended since 1995. The aim of the study was to evaluate the effectiveness of this program. METHODS The study included 205 Lynch syndrome families with identified mutations in one of the mismatch repair genes (745 mutation carriers). We also analyzed data from non-Lynch syndrome families (46 families, 344 relatives). Patients were observed from January 1, 1995, until January 1, 2009. End points of the study were CRC or date of the last colonoscopy. RESULTS After a mean follow-up of 7.2 years, 33 patients developed CRC under surveillance. The cumulative risk of CRC was 6% after the 10-year follow-up period. The risk of CRC was higher in carriers older than 40 years and in carriers of MLH1 and MSH2 mutations. After a mean follow-up of 7.0 years, 6 cases of CRC were detected among non-Lynch syndrome families. The risk of CRC was significantly higher among families with Lynch syndrome, compared with those without. CONCLUSIONS With surveillance intervals of 1-2 years, members of families with Lynch syndrome have a lower risk of developing CRC than with surveillance intervals of 2-3 years. Because of the low risk of CRC in non-Lynch syndrome families, a less intensive surveillance protocol can be recommended.
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Affiliation(s)
- Hans F A Vasen
- The Netherlands Foundation for the Detection of Hereditary Tumours, Leiden, The Netherlands.
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16
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Bijlsma A, Blokzijl H, Vecht J. [Severe oesophagus injury as a complication during treatment with risedronic acid]. Ned Tijdschr Geneeskd 2008; 152:2105-2107. [PMID: 18856023] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 77-year-old man, treated with risedronic acid to prevent corticosteroid-induced osteoporosis, was admitted to hospital with acute abdominal pain. The patient appeared to have an oesophageal perforation, which was treated with an endoprosthesis. Additional research showed a motility disorder of the oesophagus. Although bisphosphonates are considered a safe medication, the perforation was probably secondary to treatment with an oral bisphosphonate in combination with the motility disorder. Pre-existent gastrointestinal diseases such as motility disorders of the oesophagus occur more frequently among elderly. Therefore it is important to take the increased risk of complications to the gastrointestinal tract into account when prescribing bisphosphonates to these patients.
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Affiliation(s)
- A Bijlsma
- Isala klinieken, afd. Maag-, Darm- en Leverziekten, Postbus 10.400, 8014 GK Zwolle
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Eshuis EJ, Bemelman WA, van Bodegraven AA, Sprangers MAG, Bossuyt PMM, van Milligen de Wit AWM, Crolla RMPH, Cahen DL, Oostenbrug LE, Sosef MN, Voorburg AMCJ, Davids PHP, van der Woude CJ, Lange J, Mallant RC, Boom MJ, Lieverse RJ, van der Zaag ES, Houben MHMG, Vecht J, Pierik REGJM, van Ditzhuijsen TJM, Prins HA, Marsman WA, Stockmann HB, Brink MA, Consten ECJ, van der Werf SDJ, Marinelli AWKS, Jansen JM, Gerhards MF, Bolwerk CJM, Stassen LPS, Spanier BWM, Bilgen EJS, van Berkel AM, Cense HA, van Heukelem HA, van de Laar A, Slot WB, Eijsbouts QA, van Ooteghem NAM, van Wagensveld B, van den Brande JMH, van Geloven AAW, Bruin KF, Maring JK, Oldenburg B, van Hillegersberg R, de Jong DJ, Bleichrodt R, van der Peet DL, Dekkers PEP, Goei TH, Stokkers PCF. Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial). BMC Surg 2008; 8:15. [PMID: 18721465 PMCID: PMC2533646 DOI: 10.1186/1471-2482-8-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 08/22/2008] [Indexed: 12/24/2022] Open
Abstract
Background With the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction. The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs. Methods/design The study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007. Discussion The LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease. Trial registration Nederlands Trial Register NTR1150
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Affiliation(s)
- Emma J Eshuis
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
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18
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Rasoul S, Vecht J, Groeneveld PHP. Bacteraemia following rubber band ligation for non-bleeding oesophageal varices in a patient with alcoholic liver cirrhosis. Neth J Med 2008; 66:218. [PMID: 18490803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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de Groot JWB, Vecht J, van den Bergen HA, Coenen JLLM. Extrapulmonary lymphangioleiomyomatosis: an unusual cause of biliary tract obstruction. Neth J Med 2008; 66:31-34. [PMID: 18219066] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We present a patient who was diagnosed with retroperitoneal lymphangioleiomyomatosis (LAM) and who developed biliary tract obstruction caused by LAM in the papilla of Vater. After endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy, the patient's liver enzymes normalised. Disease progression was slowed down with gosereline and interferon alpha 2b (IF N-alpha 2b). In patients with LAM and signs of biliary tract obstruction, disseminated LAM should be considered. IFN alpha 2b can be a useful treatment in patients with widespread LAM.
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Affiliation(s)
- J W B de Groot
- Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands.
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20
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van der Wouden EJ, Nelis GF, Vecht J. Screening for coeliac disease in patients fulfilling the Rome II criteria for irritable bowel syndrome in a secondary care hospital in The Netherlands: a prospective observational study. Gut 2007; 56:444-5. [PMID: 17339255 PMCID: PMC1856831 DOI: 10.1136/gut.2006.112052] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Vecht J, Symersky T, Lamers CBHW, Masclee AAM. Efficacy of lower than standard doses of pancreatic enzyme supplementation therapy during acid inhibition in patients with pancreatic exocrine insufficiency. J Clin Gastroenterol 2006; 40:721-5. [PMID: 16940886 DOI: 10.1097/00004836-200609000-00012] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [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] [Indexed: 12/09/2022]
Abstract
GOAL To compare, during strong acid inhibition with omeprazole, the effect of 2 different doses of an enteric-coated pancreatic enzyme preparation on fecal fat excretion and abdominal symptoms in patients with exocrine insufficiency due to chronic pancreatitis (CP). BACKGROUND Treatment with pancreatic enzymes reduces fecal fat excretion in patients with CP but is rather unsuccessful due to irreversible lipase inactivation at pH below 4. STUDY Sixteen patients with CP (3 women, 13 men; age 53+/-3 y) participated in this randomized double blind 2-way cross over study. Fecal fat excretion and fat intake were measured and abdominal symptoms (visual analog scales) were scored during a 2 weeks control period, during omeprazole 60 mg+pancreatic enzymes 10,000 Fédération Internationale Pharmaceutique IU lipase tid (treatment A) for 2 weeks and during omeprazole 60 mg+pancreatic enzymes, 20,000 Fédération Internationale Pharmaceutique IU lipase tid (treatment B) for 2 weeks. RESULTS During acid inhibition with enzyme supplementation fecal fat excretion was significantly (P<0.01) reduced compared with control: 18+/-7 and 18+/-5 g/24 h versus 36+/-8 g/24 h for treatment A, B, and control, respectively. Abdominal symptom score and general well being improved significantly (P<0.05) during treatments A and B versus control. No differences in fat excretion or symptoms scores between treatments A and B were observed. CONCLUSIONS During strong acid inhibition, lower than recommended oral doses of pancreatic enzymes are therapeutically effective with respect to fat absorption and symptom reduction.
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Affiliation(s)
- Juda Vecht
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands
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22
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Abstract
BACKGROUND Dumping syndrome is a serious complication occurring in 10% of patients after gastric surgery. Dumping symptoms are effectively reduced by subcutaneous application of the somatostatin analogue octreotide, but side-effects limit its use. AIM To evaluate the efficacy of depot long-acting release octreotide (Sandostatin-LAR) vs. octreotide subcutaneous on dumping symptoms, quality of life and side-effects. METHODS Twelve patients (five females, age 58 +/- 3 years) with severe dumping symptoms, requiring daily use of octreotide subcutaneous, were included in an open study and changed from octreotide subcutaneous after a 2 weeks washout to Sandostatin-LAR 10 mg i.m., every 4 weeks for 6 months. Symptoms (diary), body weight, fat excretion, food intake and Gastrointestinal Specific Quality of Life Index were evaluated. RESULTS Gastrointestinal Specific Quality of Life Index increased significantly (P < 0.05) during Sandostatin-LAR treatment (88 +/- 4) compared with octreotide (74 +/- 4) and washout (75 +/- 6). During Sandostatin-LAR treatment, abdominal symptom score was lower compared with octreotide and washout, but not significantly. During Sandostatin-LAR treatment, body weight increased (66 +/- 4 to 70 +/- 3 kg; P = 0.19). CONCLUSIONS Sandostatin-LAR is at least as effective as octreotide subcutaneous in suppressing symptoms in patients with severe dumping syndrome and is more effective than octreotide subcutaneous in increasing body weight and quality of life.
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Affiliation(s)
- C Penning
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands
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23
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Volbeda F, Jonker AM, Vecht J, Groeneveld PH. [Liver cirrhosis due to chronic use of nitrofurantoin]. Ned Tijdschr Geneeskd 2004; 148:235-8. [PMID: 14983581] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
A 74-year-old woman was admitted with jaundice. She was suffering from generalised liver failure with a highly prolonged prothrombin time, a low albumin level and ascites. Further anamnesis revealed that she had been taking nitrofurantoin as a prophylactic agent for recurrent urinary tract infections every day for 5 years. Because of the indications for liver damage due to nitrofurantoin, the drug was discontinued immediately on admission. After withdrawal of nitrofurantoin there was a very gradual clinical and biochemical improvement. Liver biopsies to confirm the diagnosis revealed extensive liver damage with cirrhosis such as may be seen following long-term use of nitrofurantoin. Nitrofurantoin should be prescribed with caution as a prophylactic agent in elderly women and patients with renal dysfunction because the risk of liver damage as a serious side effect of nitrofurantoin is greatly increased in these patients.
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Affiliation(s)
- F Volbeda
- Locatie Sophia, afd. Interne Geneeskunde, Isala Klinieken, Zwolle.
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24
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Vu MK, Vecht J, Eddes EH, Biemond I, Lamers CB, Masclee AA. Antroduodenal motility in chronic pancreatitis: are abnormalities related to exocrine insufficiency? Am J Physiol Gastrointest Liver Physiol 2000; 278:G458-66. [PMID: 10712266 DOI: 10.1152/ajpgi.2000.278.3.g458] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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] [Indexed: 01/31/2023]
Abstract
In patients with chronic pancreatitis (CP) the relation among exocrine pancreatic secretion, gastrointestinal hormone release, and motility is disturbed. We studied digestive and interdigestive antroduodenal motility and postprandial gut hormone release in 26 patients with CP. Fifteen of these patients had pancreatic insufficiency (PI) established by urinary para-aminobenzoic acid test and fecal fat excretion. Antroduodenal motility was recorded after ingestion of a mixed liquid meal. The effect of pancreatic enzyme supplementation was studied in 8 of the 15 CP patients with PI. The duration of the postprandial antroduodenal motor pattern was significantly (P < 0.01) prolonged in CP patients (324 +/- 20 min) compared with controls (215 +/- 19 min). Antral motility indexes in the first hour after meal ingestion were significantly reduced in CP patients. The interdigestive migrating motor complex cycle length was significantly (P < 0.01) shorter in CP patients (90 +/- 8 min) compared with controls (129 +/- 8 min). These abnormalities were more pronounced in CP patients with exocrine PI. After supplementation of pancreatic enzymes, these alterations in motility reverted toward normal. Digestive and interdigestive antroduodenal motility are abnormal in patients with CP but significantly different from controls only in those with exocrine PI. These abnormalities in antroduodenal motility in CP are related to maldigestion.
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Affiliation(s)
- M K Vu
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
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25
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Abstract
OBJECTIVE Little is known about the long-term results of octreotide therapy in dumping syndrome. We report the results of an open study including 20 patients with severe dumping symptoms after gastric surgery treated with octreotide between 1987 and 1997 at the Leiden University Medical Centre. DESIGN Patient selection was based on (1) the results of a dumping provocation test and (2) symptoms that were refractory to other therapeutic measures. At regular intervals the presence of dumping symptoms was evaluated together with measurement of body weight and faecal fat excretion. RESULTS Mean follow-up was 37 +/- 9 months (range 1-107 months). Doses of octreotide ranged from 25 to 200 microg/day. Initial relief of symptoms was achieved in all subjects, but after three months of therapy symptom relief persisted in 80% of patients. Mean body weight increased by 2.4 +/- 1.2 kg despite a significant increase in faecal fat excretion from 10 +/- 2 g/24 h to 24 +/- 3 g/24 h. Reasons for discontinuation of therapy were diminished efficacy in the longer term in 4 patients and side-effects in 7 patients. Biliary complications were encountered in 3 patients. CONCLUSIONS Self-administration of octreotide proves an effective symptomatic treatment of severe dumping, even on the long-term. Its use is frequently limited by the occurrence of side-effects.
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Affiliation(s)
- J Vecht
- Department of Gastroenterology-Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Eddes EH, Masclee AA, Gielkens HA, Verkijk M, Vecht J, Biemond I, Lamers CB. Cholecystokinin secretion in patients with chronic pancreatitis and after different types of pancreatic surgery. Pancreas 1999; 19:119-25. [PMID: 10438157 DOI: 10.1097/00006676-199908000-00003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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] [Indexed: 12/10/2022]
Abstract
UNLABELLED Cholecystokinin (CCK) secretion may be affected in patients with chronic pancreatitis (CP), but little is known on the effect of pancreatic surgery on CCK secretion. We measured CCK secretion (radioimmunoassay, RIA) in response to bombesin infusion (100 ng/kg/20 min) for 120 min to test CCK secretory capacity, to ingestion of a liquid diet (400 kcal) for 120 min, and in response to a solid fat-rich meal (500 kcal) for 120 min. These studies were performed in 45 patients with CP (25 with exocrine insufficiency), 15 patients after duodenum-preserving pancreatic head resection (DPRHP), 18 patients after the Whipple operation, 12 patients after distal pancreatectomy (DP), and 35 control subjects. In CP patients, the CCK secretory capacity was preserved, but the postprandial CCK response was reduced, depending on meal composition and the presence of exocrine insufficiency. In patients after Whipple's operation, CCK secretory capacity and postprandial CCK secretion were significantly (p < 0.05) reduced. In patients after DPRHP, CCK secretory capacity was not affected, but the postprandial CCK response was significantly (p < 0.05) reduced, depending on meal composition and the presence of exocrine insufficiency. In patients after DPRHP, fasting plasma CCK levels were significantly (p < 0.01) increased, pointing to the absence of feedback inhibition on CCK secretion by intraluminal enzymes. After DP, the CCK secretory capacity was not affected. IN CONCLUSION alterations in CCK secretion are observed in patients with chronic pancreatitis and after pancreatic surgery. These alterations are related not only to the disease process (exocrine insufficiency) but also to the type of surgery and type of stimulus.
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Affiliation(s)
- E H Eddes
- Department of General Surgery, Leiden University Medical Center, The Netherlands
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Ledeboer M, Masclee AA, Coenraad M, Vecht J, Biemond I, Lamers CB. Antroduodenal motility and small bowel transit during continuous intraduodenal or intragastric administration of enteral nutrition. Eur J Clin Invest 1999; 29:615-23. [PMID: 10411668 DOI: 10.1046/j.1365-2362.1999.00507.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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] [Indexed: 11/20/2022]
Abstract
BACKGROUND Gastrointestinal intolerance is observed more frequently during intraduodenal (ID) tube feeding than during intragastric (IG) feeding, possibly because it evokes a stronger gastrointestinal response and accelerates small bowel transit. We have investigated whether the accelerated small bowel transit during ID feeding results from alterations in antroduodenal motility pattern. DESIGN The effect of IG and ID infusion of a polymeric diet (Nutrison, 125 kcal h-1) on antroduodenal motility, small bowel transit time (SBTT) and gastrointestinal hormone release was studied in nine healthy subjects. These subjects were studied on three occasions for 6 h during fasting, continuous IG or ID feeding. RESULTS Phase III recurrence time was significantly prolonged during IG feeding compared with fasting (240 +/- 51 vs. 136 +/- 24 min; P < 0.05). None of the subjects had recurrence of phase III during ID feeding; the fed motor pattern remained present. Parameters of fed motility (mean amplitude and motility index) were not significantly different between IG and ID feeding, although the frequency of antral and duodenal contractions was lower during ID than during IG feeding. SBTT was significantly accelerated during ID compared with IG feeding and with fasting (58 +/- 8 vs. 73 +/- 9 and 83 +/- 10 min respectively; P < 0.05). Plasma cholecystokinin (CCK) and pancreatic polypeptide (PP) levels were significantly higher during ID than during IG feeding. Peptide YY (PYY) levels were significantly higher during ID than during fasting, but not during IG feeding CONCLUSIONS During intraduodenal feeding, a fed motility pattern is preserved, whereas during intragastric feeding transition from a fed to a fasting motor pattern is observed in over 50% of the subjects. These differences may be related to augmented hormone release during intraduodenal feeding.
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Affiliation(s)
- M Ledeboer
- Department of Gastroenterology-Hepatology, Leiden University Medical Centre, The Netherlands
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Gielkens HA, van den Biggelaar A, Vecht J, Onkenhout W, Lamers CB, Masclee AA. Effect of intravenous amino acids on interdigestive antroduodenal motility and small bowel transit time. Gut 1999; 44:240-5. [PMID: 9895384 PMCID: PMC1727372 DOI: 10.1136/gut.44.2.240] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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] [Indexed: 12/08/2022]
Abstract
BACKGROUND Patients on total parenteral nutrition have an increased risk of developing gallstones because of gall bladder hypomotility. High dose amino acids may prevent biliary stasis by stimulating gall bladder emptying. AIMS To investigate whether intravenous amino acids also influence antroduodenal motility. METHODS Eight healthy volunteers received, on three separate occasions, intravenous saline (control), low dose amino acids (LDA), or high dose amino acids (HDA). Antroduodenal motility was recorded by perfusion manometry and duodenocaecal transit time (DCTT) using the lactulose breath hydrogen test. RESULTS DCTT was significantly prolonged during LDA and HDA treatment compared with control. The interdigestive motor pattern was maintained and migrating motor complex (MMC) cycle length was significantly reduced during HDA compared with control and LDA due to a significant reduction in phase II duration. Significantly fewer phase IIIs originated in the gastric antrum during LDA and HDA compared with control. Duodenal phase II motility index was significantly reduced during HDA, but not during LDA, compared with control. CONCLUSIONS Separate intravenous infusion of high doses of amino acids in healthy volunteers: (1) modulates interdigestive antroduodenal motility; (2) shortens MMC cycle length due to a reduced duration of phase II with a lower contractile incidence both in the antrum and duodenum (phase I remains unchanged whereas the effect on phase III is diverse: in the antrum phase III is suppressed and in the duodenum the frequency is increased); and (3) prolongs interdigestive DCTT.
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Affiliation(s)
- H A Gielkens
- Department of Gastroenterology- Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Abstract
OBJECTIVE Dumping occurs in about 10% of patients after gastric surgery. It has been suggested that early dumping is associated with an abnormal increase in postprandial splanchnic flow, but data from controlled studies are lacking. Therefore we have studied basal and postprandial superior mesenteric artery (SMA) blood flow in patients with dumping and in two control groups. METHODS Three groups were studied, one group of patients after gastric surgery with early dumping (n = 6), one surgical control group with patients after gastric surgery without dumping symptoms (n = 7), and a healthy control group without previous gastric surgery (n = 10). Blood glucose and heart rate were measured after dumping provocation by oral ingestion of 50 g glucose. SMA blood flow was measured both basally and 20 min after glucose ingestion. RESULTS Basal SMA flow was similar in the three groups. After glucose ingestion SMA flow was not significantly different between dumping patients and surgical controls. However, stimulated SMA flow in both groups after gastric surgery combined was significantly (p < 0.05) higher than in healthy controls. CONCLUSION The systemic symptoms associated with early dumping do not result from increased SMA blood flow per se. After gastric surgery patients have an increased postprandial SMA flow irrespective of the presence of dumping.
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Affiliation(s)
- J Vecht
- Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands
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Verkijk M, Vecht J, Gielkens HA, Lamers CB, Masclee AA. Effects of medium-chain and long-chain triglycerides on antroduodenal motility and small bowel transit time in man. Dig Dis Sci 1997; 42:1933-9. [PMID: 9331158 DOI: 10.1023/a:1018823512901] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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] [Indexed: 02/05/2023]
Abstract
UNLABELLED Medium-chain triglycerides are known to induce diarrhea, possibly resulting from accelerated intestinal transit. We performed antroduodenal manometry and lactulose hydrogen breath testing simultaneously in eight healthy subjects in order to determine the effects of intraduodenally administered medium-chain triglycerides (MCT) and long-chain triglycerides (LCT) on gastrointestinal motility and small bowel transit time. LCT (15 mmol/hr) induced a fed motor pattern. In contrast, during MCT, in both equimolar (15 mmol/hr; MCT-1) and equicaloric (30 mmol/hr; MCT-2) amounts comparable to LCT, interdigestive motility was preserved but with a significantly (P < 0.05) shorter MMC cycle length (MCT-1, 65 +/- 7 min; MCT-2, 53 +/- 6 min) compared to control (saline infusion; 127 +/- 14 min). Duodenocecal transit time (DCTT) was significantly (P < 0.05) accelerated during administration of MCT (MCT-1, 56 +/- 6 min; MCT-2, 69 +/- 9 min) and was not affected by LCT (105 +/- 13 min) when compared to control (101 +/- 9 min). IN CONCLUSION MCT, in contrast to LCT, preserve interdigestive motility with a shorter MMC cycle length and accelerate DCTT.
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Affiliation(s)
- M Verkijk
- Department of Gastroenterology-Hepatology, University Hospital Leiden, The Netherlands
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Abstract
In patients after gastric surgery, early dumping symptoms can be provoked by oral glucose challenge. Octreotide effectively prevents the occurrence of dumping symptoms. We have studied plasma renin activity (PRA), aldosterone and atrial natriuretic peptide (ANP) concentrations in nine patients with early dumping, 10 surgical control subjects and nine healthy control subjects after an oral glucose challenge preceded by either placebo or 25 micrograms of octreotide subcutaneously (s.c.). In the dumping group, basal PRA was significantly (P < 0.01) higher (3.9 +/- 0.6 micrograms L-1 h-1) than in either surgical or healthy control subjects (1.1 +/- 0.3 micrograms L-1 h-1 and 1.1 +/- 0.2 micrograms L-1 h-1 respectively) and showed a significant rise after glucose ingestion to 5.4 +/- 0.9 micrograms L-1 h-1 that did not occur in control subjects. Aldosterone concentration showed a concomitant rise. In dumping patients, plasma ANP decreased after glucose ingestion from 31 +/- 6 ngL-1 to 21 +/- 5 ngL-1 (P < 0.05). This decrease did not occur in control subjects. Early dumping is associated with an activation of the renin-aldosterone axis and a decrease in plasma ANP, reflecting a hypovolaemic state. Octreotide prevents the occurrence of these changes.
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Affiliation(s)
- J Vecht
- Department of Gastroenterology-Hepatology, University Hospital Leiden, The Netherlands
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Gielkens HA, Eddes EH, Vecht J, van Oostayen JA, Lamers CB, Masclee AA. Gallbladder motility and cholecystokinin secretion in chronic pancreatitis: relationship with exocrine pancreatic function. J Hepatol 1997; 27:306-12. [PMID: 9288605 DOI: 10.1016/s0168-8278(97)80176-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND/AIMS Postprandial gallbladder motility is regulated mainly by the hormone cholecystokinin (CCK). Since CCK secretion may be reduced in patients with pancreatic insufficiency (PI), we studied postprandial gallbladder motility in these patients. METHODS Fifteen patients with PI due to chronic pancreatitis and 17 healthy control subjects were studied. Gallbladder volumes (ultrasonography) and plasma CCK concentrations (RIA) were determined at regular intervals for 120 min after meal ingestion. Urinary PABA and faecal fat excretion were measured to determine pancreatic exocrine function. RESULTS Patients with PI had larger fasting gallbladder volumes than controls (48 +/- 6 cm3 versus 29 +/- 2 cm3; p < 0.01). Gallbladder ejection volume at time 120 min was not significantly different between patients with PI (14 +/- 4 cm3) and controls (20 +/- 2 cm3). However, the percentage postprandial gallbladder emptying in patients with PI was significantly reduced compared to controls (at 120 min: 29 +/- 8% versus 68 +/- 3%; p < 0.001). Residual postprandial gallbladder volume was increased in patients with PI compared to controls (at 120 min: 34 +/- 4 cm3 versus 9 +/- 1 cm3; p < 0.001). Postprandial endogenous CCK secretion was significantly reduced in patients with PI compared to controls (78 +/- 13 pM.120 min versus 155 +/- 14 pM.120 min; p < 0.001). Postprandial gallbladder emptying (%) was related to the degree of exocrine pancreatic insufficiency (r = 0.81; p < 0.001). CONCLUSIONS In patients with pancreatic insufficiency due to chronic pancreatitis: 1) fasting and residual postprandial gallbladder volumes are significantly increased; 2) postprandial CCK secretion and percentage gallbladder contraction are significantly reduced; 3) percentage postprandial gallbladder emptying is related to the degree of pancreatic exocrine insufficiency.
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Affiliation(s)
- H A Gielkens
- Department of Gastroenterology-Hepatology, University Hospital Leiden, The Netherlands
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Vecht J, Masclee AA, Lamers CB. The dumping syndrome. Current insights into pathophysiology, diagnosis and treatment. Scand J Gastroenterol Suppl 1997; 223:21-7. [PMID: 9200302] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The dumping syndrome is encountered in approximately 10% of patients after gastric surgery. A postprandial peripheral and splanchnic vasodilatation and ensuing relative hypovolaemia are pivotal in the pathophysiology of early systemic symptoms. Late dumping symptoms are a consequence of a reactive hypoglycaemia, which results from an exaggerated insulin and glucagon-like peptide-1 release. The diagnosis of dumping syndrome can reliably be made with the aid of a provocation test using 50 g glucose orally. Most patients with dumping can be treated with advice on diet and lifestyle. Octreotide effectively controls the signs and symptoms of dumping in patients refractory to standard therapy. It acts through its inhibitory effects on insulin and gut hormone release, a delay of intestinal transit time and inhibition of food-induced circulatory changes. Its long-term use is somewhat limited by side effects, particularly diarrhoea and steatorrhoea.
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Affiliation(s)
- J Vecht
- Dept. of Gastroenterology-Hepatology, University Hospital Leiden, The Netherlands
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Abstract
BACKGROUND In patients after gastric surgery it is often difficult to discern symptoms from dumping from other postcibal complaints. Strict criteria for dumping provocation test have not been defined. METHODS The sensitivity and specificity of a dumping provocation using 50 g of glucose orally was assessed in 48 patients after gastric surgery, of whom 19 had a typical history of early dumping and 11 had a history of late dumping. Factors were heart rate, packed cell volume, breath hydrogen excretion, and blood glucose concentration. RESULTS An increase in heart rate of > or = 10 beats/min in the 1st h had a sensitivity of 100% and a specificity of 94% in detecting early dumping. An early rise in breath H2 excretion showed a sensitivity of 84% and specificity of 94%. The nadir blood glucose concentration was not a sensitive or specific indicator for late dumping. CONCLUSIONS Both an increase in heart rate of > or = 10 beats/min and a positive breath hydrogen excretion are sensitive indicators for early dumping. Late dumping is better recognized by the occurrence of subjective symptoms during provocation.
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Affiliation(s)
- F G van der Kleij
- Dept. of Gastroenterology-Hepatology, University Hospital Leiden, The Netherlands
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Veenstra J, Vecht J, Jonkers GJ, Roozendaal KJ. [Accessory spleens as a cause of recurrent idiopathic thrombopenia]. Ned Tijdschr Geneeskd 1991; 135:855-7. [PMID: 2046784] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A female aged 62 yr developed a recurrence of chronic idiopathic thrombocytopenia 7 years after splenectomy. Two accessory spleens were identified and removed surgically. An increase in platelet count was seen. An analysis of the literature shows that extirpation of accessory spleens was successful in over 60% of the patients (32/52) with recurring idiopathic thrombocytopenia after splenectomy.
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Affiliation(s)
- J Veenstra
- Onze Lieve Vrouwe Gasthuis, afd. Interne Geneeskunde en Hematologie, Amsterdam
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Vecht J, Zeigler M, Segal M, Bach G. Tay-Sachs disease among Moroccan Jews. Isr J Med Sci 1983; 19:67-9. [PMID: 6832951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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