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Rugge M, Genta RM, Malfertheiner P, Dinis-Ribeiro M, El-Serag H, Graham DY, Kuipers EJ, Leung WK, Park JY, Rokkas T, Schulz C, El-Omar EM. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut 2024; 73:407-441. [PMID: 38383142 DOI: 10.1136/gutjnl-2023-331164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 02/23/2024]
Abstract
At the end of the last century, a far-sighted 'working party' held in Sydney, Australia addressed the clinicopathological issues related to gastric inflammatory diseases. A few years later, an international conference held in Houston, Texas, USA critically updated the seminal Sydney classification. In line with these initiatives, Kyoto Global Consensus Report, flanked by the Maastricht-Florence conferences, added new clinical evidence to the gastritis clinicopathological puzzle.The most relevant topics related to the gastric inflammatory diseases have been addressed by the Real-world Gastritis Initiative (RE.GA.IN.), from disease definitions to the clinical diagnosis and prognosis. This paper reports the conclusions of the RE.GA.IN. consensus process, which culminated in Venice in November 2022 after more than 8 months of intense global scientific deliberations. A forum of gastritis scholars from five continents participated in the multidisciplinary RE.GA.IN. consensus. After lively debates on the most controversial aspects of the gastritis spectrum, the RE.GA.IN. Faculty amalgamated complementary knowledge to distil patient-centred, evidence-based statements to assist health professionals in their real-world clinical practice. The sections of this report focus on: the epidemiology of gastritis; Helicobacter pylori as dominant aetiology of environmental gastritis and as the most important determinant of the gastric oncogenetic field; the evolving knowledge on gastric autoimmunity; the clinicopathological relevance of gastric microbiota; the new diagnostic horizons of endoscopy; and the clinical priority of histologically reporting gastritis in terms of staging. The ultimate goal of RE.GA.IN. was and remains the promotion of further improvement in the clinical management of patients with gastritis.
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Affiliation(s)
- Massimo Rugge
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Azienda Zero, Veneto Tumour Registry, Padua, Italy
| | - Robert M Genta
- Gastrointestinal Pathology, Inform Diagnostics Research Institute, Dallas, Texas, USA
- Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Malfertheiner
- Medizinische Klinik und Poliklinik II, Ludwig Maximilian Universität Klinikum München, Munich, Germany
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität Magdeburg, Magdeburg, Germany
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center & RISE@CI-IPO, University of Porto, Porto, Portugal
- Gastroenterology Department, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | - Hashem El-Serag
- Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
- Houston VA Health Services Research & Development Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - David Y Graham
- Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Ernst J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jin Young Park
- International Agency for Research on Cancer, Lyon, France
| | - Theodore Rokkas
- Gastroenterology, Henry Dunant Hospital Center, Athens, Greece
| | | | - Emad M El-Omar
- Microbiome Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Kuipers EJ, Spaander MCW. Lifetime Gained With Cancer Screening. JAMA Intern Med 2024; 184:226-227. [PMID: 38165702 DOI: 10.1001/jamainternmed.2023.7076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Sugano K, Moss SF, Kuipers EJ. Gastric Intestinal Metaplasia: Real Culprit or Innocent Bystander as a Precancerous Condition for Gastric Cancer? Gastroenterology 2023; 165:1352-1366.e1. [PMID: 37652306 DOI: 10.1053/j.gastro.2023.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
Gastric intestinal metaplasia (GIM), which denotes conversion of gastric mucosa into an intestinal phenotype, can occur in all regions of the stomach, including cardiac, fundic, and pyloric mucosa. Since the earliest description of GIM, its association with gastric cancer of the differentiated (intestinal) type has been a well-recognized concern. Many epidemiologic studies have confirmed GIM to be significantly associated with subsequent gastric cancer development. Helicobacter pylori, the principal etiologic factor for gastric cancer, plays the most important role in predisposing to GIM. Although the role of GIM in the stepwise progression model of gastric carcinogenesis (the so-called "Correa cascade") has come into question recently, we review the scientific evidence that strongly supports this long-standing model and propose a new progression model that builds on the Correa cascade. Eradication of H pylori is the most important method for preventing gastric cancer globally, but the effect of eradication on established GIM, is limited, if any. Endoscopic surveillance for GIM may, therefore, be necessary, especially when there is extensive corpus GIM. Recent advances in image-enhanced endoscopy with integrated artificial intelligence have facilitated the identification of GIM and neoplastic lesions, which will impact preventive strategies in the near future.
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Affiliation(s)
| | - Steven F Moss
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ernst J Kuipers
- Erasmus Medical Center, Rotterdam and Minister, Ministry of Health, Welfare, and Sport, Hague, The Netherlands
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Mommersteeg MC, Nieuwenburg SAV, Wolters LMM, Roovers BHCM, van Vuuren HAJ, Verhaar AP, Bruno MJ, Kuipers EJ, Peppelenbosch MP, Spaander MCW, Fuhler GM. The use of non-invasive stool tests for verification of Helicobacter pylori eradication and clarithromycin resistance. United European Gastroenterol J 2023; 11:894-903. [PMID: 37854002 PMCID: PMC10637120 DOI: 10.1002/ueg2.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/24/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Clarithromycin resistance of Helicobacter pylori (H. pylori) represents a major challenge in eradication therapy. In this study, we assessed if non-invasive stool tests can be used to verify successful H. pylori eradication and determine clarithromycin resistance. MATERIALS AND METHODS In this prospective study, patients undergoing urea breath testing (UBT) for confirmation of H. pylori eradication were asked to collect the stool as both a dry fecal sample and fecal immunochemical test (FIT). Stool H. pylori antigen testing (SAT) was performed on these samples and assessed for its accuracy in eradication verification. Type and duration of antibiotic treatment were retrospectively collected from patient records and compared with clarithromycin resistance determined by PCR of stool samples. RESULTS H. pylori eradication information was available for a total of 145 patients (42.7% male, median age: 51.2). Successful eradication was achieved in 68.1% of patients. SAT on FIT samples had similar accuracy for eradication assessment compared to dry fecal samples, 72.1% [95% CI 61.4-81.2] versus 72.2% [95% CI 60.9-81.7]. Clarithromycin resistance rate was 13.4%. CONCLUSION H. pylori antigen testing on FIT stool samples to verify H. pylori eradication is feasible and has similar accuracy as H. pylori antigen testing on dry stool samples. Dry stool, but not FIT, was suitable for non-invasive identification of H. pylori clarithromycin resistance by rt-PCR personalizing antibiotic treatment strategies without the need for invasive diagnostics is desirable, as the cure rate of first-line empirical H. pylori treatment remains low.
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Affiliation(s)
- Michiel C. Mommersteeg
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Stella A. V. Nieuwenburg
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Leonieke M. M. Wolters
- Department of Gastroenterology and HepatologyAlbert Schweitzer HospitalDordrechtThe Netherlands
| | - Buddy H. C. M. Roovers
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Hanneke A. J. van Vuuren
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Auke P. Verhaar
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Maikel P. Peppelenbosch
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Gwenny M. Fuhler
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
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Abstract
In the past decades the incidence of colorectal cancer (CRC) in people under the age of 50 years has increased, which is referred to as early-onset CRC or young-onset CRC (YO-CRC). YO-CRC is expected to account for 11% of colon cancers and 23% of rectal cancers by 2030. This trend is observed in different parts of the world and in both men and women. In 20% of patients with YO-CRC, a hereditary cancer syndrome is found as the underlying cause; however, in the majority of patients no genetic predisposition is present. Beginning in the 1950s, major changes in lifestyle such as antibiotic use, low physical activity and obesity have affected the gut microbiome and may be an important factor in YO-CRC development. Owing to a lack of screening, patients with YO-CRC are often diagnosed with advanced-stage disease. Long-term treatment-related complications should be taken into account in these younger patients, making the more traditional sequential approaches of drug therapy not always the most appropriate option. To better understand the underlying mechanism and define relationships between environmental factors and YO-CRC development, long-term prospective studies are needed with lifestyle data collected from childhood.
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Affiliation(s)
- Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center/Erasmus MC Cancer Institute, Rotterdam, Netherlands.
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sapna Syngal
- Brigham and Women's Hospital, Boston, MA, USA
- Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Martin J Blaser
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ, USA
| | - Joseph J Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Y Nancy You
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center/Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Meester RGS, van de Schootbrugge-Vandermeer HJ, Breekveldt ECH, de Jonge L, Toes-Zoutendijk E, Kooyker A, Nieboer D, Ramakers CR, Spaander MCW, van Vuuren AJ, Kuipers EJ, van Kemenade FJ, Nagtegaal ID, Dekker E, van Leerdam ME, Lansdorp-Vogelaar I. Faecal occult blood loss accurately predicts future detection of colorectal cancer. A prognostic model. Gut 2023; 72:101-108. [PMID: 35537811 PMCID: PMC9763180 DOI: 10.1136/gutjnl-2022-327188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/16/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine the prognostic potential of repeated faecal haemoglobin (F-Hb) concentration measurements in faecal immunochemical test (FIT)-based screening for colorectal cancer (CRC). DESIGN Prognostic model. SETTING Dutch biennial FIT-based screening programme during 2014-2018. PARTICIPANTS 265 881 participants completing three rounds of FIT, with negative test results (F-Hb <47 µg Hb/g faeces) in rounds 1 and 2. INTERVENTIONS Colonoscopy follow-up in participants with a positive FIT (F-Hb ≥47 µg Hb/g faeces). MAIN OUTCOMES We evaluated prognostic models for detecting advanced neoplasia (AN) and CRC in round 3, with as predictors, participant age, sex, F-Hb in rounds 1 and 2, and categories/combinations/non-linear transformations of F-Hb. Primary evaluation criteria included: risk prediction accuracy (calibration), discrimination of participants with versus without AN or CRC (optimism-adjusted C-statistics, range 0.5-1.0), the degree of risk stratification and C-statistics in external validation. RESULTS Among study participants, 8806 (3.3%) had a positive FIT result, 3254 (1.2%) had AN detected and 557 (0.2%) had cancer. F-Hb concentrations in rounds 1 and 2 were the strongest outcome predictors, with adjusted ORs of up to 9.4 (95% CI 7.5 to 11.7) for the highest F-Hb category. Risk predictions matched the observed risk for most participants (calibration intercept -0.008 to -0.099; slope 0.982-0.998), and discriminated participants with versus without AN or CRC with C-statistics of 0.78 (95% CI 0.77 to 0.79) and 0.73 (95% CI 0.71 to 0.75), respectively. The predicted risk ranged from 0.4% to 36.7% for AN and from 0.0% to 5.5% for CRC across participants. In external validation, the model retained similar discrimination accuracy for AN (C-statistic 0.77, 95% CI 0.66 to 0.87) and CRC (C-statistic 0.78, 95% CI 0.66 to 0.91). CONCLUSION Participants at lower versus higher risk of future AN or CRC can be accurately identified based on their age, sex and particularly, prior F-Hb concentrations. Risk stratification should be considered based on this information.
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Affiliation(s)
- Reinier G S Meester
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - Emilie C H Breekveldt
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Lucie de Jonge
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Arthur Kooyker
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Christian R Ramakers
- Clinical Chemistry, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | | | - Iris D Nagtegaal
- Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Monique E van Leerdam
- Gastroenterology and Hepatology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands,Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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7
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia.,Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand.,The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Bretthauer M, Løberg M, Wieszczy P, Kalager M, Emilsson L, Garborg K, Rupinski M, Dekker E, Spaander M, Bugajski M, Holme Ø, Zauber AG, Pilonis ND, Mroz A, Kuipers EJ, Shi J, Hernán MA, Adami HO, Regula J, Hoff G, Kaminski MF. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. N Engl J Med 2022; 387:1547-1556. [PMID: 36214590 DOI: 10.1056/nejmoa2208375] [Citation(s) in RCA: 183] [Impact Index Per Article: 91.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. METHODS We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. RESULTS Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). CONCLUSIONS In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.).
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Affiliation(s)
- Michael Bretthauer
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Magnus Løberg
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Paulina Wieszczy
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Mette Kalager
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Louise Emilsson
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Kjetil Garborg
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Maciej Rupinski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Evelien Dekker
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Manon Spaander
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Marek Bugajski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Øyvind Holme
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Ann G Zauber
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Nastazja D Pilonis
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Andrzej Mroz
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Ernst J Kuipers
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Joy Shi
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Miguel A Hernán
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Hans-Olov Adami
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Jaroslaw Regula
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Geir Hoff
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
| | - Michal F Kaminski
- From the Clinical Effectiveness Research Group (M. Bretthauer, M.L., P.W., M.K., K.G., M. Bugajski, Ø.H., H.-O.A., M.F.K.) and the Department of General Practice, Institute of Health and Society (L.E.), University of Oslo, the Clinical Effectiveness Research Group, Department of Transplantation Medicine, Oslo University Hospital (M. Bretthauer, M.L., M.K., K.G., Ø.H., H.-O.A.), and the Cancer Registry of Norway (G.H.), Oslo, the Institute of Clinical Medicine, University of Tromsø, Tromsø (M. Bretthauer), and the Department of Research and Development, Telemark Hospital, Skien (G.H.) - all in Norway; the Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), and the Departments of Pathology (A.M.) and Gastroenterological Oncology (P.W., M.R., M. Bugajski, N.D.P., A.M., J.R., M.F.K.), Medical Center of Postgraduate Education - both in Warsaw, Poland; Vårdcentralen Värmlands Nysäter and the Center for Clinical Research, County Council of Värmland, Karlsdad (L.E.), and the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna (L.E., H.-O.A.) - both in Sweden; the Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, and the University of Amsterdam, Amsterdam (E.D.), and the Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (M.S., E.J.K.) - all in the Netherlands; the Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York (A.G.Z.); and CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston (J.S., M.A.H.)
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9
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Wisse PHA, Erler NS, de Boer SY, den Hartog B, Oudkerk Pool M, Terhaar Sive Droste JS, Verveer C, Meijer GA, Lansdorp-Vogelaar I, Kuipers EJ, Dekker E, Spaander MCW. Adenoma Detection Rate and Risk for Interval Postcolonoscopy Colorectal Cancer in Fecal Immunochemical Test-Based Screening : A Population-Based Cohort Study. Ann Intern Med 2022; 175:1366-1373. [PMID: 36162114 DOI: 10.7326/m22-0301] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 11/22/2022] Open
Abstract
BACKGROUND The adenoma detection rate (ADR) is an essential quality indicator for endoscopists performing colonoscopies for colorectal cancer (CRC) screening as it is associated with postcolonoscopy CRCs (PCCRCs). Currently, data on ADRs of endoscopists performing colonoscopies in fecal immunochemical testing (FIT)-based screening, the most common screening method, are scarce. Also, the association between the ADR and PCCRC has not been demonstrated in this setting. OBJECTIVE To evaluate the association between the ADR and PCCRC risk in colonoscopies done after a positive FIT result. DESIGN Population-based cohort. SETTING Dutch, FIT-based, CRC screening program. PARTICIPANTS Patients undergoing colonoscopy, done by accredited endoscopists, after a positive FIT result. MEASUREMENTS Quality indicator performance and PCCRC incidence for colonoscopies in FIT-positive screenees were assessed. The PCCRCs were classified as interval, a cancer detected before recommended surveillance, or noninterval. The association between ADR and interval PCCRC was evaluated with a multivariable Cox regression model and PCCRC incidence was determined for different ADRs. RESULTS 362 endoscopists performed 116 360 colonoscopies with a median ADR of 67%. In total, 209 interval PCCRCs were identified. The ADR was associated with interval PCCRC, with an adjusted hazard ratio of 0.95 (95% CI, 0.92 to 0.97) per 1% increase in ADR. For every 1000 patients undergoing colonoscopy, the expected number of interval PCCRC diagnoses after 5 years was approximately 2 for endoscopists with ADRs of 70%, compared with more than 2.5, almost 3.5, and more than 4.5 for endoscopists with ADRs of 65%, 60%, and 55%, respectively. LIMITATION The relative short duration of follow-up (median, 52 months) could be considered a limitation. CONCLUSION The ADR of endoscopists is inversely associated with the risk for interval PCCRC in FIT-positive colonoscopies. Endoscopists performing colonoscopy in FIT-based screening should aim for markedly higher ADRs compared with primary colonoscopy. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Pieter H A Wisse
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.)
| | - Nicole S Erler
- Department of Biostatistics and Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands (N.S.E.)
| | - Sybrand Y de Boer
- Regional Organization for Population Screening Mid-West Netherlands, Amsterdam, the Netherlands (S.Y.B.)
| | - Bert den Hartog
- Regional Organization for Population Screening East Netherlands, Deventer, the Netherlands (B.H.)
| | - Marco Oudkerk Pool
- Regional Organization for Population Screening North Netherlands, Groningen, the Netherlands (M.O.P.)
| | | | - Claudia Verveer
- Regional Organization for Population Screening South-West Netherlands, Rotterdam, the Netherlands (C.V.)
| | - Gerrit A Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands (G.A.M.)
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands (I.L.)
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.)
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands (E.D.)
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands (P.H.A.W., E.J.K., M.C.W.S.)
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10
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Mommersteeg MC, Yu BT, van den Bosch TPP, von der Thüsen J, Kuipers EJ, Doukas M, Spaander M, Peppelenbosch MP, Fuhler GM. Constitutive programmed death ligand 1 expression protects gastric G-cells from Helicobacter pylori-induced inflammation. Helicobacter 2022; 27:e12917. [PMID: 35899973 PMCID: PMC9542424 DOI: 10.1111/hel.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/20/2022] [Accepted: 06/23/2022] [Indexed: 12/09/2022]
Abstract
INTRODUCTION Gastric intestinal metaplasia (GIM) is a premalignant lesion, highly associated with Helicobacter pylori infection. Previous studies have shown that H. pylori is able to induce the expression of programmed death ligand 1 (PD-L1), an inhibitory immune modulator, in gastric cells. Our aim was to investigate whether tissues from GIM patients may exploit PD-L1 expression upon H. pylori infection to evade immunosurveillance. METHODS Immunohistochemistry was performed for PD-L1 and enteroendocrine markers somatostatin and gastrin on samples derived from a cohort of patients with known GIM, both before and after H. pylori eradication. To determine the identity of any observed PD-L1-positive cells, we performed multiplex immunofluorescent staining and analysis of single-cell sequencing data. RESULTS GIM tissue was rarely positive for PD-L1. In normal glands from GIM patients, PD-L1 was mainly expressed by gastrin-positive G-cells. While the D-cell and G-cell compartments were both diminished 2-fold (p = .015 and p = .01, respectively) during H. pylori infection in the normal antral tissue of GIM patients, they were restored 1 year after eradication. The total number of PD-L1-positive cells was not affected by H. pylori, but the percentage of PD-L1-positive G-cells was 30% higher in infected subjects (p = .011), suggesting that these cells are preferentially rescued from destruction. CONCLUSIONS Antral G-cells frequently express PD-L1 during homeostasis. G-cells seem to be protected from H. pylori-induced immune destruction by PD-L1 expression. GIM itself does not express PD-L1 and is unlikely to escape immunosurveillance via expression of PD-L1.
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Affiliation(s)
- Michiel C. Mommersteeg
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Bing Ting Yu
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | | | | | - Ernst J. Kuipers
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Michael Doukas
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Maikel P. Peppelenbosch
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Gwenny M. Fuhler
- Department of Gastroenterology and HepatologyErasmus MC University Medical CenterRotterdamThe Netherlands
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11
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Moen S, Vuik FER, Kuipers EJ, Spaander MCW. Artificial Intelligence in Colon Capsule Endoscopy—A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12081994. [PMID: 36010345 PMCID: PMC9407289 DOI: 10.3390/diagnostics12081994] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 12/17/2022] Open
Abstract
Background and aims: The applicability of colon capsule endoscopy in daily practice is limited by the accompanying labor-intensive reviewing time and the risk of inter-observer variability. Automated reviewing of colon capsule endoscopy images using artificial intelligence could be timesaving while providing an objective and reproducible outcome. This systematic review aims to provide an overview of the available literature on artificial intelligence for reviewing colonic mucosa by colon capsule endoscopy and to assess the necessary action points for its use in clinical practice. Methods: A systematic literature search of literature published up to January 2022 was conducted using Embase, Web of Science, OVID MEDLINE and Cochrane CENTRAL. Studies reporting on the use of artificial intelligence to review second-generation colon capsule endoscopy colonic images were included. Results: 1017 studies were evaluated for eligibility, of which nine were included. Two studies reported on computed bowel cleansing assessment, five studies reported on computed polyp or colorectal neoplasia detection and two studies reported on other implications. Overall, the sensitivity of the proposed artificial intelligence models were 86.5–95.5% for bowel cleansing and 47.4–98.1% for the detection of polyps and colorectal neoplasia. Two studies performed per-lesion analysis, in addition to per-frame analysis, which improved the sensitivity of polyp or colorectal neoplasia detection to 81.3–98.1%. By applying a convolutional neural network, the highest sensitivity of 98.1% for polyp detection was found. Conclusion: The use of artificial intelligence for reviewing second-generation colon capsule endoscopy images is promising. The highest sensitivity of 98.1% for polyp detection was achieved by deep learning with a convolutional neural network. Convolutional neural network algorithms should be optimized and tested with more data, possibly requiring the set-up of a large international colon capsule endoscopy database. Finally, the accuracy of the optimized convolutional neural network models need to be confirmed in a prospective setting.
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12
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Sonneveld MJ, Hardeman S, Kuipers EJ, de Graaf W, Spaander MCW, van der Meer AJ. Effect of the COVID-19 pandemic on procedure volumes in gastroenterology in the Netherlands. Lancet Gastroenterol Hepatol 2022; 7:595-598. [PMID: 35605622 PMCID: PMC9122781 DOI: 10.1016/s2468-1253(22)00164-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 04/08/2023]
Affiliation(s)
- Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands.
| | | | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wilmar de Graaf
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Adriaan J van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
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13
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Sung JJY, Moreea S, Dhaliwal H, Moffatt DC, Ragunath K, Ponich T, Barkun AN, Kuipers EJ, Bailey R, Donnellan F, Wagner D, Sanborn K, Lau J. Use of topical mineral powder as monotherapy for treatment of active peptic ulcer bleeding. Gastrointest Endosc 2022; 96:28-35.e1. [PMID: 35124074 DOI: 10.1016/j.gie.2022.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/28/2021] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the safety and effectiveness of Hemospray (Cook Medical, Winston-Salem, NC, USA), a hemostatic powder, as monotherapy for active peptic ulcer bleeding. METHODS In this prospective, multicenter, single-arm study, patients with Forrest Ia or Ib peptic ulcers underwent endoscopic application of Hemospray as treatment of first intent. Effectiveness endpoints were successful hemostasis at the end of the index endoscopy, recurrent bleeding within 72 hours and from 72 hours to 30 days, adverse events requiring reintervention or resulting in morbidity or mortality, and 30-day mortality. RESULTS Hemospray was successfully administered in 98.5% of patients (66/67). Hemostasis was achieved at the index endoscopy in 90.9% of patients (60/66) with Hemospray alone and in an additional 4 patients treated with additional modalities, yielding an overall hemostasis rate of 97.0% (64/66). Rebleeding occurred in 13.3% of patients (8/60), 5 within 72 hours and 3 between 72 hours and 30 days. Two cases of perforation and 2 patient deaths occurred during the study, but none of these cases or any other adverse events were attributed to the use of Hemospray. The rate of early rebleeding was significantly higher in patients with Forrest Ia ulcers compared with patients with Forrest Ib ulcers. Higher rates of early bleeding in patients with Forrest Ia ulcers is consistent with results from studies where Hemospray was used as rescue after failure of conventional methods. CONCLUSIONS Hemospray is an effective initial treatment for patients with active peptic ulcer bleeding, but care should be taken to monitor for recurrent bleeding. (Clinical trial registration number: NCT01306864.).
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Affiliation(s)
- Joseph J Y Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Sulleman Moreea
- Department of Gastroenterology, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Harinder Dhaliwal
- Department of Medicine, Division of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dana C Moffatt
- Department of Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Krish Ragunath
- Department of Gastroenterology, NIHR Nottingham Digestive Diseases Biomedical Research Centre, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Terry Ponich
- Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert Bailey
- Department of Gastroenterology and Hepatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Fergal Donnellan
- Department of Gastroenterology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - David Wagner
- Cook Endoscopy, Winston-Salem, North Carolina, USA
| | - Keith Sanborn
- Cook Research Incorporated, West Lafayette, Indiana, USA
| | - James Lau
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
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Grobbee EJ, Wisse PHA, Schreuders EH, van Roon A, van Dam L, Zauber AG, Lansdorp-Vogelaar I, Bramer W, Berhane S, Deeks JJ, Steyerberg EW, van Leerdam ME, Spaander MC, Kuipers EJ. Guaiac-based faecal occult blood tests versus faecal immunochemical tests for colorectal cancer screening in average-risk individuals. Cochrane Database Syst Rev 2022; 6:CD009276. [PMID: 35665911 PMCID: PMC9169237 DOI: 10.1002/14651858.cd009276.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Worldwide, many countries have adopted colorectal cancer (CRC) screening programmes, often based on faecal occult blood tests (FOBTs). CRC screening aims to detect advanced neoplasia (AN), which is defined as CRC or advanced adenomas. FOBTs fall into two categories based on detection technique and the detected blood component: qualitative guaiac-based FOBTs (gFOBTs) and faecal immunochemical tests (FITs), which can be qualitative and quantitative. Screening with gFOBTs reduces CRC-related mortality. OBJECTIVES To compare the diagnostic test accuracy of gFOBT and FIT screening for detecting advanced colorectal neoplasia in average-risk individuals. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, BIOSIS Citation Index, Science Citation Index Expanded, and Google Scholar. We searched the reference lists and PubMed-related articles of included studies to identify additional studies. SELECTION CRITERIA We included prospective and retrospective studies that provided the number of true positives, false positives, false negatives, and true negatives for gFOBTs, FITs, or both, with colonoscopy as reference standard. We excluded case-control studies. We included studies in which all participants underwent both index test and reference standard ("reference standard: all"), and studies in which only participants with a positive index test underwent the reference standard while participants with a negative test were followed for at least one year for development of interval carcinomas ("reference standard: positive"). The target population consisted of asymptomatic, average-risk individuals undergoing CRC screening. The target conditions were CRC and advanced neoplasia (advanced adenomas and CRC combined). DATA COLLECTION AND ANALYSIS Two review authors independently screened and selected studies for inclusion. In case of disagreement, a third review author made the final decision. We used the Rutter and Gatsonis hierarchical summary receiver operating characteristic model to explore differences between tests and identify potential sources of heterogeneity, and the bivariate hierarchical model to estimate sensitivity and specificity at common thresholds: 10 µg haemoglobin (Hb)/g faeces and 20 µg Hb/g faeces. We performed indirect comparisons of the accuracy of the two tests and direct comparisons when both index tests were evaluated in the same population. MAIN RESULTS We ran the initial search on 25 June 2019, which yielded 63 studies for inclusion. We ran a top-up search on 14 September 2021, which yielded one potentially eligible study, currently awaiting classification. We included a total of 33 "reference standard: all" published articles involving 104,640 participants. Six studies evaluated only gFOBTs, 23 studies evaluated only FITs, and four studies included both gFOBTs and FITs. The cut-off for positivity of FITs varied between 2.4 μg and 50 µg Hb/g faeces. For each Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 domain, we assessed risk of bias as high in less than 20% of studies. The summary curve showed that FITs had a higher discriminative ability than gFOBTs for AN (P < 0.001) and CRC (P = 0.004). For the detection of AN, the summary sensitivity of gFOBTs was 15% (95% confidence interval (CI) 12% to 20%), which was significantly lower than FITs at both 10 μg and 20 μg Hb/g cut-offs with summary sensitivities of 33% (95% CI 27% to 40%; P < 0.001) and 26% (95% CI 21% to 31%, P = 0.002), respectively. Results were simulated in a hypothetical cohort of 10,000 screening participants with 1% CRC prevalence and 10% AN prevalence. Out of 1000 participants with AN, gFOBTs missed 850, while FITs missed 670 (10 μg Hb/g cut-off) and 740 (20 μg Hb/g cut-off). No significant differences in summary specificity for AN detection were found between gFOBTs (94%; 95% CI 92% to 96%), and FITs at 10 μg Hb/g cut-off (93%; 95% CI 90% to 95%) and at 20 μg Hb/g cut-off (97%; 95% CI 95% to 98%). So, among 9000 participants without AN, 540 were offered (unnecessary) colonoscopy with gFOBTs compared to 630 (10 μg Hb/g) and 270 (20 μg Hb/g) with FITs. Similarly, for the detection of CRC, the summary sensitivity of gFOBTs, 39% (95% CI 25% to 55%), was significantly lower than FITs at 10 μg and 20 μg Hb/g cut-offs: 76% (95% CI 57% to 88%: P = 0.001) and 65% (95% CI 46% to 80%; P = 0.035), respectively. So, out of 100 participants with CRC, gFOBTs missed 61, and FITs missed 24 (10 μg Hb/g) and 35 (20 μg Hb/g). No significant differences in summary specificity for CRC were found between gFOBTs (94%; 95% CI 91% to 96%), and FITs at the 10 μg Hb/g cut-off (94%; 95% CI 87% to 97%) and 20 μg Hb/g cut-off (96%; 95% CI 91% to 98%). So, out of 9900 participants without CRC, 594 were offered (unnecessary) colonoscopy with gFOBTs versus 594 (10 μg Hb/g) and 396 (20 μg Hb/g) with FITs. In five studies that compared FITs and gFOBTs in the same population, FITs showed a higher discriminative ability for AN than gFOBTs (P = 0.003). We included a total of 30 "reference standard: positive" studies involving 3,664,934 participants. Of these, eight were gFOBT-only studies, 18 were FIT-only studies, and four studies combined both gFOBTs and FITs. The cut-off for positivity of FITs varied between 5 µg to 250 µg Hb/g faeces. For each QUADAS-2 domain, we assessed risk of bias as high in less than 20% of studies. The summary curve showed that FITs had a higher discriminative ability for detecting CRC than gFOBTs (P < 0.001). The summary sensitivity for CRC of gFOBTs, 59% (95% CI 55% to 64%), was significantly lower than FITs at the 10 μg Hb/g cut-off, 89% (95% CI 80% to 95%; P < 0.001) and the 20 μg Hb/g cut-off, 89% (95% CI 85% to 92%; P < 0.001). So, in the hypothetical cohort with 100 participants with CRC, gFOBTs missed 41, while FITs missed 11 (10 μg Hb/g) and 11 (20 μg Hb/g). The summary specificity of gFOBTs was 98% (95% CI 98% to 99%), which was higher than FITs at both 10 μg and 20 μg Hb/g cut-offs: 94% (95% CI 92% to 95%; P < 0.001) and 95% (95% CI 94% to 96%; P < 0.001), respectively. So, out of 9900 participants without CRC, 198 were offered (unnecessary) colonoscopy with gFOBTs compared to 594 (10 μg Hb/g) and 495 (20 μg Hb/g) with FITs. At a specificity of 90% and 95%, FITs had a higher sensitivity than gFOBTs. AUTHORS' CONCLUSIONS FITs are superior to gFOBTs in detecting AN and CRC in average-risk individuals. Specificity of both tests was similar in "reference standard: all" studies, whereas specificity was significantly higher for gFOBTs than FITs in "reference standard: positive" studies. However, at pre-specified specificities, the sensitivity of FITs was significantly higher than gFOBTs.
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Affiliation(s)
- Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Pieter HA Wisse
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Aafke van Roon
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | - Leonie van Dam
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wichor Bramer
- Medical Library , Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sarah Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
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15
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Lam SY, Mommersteeg MC, Yu B, Broer L, Spaander MCW, Frost F, Weiss S, Völzke H, Lerch MM, Schöttker B, Zhang Y, Stocker H, Brenner H, Levy D, Hwang SJ, Wood AC, Rich SS, Rotter JI, Taylor KD, Tracy RP, Kabagambe EK, Leja M, Klovins J, Peculis R, Rudzite D, Nikitina-Zake L, Skenders G, Rovite V, Uitterlinden A, Kuipers EJ, Fuhler GM, Homuth G, Peppelenbosch MP. Toll-Like Receptor 1 Locus Re-examined in a Genome-Wide Association Study Update on Anti-Helicobacter pylori IgG Titers. Gastroenterology 2022; 162:1705-1715. [PMID: 35031300 DOI: 10.1053/j.gastro.2022.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/03/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS A genome-wide significant association between anti-Helicobacter pylori (H pylori) IgG titers and Toll-like receptor (TLR1/6/10) locus on 4p14 was demonstrated for individuals of European ancestry, but not uniformly replicated. We re-investigated this association in an updated genome-wide association study (GWAS) meta-analysis for populations with low gastric cancer incidence, address potential causes of cohort heterogeneity, and explore functional implications of genetic variation at the TLR1/6/10 locus. METHODS The dichotomous GWAS (25% individuals exhibiting highest anti-H pylori IgG titers vs remaining 75%) included discovery and replication sampls of, respectively, n = 15,685 and n = 9676, all of European ancestry. Longitudinal analysis of serologic data was performed on H pylori-eradicated subjects (n = 132) and patients under surveillance for premalignant gastric lesions (n = 107). TLR1/6/10 surface expression, TLR1 mRNA, and cytokine levels were measured in leukocyte subsets of healthy subjects (n = 26) genotyped for TLR1/6/10 variants. RESULTS The association of the TLR1/6/10 locus with anti-H pylori IgG titers (rs12233670; β = -0.267 ± SE 0.034; P = 4.42 × 10-15) presented with high heterogeneity and failed replication. Anti-H pylori IgG titers declined within 2-4 years after eradication treatment (P = 0.004), and decreased over time in patients with premalignant gastric lesions (P < 0.001). Variation at the TLR1/6/10 locus affected TLR1-mediated cytokine production and TLR1 surface expression on monocytes (P = 0.016) and neutrophils (P = 0.030), but not mRNA levels. CONCLUSIONS The association between anti-H pylori IgG titers and TLR1/6/10 locus was not replicated across cohorts, possibly owing to dependency of anti-H pylori IgG titers on therapy, clearance, and antibody decay. H pylori-mediated immune cell activation is partly mediated via TLR1 signaling, which in turn is affected by genetic variation.
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Affiliation(s)
- Suk Yee Lam
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michiel C Mommersteeg
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bingting Yu
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Weiss
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany; Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Yan Zhang
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hannah Stocker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Daniel Levy
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Shih-Jen Hwang
- Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, Massachusetts, USA; Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Alexis C Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, Department of Pediatrics, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Russell P Tracy
- Laboratory for Clinical Biochemistry Research, University of Vermont College of Medicine, Colchester, Vermont, USA
| | | | - Marcis Leja
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Janis Klovins
- Latvian Biomedical Research and Study Center, Riga, Latvia
| | - Raitis Peculis
- Latvian Biomedical Research and Study Center, Riga, Latvia
| | - Dace Rudzite
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | | | - Girts Skenders
- Institute of Clinical and Preventive Medicine, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Vita Rovite
- Latvian Biomedical Research and Study Center, Riga, Latvia
| | - André Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gwenny M Fuhler
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Georg Homuth
- Department of Functional Genomics, Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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16
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Kuiper JG, van Herk-Sukel MPP, Lemmens VEPP, Kuiper MJ, Kuipers EJ, Herings RMC. Risk of heart failure among colon and rectal cancer survivors: a population-based case-control study. ESC Heart Fail 2022; 9:2139-2146. [PMID: 35451236 PMCID: PMC9288790 DOI: 10.1002/ehf2.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS This population-based case-control study aims to investigate the occurrence of heart failure (HF) among colon and rectal cancer survivors compared with a cancer-free control population taking into account pre-existing cardiovascular risk factors and the influence of treatment. METHODS AND RESULTS Colon and rectal cancer survivors diagnosed between 2007 and 2014 were selected from a linked cohort of cancer and primary care data in the Netherlands and matched based on gender, birth year, general practitioner (GP) practice, and follow-up period to cancer-free controls. The occurrence of HF was identified based on GP recorded diagnoses after index date (diagnosis date for cases). A Cox proportional hazards model was used to estimate hazard ratios (HRs), adjusted for age, sex, hypertension, diabetes, and hypercholesterolaemia. A total of 5333 colon cancer cases and 2468 rectal cancer cases could be matched to a total of 31 204 cancer-free controls. A statistically significant increased risk of HF was seen among all cases compared with cancer-free controls (HR 1.33; 95% confidence interval: 1.12-1.59). This was also seen when analysing colon cancer and rectal cancer separately. Being diagnosed with stage IV cancer, having hypertension, or having hypercholesterolaemia statistically significantly increased the risk of HF among colon cancer. Hypertension was a statistically significant risk factor for developing HF among rectal cancer cases. CONCLUSIONS Colon and rectal cancer survivors are at increased risk for developing HF. More awareness should be created by treating physicians and GPs for this potential increased risk in order to further improve survival.
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Affiliation(s)
- Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Mathijs J Kuiper
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
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17
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Vuik FER, Nieuwenburg SAV, Moen S, Schreuders EH, Oudkerk Pool MD, Peterse EFP, Spada C, Epstein O, Fernández-Urién I, Hofman A, Kuipers EJ, Spaander MCW. Population-Based Prevalence of Gastrointestinal Abnormalities at Colon Capsule Endoscopy. Clin Gastroenterol Hepatol 2022; 20:692-700.e7. [PMID: 33130189 DOI: 10.1016/j.cgh.2020.10.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 07/07/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The population prevalence of gastrointestinal (GI) disease is unclear and difficult to assess in an asymptomatic population. The aim of this study was to determine prevalence of GI lesions in a largely asymptomatic population undergoing colon capsule endoscopy (CCE). METHODS Participants aged between 50-75 years were retrieved from the Rotterdam Study, a longitudinal epidemiological study, between 2017-2019. Participants received CCE with bowel preparation. Abnormalities defined as clinically relevant were Barrett segment >3cm, severe ulceration, polyp >10 mm or ≥3 polyps in small bowel (SB) or colon, and cancer. RESULTS Of 2800 invited subjects, 462 (16.5%) participants (mean age 66.8 years, female 53.5%) ingested the colon capsule. A total of 451 videos were analyzed, and in 94.7% the capsule reached the descending colon. At least 1 abnormal finding was seen in 448 (99.3%) participants. The prevalence of abnormalities per GI segment, and the most common type of abnormality, were as follows: Esophageal 14.8% (Barrett's esophagus <3 cm in 8.3%), gastric 27.9% (fundic gland polyps in 18.1%), SB abnormalities 33.9% (erosions in 23.8%), colon 93.3% (diverticula in 81.2%). A total of 54 participants (12%) had clinically relevant abnormalities, 3 (0.7%) in esophagus/stomach (reflux esophagitis grade D, Mallory Weiss lesion and severe gastritis), 5 (1.1%) in SB (polyps > 10 mm; n = 4, severe ulcer n = 1,) and 46 (10.2%) in colon (polyp > 10 mm or ≥3 polyps n = 46, colorectal cancer n = 1). CONCLUSIONS GI lesions are very common in a mostly asymptomatic Western population, and clinically relevant lesions were found in 12% at CCE. These findings provide a frame of reference for the prevalence rates of GI lesions in the general population.
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Affiliation(s)
- Fanny E R Vuik
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stella A V Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Elisabeth F P Peterse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Owen Epstein
- Centre for Gastroenterology, Royal Free Hospital, Pond St, London, United Kingdom
| | - Ignacio Fernández-Urién
- Department of Gastroenterology and Hepatology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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18
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van der Meulen MP, Toes-Zoutendijk E, Spaander MCW, Dekker E, Bonfrer JMG, van Vuuren AJ, Kuipers EJ, van Kemenade FJ, van Velthuysen MF, Thomeer MGJ, van Veldhuizen H, de Koning HJ, Lansdorp-Vogelaar I, van Leerdam ME. Socioeconomic differences in participation and diagnostic yield within the Dutch national colorectal cancer screening programme with faecal immunochemical testing. PLoS One 2022; 17:e0264067. [PMID: 35176116 PMCID: PMC8853540 DOI: 10.1371/journal.pone.0264067] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/02/2022] [Indexed: 12/22/2022] Open
Abstract
Background CRC mortality rates are higher for individuals with a lower socioeconomic status (SES). Screening could influence health inequalities. We therefore aimed to investigate SES differences in participation and diagnostic yield of FIT screening. Methods All invitees in 2014 and 2015 in the Dutch national CRC screening programme were included in the analyses. We used area SES as a measure for SES and divided invitees into quintiles, with Quintile 1 being the highest SES. Logistic regression analysis was used to compare the participation rate, positivity rate, colonoscopy uptake, positive predictive value (PPV) and detection rate across the SES groups. Results Participation to FIT screening was significantly lower for Quintile 5 (67.0%) compared to the other Quintiles (73.0% to 75.1%; adjusted OR quintile 5 versus quintile 1: 0.73, 95%CI: 0.72–0.74), as well as colonoscopy uptake after a positive FIT (adjusted OR 0.73, 95%CI: 0.69–0.77). The detection rate per FIT participant for advanced neoplasia gradually increased from 3.3% in Quintile 1 to 4.0% in Quintile 5 (adjusted OR 1.20%, 95%CI 1.16–1.24). As a result of lower participation, the yield per invitee was similar for Quintile 5 (2.04%) and Quintile 1 (2.00%), both being lower than Quintiles 2 to 4 (2.20%-2.28%). Conclusions Screening has the potential to reduce health inequalities in CRC mortality, because of a higher detection in participants with a lower SES. However, in the Dutch screening programme, this is currently offset by the lower participation in this group.
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Affiliation(s)
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Academic University Medical Centers, Amsterdam, The Netherlands
| | - Johannes M. G. Bonfrer
- Department of Clinical Chemistry, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anneke J. van Vuuren
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - M. F. van Velthuysen
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten G. J. Thomeer
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harriët van Veldhuizen
- Department of Quality Improvement, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Harry J. de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Driessen MLS, Sturms LM, Bloemers FW, Duis HJT, Edwards MJR, den Hartog D, Kuipers EJ, Leenhouts PA, Poeze M, Schipper IB, Spanjersberg RW, Wendt KW, de Wit RJ, van Zutphen SWAM, de Jongh MAC, Leenen LPH. The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study. Ann Surg 2022; 275:252-258. [PMID: 35007227 PMCID: PMC8745885 DOI: 10.1097/sla.0000000000005300] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands. SUMMARY BACKGROUND DATA Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome. METHODS A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period). RESULTS During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012). CONCLUSIONS The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.
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Affiliation(s)
| | | | - Frank W Bloemers
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E J Kuipers
- Dutch Network for Emergency Care (LNAZ), Utrecht, The Netherlands
| | - Peter A Leenhouts
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center, Groningen, The Netherlands
| | - Ralph J de Wit
- Department of Trauma Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | | | | | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Kuiper JG, Fenneman AC, van der Spek AH, Rampanelli E, Nieuwdorp M, van Herk-Sukel MPP, Lemmens VEPP, Kuipers EJ, Herings RMC, Fliers E. Levothyroxine use and the risk of colorectal cancer: a large population-based case-control study. Endocr Connect 2022; 11:EC-21-0463.R1. [PMID: 34860178 PMCID: PMC8789018 DOI: 10.1530/ec-21-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/03/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Whether an association between oral levothyroxine use, leading to supraphysiological exposure of the colon to thyroid hormones, and risk of colorectal cancer exists in humans is unclear. We therefore aimed to assess whether the use of levothyroxine is associated with a reduced risk of colorectal cancer in a linked cohort of pharmacy and cancer data. DESIGN Population-based matched case-control study. METHODS A total of 28,121 patients diagnosed with colorectal cancer between 1998 and 2014 were matched to 106,086 controls. Multivariable logistic regression was used to estimate the association between levothyroxine use and occurrence of colorectal cancer, adjusted for potential confounders. Results were stratified by gender, age, tumour subtype, and staging, as well as treatment duration and dosing. RESULTS A total of 1066 colorectal cancer patients (4%) and 4024 (4%) controls had used levothyroxine at any point before index date (adjusted odds ratio 0.95 (0.88-1.01)). Long-term use of levothyroxine was seen in 323 (30%) colorectal cancer patients and 1111 (28%) controls (adjusted odds ratio 1.00 (0.88-1.13)). Stratification by tumour subsite showed a borderline significant risk reduction of rectal cancer, while this was not seen for proximal colon cancer or distal colon cancer. There was no relationship with treatment duration or with levothyroxine dose. CONCLUSIONS In this study, no reduced risk of colorectal cancer was seen in levothyroxine users. When stratifying by tumour subsite, a borderline significant risk reduction of rectal cancer was found and may warrant further research.
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Affiliation(s)
- Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, AE Utrecht, Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Correspondence should be addressed to J G Kuiper:
| | - Aline C Fenneman
- Department of Clinical and Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Anne H van der Spek
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Elena Rampanelli
- Department of Clinical and Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Max Nieuwdorp
- Department of Clinical and Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, AE Utrecht, Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Amsterdam Gastroenterology Endocrinology Metabolism (AGEM), Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Moen S, Vuik FER, Voortman T, Kuipers EJ, Spaander MCW. Predictors of Gastrointestinal Transit Times in Colon Capsule Endoscopy. Clin Transl Gastroenterol 2022; 13:e00498. [PMID: 35584543 PMCID: PMC9236601 DOI: 10.14309/ctg.0000000000000498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/22/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Optimizing the accuracy of colon capsule endoscopy (CCE) requires high completion rates. To prevent incomplete CCE, we aimed to identify predictors associated with slow CCE transit times. METHODS In this population-based study, participants received CCE with a split-dose polyethylene glycol bowel preparation and booster regimen (0.5 L oral sulfate solution and 10 mg metoclopramide if capsule remained in stomach for > 1 hour). The following predictors were assessed: age, sex, body mass index (BMI), smoking, coffee and fiber intake, diet quality, physical activity, dyspeptic complaints, stool pattern, history of abdominal surgery, medication use, and CCE findings. Multivariable logistic and linear regressions with backward elimination were performed. RESULTS We analyzed 451 CCE procedures with a completion rate of 51.9%. The completion rate was higher among older participants (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.04-2.28, P = 0.03) and participants with a changed stool pattern (OR 2.27, 95% CI 1.20-4.30, P = 0.01). Participants with a history of abdominal surgery had a lower completion rate (OR 0.54, 95% CI 0.36-0.80, P = 0.003). Participants with higher BMI had faster stomach, small bowel, and total transit times (β = -0.10, P = 0.01; β = -0.14, P = 0.001; β = -0.12, P = 0.01). A faster small bowel transit was found in participants with a changed stool pattern (β = -0.08, P = 0.049) and the use of metoclopramide (β = -0.14, P = 0.001). Participants with high fiber intake had a slower colonic transit (β = 0.11, P = 0.03). DISCUSSION Younger age, unchanged stool pattern, history of abdominal surgery, low BMI, and high fiber intake resulted in slower CCE transit times and lower completion rates. In future practice, these factors can be considered to adjust preparation protocols.
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Affiliation(s)
- Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Fanny E. R. Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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22
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Ykema BLM, Rigter LS, Spaander MCW, Moons LMG, Bisseling TM, Aleman BMP, Dekker E, Verbeek WHM, Kuipers EJ, de Boer JP, Lugtenburg PJ, Janus CPM, Petersen EJ, Roesink JM, van der Maazen RWM, Meijer GA, Schaapveld M, van Leeuwen FE, Carvalho B, Snaebjornsson P, van Leerdam ME. Clinicopathological features and risk factors for developing colorectal neoplasia in Hodgkin's lymphoma survivors. Dig Endosc 2022; 34:163-170. [PMID: 33928678 PMCID: PMC9290704 DOI: 10.1111/den.14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hodgkin's lymphoma (HL) survivors treated with abdominal radiotherapy and/or procarbazine have an increased risk of developing colorectal neoplasia. AIMS We evaluated the clinicopathological characteristics and risk factors for developing (advanced) neoplasia (AN) in HL survivors. METHODS In all, 101 HL survivors (median age 51 years, median age of HL diagnosis 25 years) underwent colonoscopy and 350 neoplasia and 44 AN (classified as advanced adenomas/serrated lesions or colorectal cancer), mostly right-sided, were detected, as published previously. An average-risk asymptomatic cohort who underwent screening colonoscopy were controls (median age 60 years). Clinicopathological characteristics of AN were evaluated in both groups. Mismatch repair (MMR) status was assessed using immunohistochemistry (MLH1/MSH2/MSH6/PMS2). Logistic regression analysis was performed to evaluate the risk factors for AN in HL survivors, including age at HL diagnosis and interval between HL and colonoscopy. RESULTS In 101 colonoscopies in HL survivors, AN was primarily classified based on polyp size ≥10 mm, whereas (high-grade)dysplasia was more often seen in AN in controls. An interval between HL diagnosis and colonoscopy >26 years was associated with more AN compared with an interval of <26 years, with an odds ratio for AN of 3.8 (95% confidence interval 1.4-9.1) (p < 0.01). All 39 AN that were assessed were MMR proficient. CONCLUSIONS Colorectal neoplasia in HL survivors differ from average-risk controls; classification AN was primarily based on polyp size (≥10 mm) in HL survivors. Longer follow-up between HL diagnosis and colonoscopy was associated with a higher prevalence of AN in HL survivors.
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Affiliation(s)
- Berbel L. M. Ykema
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Lisanne S. Rigter
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamThe Netherlands
| | - Leon M. G. Moons
- Department ofGastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Tanya M. Bisseling
- Department ofGastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Berthe M. P. Aleman
- Department ofRadiation OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and HepatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Wieke H. M. Verbeek
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamThe Netherlands
| | - Jan Paul de Boer
- Department ofMedical OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Cecile P. M. Janus
- Department ofRadiation OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Eefke J. Petersen
- Department ofHematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Judith M. Roesink
- Department ofRadiation OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Gerrit A. Meijer
- Department ofPathologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Michael Schaapveld
- Department ofEpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Beatriz Carvalho
- Department ofPathologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Monique E. van Leerdam
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyLeiden University Medical CenterLeidenThe Netherlands
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Vuik FE, Moen S, Nieuwenburg SA, Schreuders EH, Kuipers EJ, Spaander MC. Applicability of colon capsule endoscopy as pan-endoscopy: From bowel preparation, transit, and rating times to completion rate and patient acceptance. Endosc Int Open 2021; 9:E1852-E1859. [PMID: 34917449 PMCID: PMC8670994 DOI: 10.1055/a-1578-1800] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Colon capsule endoscopy (CCE) has the potential to explore the entire gastrointestinal tract. The aim of this study was to assess the applicability of CCE as pan-endoscopy. Patients and methods Healthy participants received CCE with bowel preparation (bisacodyl, polyethylene electrolyte glycol (PEG) + ascorbic acid) and booster regimen (metoclopramide, oral sulfate solution (OSS)). For each segment of the gastrointestinal tract, the following quality parameters were assessed: cleanliness, transit times, reading times, patient acceptance and safety of the procedure. When all gastrointestinal segments had cleansing score good or excellent, cleanliness of the whole gastrointestinal tract was assessed as good. Participants' expected and perceived burden was assessed by questionnaires and participants were asked to grade the procedure (scale 0-10). All serious adverse events (SAEs) were documented. Results A total of 451 CCE procedures were analyzed. A good cleansing score was achieved in the stomach in 69.6%, in the SB in 99.1 % and in the colon in 76.6 %. Cleanliness of the whole gastrointestinal tract was good in 52.8 % of the participants. CCE median transit time of the whole gastrointestinal tract was 583 minutes IQR 303-659). The capsule reached the descending colon in 94.7 %. Median reading time per procedure was 70 minutes (IQR 57-83). Participants graded the procedure with a 7.8. There were no procedure-related SAEs. Conclusions CCE as pan-endoscopy has shown to be a safe procedure with good patient acceptance. When cleanliness of all gastrointestinal segments per patient, completion rate and reading time will be improved, CCE can be applied as a good non-invasive alternative to evaluate the gastrointestinal tract.
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Affiliation(s)
- Fanny E.R. Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stella A.V. Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Eline H. Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Manon C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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24
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Vuik FER, Nieuwenburg SAV, Nagtegaal ID, Kuipers EJ, Spaander MCW. Clinicopathological characteristics of early onset colorectal cancer. Aliment Pharmacol Ther 2021; 54:1463-1471. [PMID: 34637541 PMCID: PMC9292775 DOI: 10.1111/apt.16638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 05/28/2021] [Accepted: 09/26/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The rising incidence of early onset colorectal cancer (EOCRC) might reflect a novel tumour entity. AIMS To evaluate clinicopathological characteristics of sporadic EOCRC (in patients < 50 years old) and investigate changes over time METHODS: All patients with sporadic EOCRC between 1989 and 2016 were included and divided by age: 20-29 years (group I), 30-39 years (group II) and 40-49 years (group III). RESULTS We included 6400 patients. The presence of signet-ring cells and more poorly differentiated tumours were more common in the younger age groups: 5.4% and 3.7% for signet-ring cells in group I and II vs 1.4% in group III (P < 0.01), and 28.5% and 20.3% for poorly differentiated in group I and II vs 16.6% in group III, (P < 0.01 group I; P = 0.07 group II). Positive lymph nodes were more frequently observed in the younger age groups: 16.2% in group I vs 9.3% in group II (P = 0.01) and 7.9% (P < 0.01) in group III. Over time, a greater proportion of CRCs were diagnosed in women in group I (34.5% < 2004 vs 54.9%>2005, P = 0.09), and a higher percentage of rectal cancer was found in age group III (34.3% < 2004 vs 40.7% > 2005, P < 0.01). Mean overall survival was 6.3 years and improved over time. CONCLUSIONS EOCRC is not only characterised by age of onset but also by the more frequent presence of signet-ring cells, more poorly differentiated tumours, and higher risk of lymph node metastases. In the most recent years, a higher proportion of rectal cancer was found from the age of 30 years, and a higher proportion of CRCs were diagnosed in females below the age of 30 years.
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Affiliation(s)
- Fanny E. R. Vuik
- Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Stella A. V. Nieuwenburg
- Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Iris D. Nagtegaal
- Department of PathologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and HepatologyErasmus University Medical CenterRotterdamThe Netherlands
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25
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Kuiper JG, van Herk-Sukel MPP, Lemmens VEPP, Kuipers EJ, Herings RMC. A population-based linked cohort of cancer and primary care data: A new source to study the management of cancer in primary care. Eur J Cancer Care (Engl) 2021; 31:e13529. [PMID: 34658095 PMCID: PMC9285474 DOI: 10.1111/ecc.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 12/25/2020] [Accepted: 10/04/2021] [Indexed: 01/04/2023]
Abstract
Objective Insight into the management of cancer in the primary care setting is pivotal to improve early recognition and survival of cancer patients. Therefore, the Netherlands Cancer Registry (NCR) was linked to the General Practitioner (GP) Database of the PHARMO Database Network to make this research possible. Methods The NCR collects tumour data on all newly diagnosed cancer patients, whereas the GP Database comprises data from electronic patient records registered by GPs. Databases were linked using a probabilistic record linkage technology. Results Through record linkage of the NCR and the GP Database, we have established a large population‐based cohort (NCR‐PHARMO GP cohort) of 135,868 cancer patients. Data are available on demographics, tumour characteristics, primary health care use before and after cancer diagnosis including medication use, medical conditions, laboratory tests, and referrals. Data can be used for a number of different studies, for example, to study the diagnostic pathway in the primary care setting in order to identify possibilities for early recognition. Conclusion The NCR‐PHARMO GP cohort provides rich data on the primary care management of cancer facilitating large‐scale observational cancer research in the primary care setting. The patient‐level linkage allows for long‐term follow‐up of cancer patients, with ongoing annual updates.
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Affiliation(s)
- Josephina G Kuiper
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ron M C Herings
- Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.,Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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Shah SC, Piazuelo MB, Kuipers EJ, Li D. AGA Clinical Practice Update on the Diagnosis and Management of Atrophic Gastritis: Expert Review. Gastroenterology 2021; 161:1325-1332.e7. [PMID: 34454714 PMCID: PMC8740554 DOI: 10.1053/j.gastro.2021.06.078] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/09/2021] [Accepted: 06/28/2021] [Indexed: 02/07/2023]
Abstract
DESCRIPTION The purpose of this Clinical Practice Update Expert Review is to provide clinicians with guidance on the diagnosis and management of atrophic gastritis, a common preneoplastic condition of the stomach, with a primary focus on atrophic gastritis due to chronic Helicobacter pylori infection-the most common etiology-or due to autoimmunity. To date, clinical guidance for best practices related to the diagnosis and management of atrophic gastritis remains very limited in the United States, which leads to poor recognition of this preneoplastic condition and suboptimal risk stratification. In addition, there is heterogeneity in the definitions of atrophic gastritis, autoimmune gastritis, pernicious anemia, and gastric neoplasia in the literature, which has led to confusion in clinical practice and research. Accordingly, the primary objective of this Clinical Practice Update is to provide clinicians with a framework for the diagnosis and management of atrophic gastritis. By focusing on atrophic gastritis, this Clinical Practice Update is intended to complement the 2020 American Gastroenterological Association Institute guidelines on the management of gastric intestinal metaplasia. These recent guidelines did not specifically discuss the diagnosis and management of atrophic gastritis. Providers should recognize, however, that a diagnosis of intestinal metaplasia on gastric histopathology implies the diagnosis of atrophic gastritis because intestinal metaplasia occurs in underlying atrophic mucosa, although this is often not distinctly noted on histopathologic reports. Nevertheless, atrophic gastritis represents an important stage with distinct histopathologic alterations in the multistep cascade of gastric cancer pathogenesis. METHODS The Best Practice Advice statements presented herein were developed from a combination of available evidence from published literature and consensus-based expert opinion. No formal rating of the strength or quality of the evidence was carried out. These statements are meant to provide practical advice to clinicians practicing in the United States. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Atrophic gastritis is defined as the loss of gastric glands, with or without metaplasia, in the setting of chronic inflammation mainly due to Helicobacter pylori infection or autoimmunity. Regardless of the etiology, the diagnosis of atrophic gastritis should be confirmed by histopathology. BEST PRACTICE ADVICE 2: Providers should be aware that the presence of intestinal metaplasia on gastric histology almost invariably implies the diagnosis of atrophic gastritis. There should be a coordinated effort between gastroenterologists and pathologists to improve the consistency of documenting the extent and severity of atrophic gastritis, particularly if marked atrophy is present. BEST PRACTICE ADVICE 3: Providers should recognize typical endoscopic features of atrophic gastritis, which include pale appearance of gastric mucosa, increased visibility of vasculature due to thinning of the gastric mucosa, and loss of gastric folds, and, if with concomitant intestinal metaplasia, light blue crests and white opaque fields. Because these mucosal changes are often subtle, techniques to optimize evaluation of the gastric mucosa should be performed. BEST PRACTICE ADVICE 4: When endoscopic features of atrophic gastritis are present, providers should assess the extent endoscopically. Providers should obtain biopsies from the suspected atrophic/metaplastic areas for histopathological confirmation and risk stratification; at a minimum, biopsies from the body and antrum/incisura should be obtained and placed in separately labeled jars. Targeted biopsies should additionally be obtained from any other mucosal abnormalities. BEST PRACTICE ADVICE 5: In patients with histology compatible with autoimmune gastritis, providers should consider checking antiparietal cell antibodies and anti-intrinsic factor antibodies to assist with the diagnosis. Providers should also evaluate for anemia due to vitamin B-12 and iron deficiencies. BEST PRACTICE ADVICE 6: All individuals with atrophic gastritis should be assessed for H pylori infection. If positive, treatment of H pylori should be administered and successful eradication should be confirmed using nonserological testing modalities. BEST PRACTICE ADVICE 7: The optimal endoscopic surveillance interval for patients with atrophic gastritis is not well-defined and should be decided based on individual risk assessment and shared decision making. A surveillance endoscopy every 3 years should be considered in individuals with advanced atrophic gastritis, defined based on anatomic extent and histologic grade. BEST PRACTICE ADVICE 8: The optimal surveillance interval for individuals with autoimmune gastritis is unclear. Interval endoscopic surveillance should be considered based on individualized assessment and shared decision making. BEST PRACTICE ADVICE 9: Providers should recognize pernicious anemia as a late-stage manifestation of autoimmune gastritis that is characterized by vitamin B-12 deficiency and macrocytic anemia. Patients with a new diagnosis of pernicious anemia who have not had a recent endoscopy should undergo endoscopy with topographical biopsies to confirm corpus-predominant atrophic gastritis for risk stratification and to rule out prevalent gastric neoplasia, including neuroendocrine tumors. BEST PRACTICE ADVICE 10: Individuals with autoimmune gastritis should be screened for type 1 gastric neuroendocrine tumors with upper endoscopy. Small neuroendocrine tumors should be removed endoscopically, followed by surveillance endoscopy every 1-2 years, depending on the burden of neuroendocrine tumors. BEST PRACTICE ADVICE 11: Providers should evaluate for iron and vitamin B-12 deficiencies in patients with atrophic gastritis irrespective of etiology, especially if corpus-predominant. Likewise, in patients with unexplained iron or vitamin B-12 deficiency, atrophic gastritis should be considered in the differential diagnosis and appropriate diagnostic evaluation pursued. BEST PRACTICE ADVICE 12: In patients with autoimmune gastritis, providers should recognize that concomitant autoimmune disorders, particularly autoimmune thyroid disease, are common. Screening for autoimmune thyroid disease should be performed.
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Affiliation(s)
- Shailja C. Shah
- Gastroenterology Section, Veterans Affairs San Diego Healthcare System, La Jolla, California,Division of Gastroenterology, University of California, San Diego, La Jolla, California
| | - M. Blanca Piazuelo
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dan Li
- Department of Gastroenterology, Kaiser Permanente Northern California, Santa Clara, California,Division of Research, Kaiser Permanente Northern California, Oakland, California
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de Klaver W, Wisse PHA, van Wifferen F, Bosch LJW, Jimenez CR, van der Hulst RWM, Fijneman RJA, Kuipers EJ, Greuter MJE, Carvalho B, Spaander MCW, Dekker E, Coupé VMH, de Wit M, Meijer GA. Clinical Validation of a Multitarget Fecal Immunochemical Test for Colorectal Cancer Screening : A Diagnostic Test Accuracy Study. Ann Intern Med 2021; 174:1224-1231. [PMID: 34280333 DOI: 10.7326/m20-8270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/09/2022] Open
Abstract
BACKGROUND The fecal immunochemical test (FIT) is used in colorectal cancer (CRC) screening, yet it leaves room for improvement. OBJECTIVE To develop a multitarget FIT (mtFIT) with better diagnostic performance than FIT. DESIGN Diagnostic test accuracy study. SETTING Colonoscopy-controlled series. PARTICIPANTS Persons (n = 1284) from a screening (n = 1038) and referral (n = 246) population were classified by their most advanced lesion (CRC [n = 47], advanced adenoma [n = 135], advanced serrated polyp [n = 30], nonadvanced adenoma [n = 250], and nonadvanced serrated polyp [n = 53]), along with control participants (n = 769). MEASUREMENTS Antibody-based assays were developed and applied to leftover FIT material. Classification and regression tree (CART) analysis was applied to biomarker concentrations to identify the optimal combination for detecting advanced neoplasia. Performance of this combination, the mtFIT, was cross-validated using a leave-one-out approach and compared with FIT at equal specificity. RESULTS The CART analysis showed a combination of hemoglobin, calprotectin, and serpin family F member 2-the mtFIT-to have a cross-validated sensitivity for advanced neoplasia of 42.9% (95% CI, 36.2% to 49.9%) versus 37.3% (CI, 30.7% to 44.2%) for FIT (P = 0.025), with equal specificity of 96.6%. In particular, cross-validated sensitivity for advanced adenomas increased from 28.1% (CI, 20.8% to 36.5%) to 37.8% (CI, 29.6% to 46.5%) (P = 0.006). On the basis of these results, early health technology assessment indicated that mtFIT-based screening could be cost-effective compared with FIT. LIMITATION Study population is enriched with persons from a referral population. CONCLUSION Compared with FIT, the mtFIT showed better diagnostic accuracy in detecting advanced neoplasia because of an increased detection of advanced adenomas. Moreover, early health technology assessment indicated that these results provide a sound basis to pursue further development of mtFIT as a future test for population-based CRC screening. A prospective screening trial is in preparation. PRIMARY FUNDING SOURCE Stand Up to Cancer/Dutch Cancer Society, Dutch Digestive Foundation, and HealthHolland.
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Affiliation(s)
- Willemijn de Klaver
- Netherlands Cancer Institute and Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (W.d.K.)
| | - Pieter H A Wisse
- Netherlands Cancer Institute, Amsterdam, and Erasmus MC University Medical Center, Rotterdam, the Netherlands (P.H.W.)
| | - Francine van Wifferen
- Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, the Netherlands (F.V., C.R.J., M.J.G., V.M.H.C.)
| | - Linda J W Bosch
- Netherlands Cancer Institute, Amsterdam, the Netherlands (L.J.B., R.J.F., B.C., M.d.W., G.A.M.)
| | - Connie R Jimenez
- Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, the Netherlands (F.V., C.R.J., M.J.G., V.M.H.C.)
| | | | - Remond J A Fijneman
- Netherlands Cancer Institute, Amsterdam, the Netherlands (L.J.B., R.J.F., B.C., M.d.W., G.A.M.)
| | - Ernst J Kuipers
- Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.J.K., M.C.S.)
| | - Marjolein J E Greuter
- Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, the Netherlands (F.V., C.R.J., M.J.G., V.M.H.C.)
| | - Beatriz Carvalho
- Netherlands Cancer Institute, Amsterdam, the Netherlands (L.J.B., R.J.F., B.C., M.d.W., G.A.M.)
| | - Manon C W Spaander
- Erasmus MC University Medical Center, Rotterdam, the Netherlands (E.J.K., M.C.S.)
| | - Evelien Dekker
- Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands (E.D.)
| | - Veerle M H Coupé
- Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, the Netherlands (F.V., C.R.J., M.J.G., V.M.H.C.)
| | - Meike de Wit
- Netherlands Cancer Institute, Amsterdam, the Netherlands (L.J.B., R.J.F., B.C., M.d.W., G.A.M.)
| | - Gerrit A Meijer
- Netherlands Cancer Institute, Amsterdam, the Netherlands (L.J.B., R.J.F., B.C., M.d.W., G.A.M.)
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Vuik FER, Nieuwenburg SAV, Moen S, Spada C, Senore C, Hassan C, Pennazio M, Rondonotti E, Pecere S, Kuipers EJ, Spaander MCW. Colon capsule endoscopy in colorectal cancer screening: a systematic review. Endoscopy 2021; 53:815-824. [PMID: 33440442 DOI: 10.1055/a-1308-1297] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 12/15/2022]
Abstract
INTRODUCTION Primary colonoscopy and fecal immunochemical test (FIT) are the most commonly used colorectal cancer (CRC) screening modalities. Colon capsule endoscopy (CCE) might be an alternative. Data on the performance of CCE as a CRC screening tool in a screening population remain scarce. This is the first systematic review to provide an overview of the applicability of CCE as a CRC screening tool. METHODS A systematic search was conducted of literature published up to September 2020. Studies reporting on CRC screening by second-generation CCE in an average-risk screening population were included. RESULTS 582 studies were identified and 13 were included, comprising 2485 patients. Eight studies used CCE as a filter test after a positive FIT result and five studies used CCE for primary screening. The polyp detection rate of CCE was 24 % - 74 %. For polyps > 6 mm, sensitivity of CCE was 79 % - 96 % and specificity was 66 % - 97 %. For polyps ≥ 10 mm, sensitivity of CCE was 84 % - 97 %, which was superior to computed tomographic colonography (CTC). The CRC detection rate for completed CCEs was 93 % (25/27). Bowel preparation was adequate in 70 % - 92 % of examinations, and completion rates varied from 57 % to 92 %, depending on the booster used. No CCE-related complications were described. CONCLUSION CCE appeared to be a safe and effective tool for the detection of CRC and polyps in a screening setting. Accuracy was comparable to colonoscopy and superior to CTC, making CCE a good alternative to colonoscopy in CRC screening programs, although completion rates require improvement.
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Affiliation(s)
- Fanny E R Vuik
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stella A V Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Moen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology Unit, Poliambulanza Foundation, Brescia, Italy.,Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Catholic University, Rome, Italy
| | - Carlo Senore
- Epidemiology and Screening Unit - CPO, University Hospital Città della Salute e della Scienza, Turin Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Marco Pennazio
- University Gastroenterology Unit, Città della Salute e della Scienza University Hospital, Turin, Italy
| | | | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A, Gemelli IRCCS, Roma, Italia
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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29
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Kooyker AI, Toes-Zoutendijk E, Opstal-van Winden AWJ, Buskermolen M, van Vuuren HJ, Kuipers EJ, van Kemenade FJ, Ramakers C, Dekker E, Nagtegaal ID, de Koning HJ, Spaander MCW, Lansdorp-Vogelaar I, van Leerdam ME. Colonoscopy-Related Mortality in a Fecal Immunochemical Test-Based Colorectal Cancer Screening Program. Clin Gastroenterol Hepatol 2021; 19:1418-1425. [PMID: 32777553 DOI: 10.1016/j.cgh.2020.07.066] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/22/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Many countries have introduced colorectal cancer (CRC) screening programs with fecal immunochemical tests (FITs), and follow-up colonoscopies for individuals with a positive FIT result. In order to make an informed decision to participate, individuals must be informed about the benefits and harms of FIT-based screening and subsequent colonoscopy. Colonoscopy-related fatal complications in FIT-based screening are understudied. We aimed to estimate the colonoscopy-related mortality in a national FIT-based CRC screening program. METHODS Colonoscopy-related mortality within 30 days after colonoscopy was assessed by analysis of data from national endoscopy complication databases in the Netherlands, determining the excess 30-day rate of death in FIT-positive individuals undergoing colonoscopy vs FIT-negative individuals (based on data from the national screening database), and determining the rate of likely colonoscopy-related deaths based on registered causes of death by the Statistics Netherlands. RESULTS Between October 2013 and December 2017, 172,797 participants underwent colonoscopy after a positive result from a FIT in the Dutch national CRC screening program; 13,848 participants received a diagnosis of CRC. The reported fatal complication rate was 0.23 per 10,000 FIT-positive participants (or 1 per 43,199; 95% CI, 0.090 - 0.60) undergoing colonoscopy, whereas this was 0.91 per 10,000 FIT-positive participants (or 1 per 10,961; 95% CI, 0.44 - 1.38) according to the excess death rate. Likely colonoscopy-related causes of death were reported in 0.86 per 10,000 FIT-positive participants (or 1 per 11,236; 95% CI, 0.48 - 1.63) who underwent colonoscopy, of which 50% considered cardiovascular events. CONCLUSIONS Colonoscopy-related mortality within the Dutch FIT-based CRC screening program was estimated to range from 0.23 to 0.91 per 10,000 FIT-positive participants undergoing colonoscopy. These findings indicate underreporting of fatal complications in registries and a noteworthy incidence of fatal cardiovascular adverse events that requires further investigation. Nevertheless, the harm of FIT-based CRC screening is vastly outweighed by the benefits.
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Affiliation(s)
- Arthur I Kooyker
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | | | - Maaike Buskermolen
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hanneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Chris Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
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30
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Kuiper JG, van Herk-Sukel MPP, Lemmens VEPP, Kuipers EJ, Herings RMC. A steep increase in healthcare seeking behaviour in the last months before colorectal cancer diagnosis. BMC Fam Pract 2021; 22:121. [PMID: 34154545 PMCID: PMC8218384 DOI: 10.1186/s12875-021-01482-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/20/2021] [Indexed: 12/22/2022]
Abstract
Background Timely recognition of colorectal cancer related symptoms is essential to reduce time to diagnosis. This study aims to investigate the primary healthcare use preceding a colorectal cancer diagnosis. Methods From a cohort of linked cancer and primary care data, patients diagnosed with primary colorectal cancer in the period 2007–2014 were selected and matched to cancer-free controls on gender, birth year, GP practice and follow-up period. Primary healthcare use among colorectal cancer cases before diagnosis was compared with matched cancer-free controls. Mean monthly number of GP consultations and newly prescribed medication was assessed in the year before index date (diagnosis date for cases). Results were stratified by colorectal cancer site: proximal colon cancer, distal colon cancer and rectal cancer. Results A total of 6,087 colorectal cancer cases could be matched to four cancer-free controls (N = 24,348). While mean monthly number of GP consultation were stable through the year among cancer-free controls, a statistical significant increase was seen among colorectal cancer cases in the last 4–8 months before diagnosis. Proximal colon cancer cases showed the longest time interval of increased mean monthly number of GP consultations. This increase was largely driven by a consultation for malignant neoplasm colon/rectum. The number patients receiving a newly prescribed medication was stable around 120 per 1,000 persons per month until 8 months before index date for proximal colon cancer cases, 4 months before index date for distal colon cancer cases and 3 months for rectal cancer cases. This increase was mainly driven by the prescription of laxatives drugs. Conclusion An increase in the healthcare seeking behaviour of colorectal cancer patients prior to diagnosis was seen. The longest period of increased GP consultations and newly prescribed medication was seen among patients diagnosed with proximal colon cancer. This can be explained by the difficultly to diagnose proximal colon cancer given the more subtle signs compared to distal colon cancer and rectal cancer. Therefore, faster diagnosis for this specific tumour subtype may only be possible when clear clinical signs and symptoms are present.
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Affiliation(s)
- Josephina G Kuiper
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands. .,Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Myrthe P P van Herk-Sukel
- Department of Internal Medicine and Dermatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Valery E P P Lemmens
- Department of Public Health, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.,Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, 3528 AE, Utrecht, Netherlands.,Department of Epidemiology & Data Science, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
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31
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Janmaat VT, Nesteruk K, Spaander MCW, Verhaar AP, Yu B, Silva RA, Phillips WA, Magierowski M, van de Winkel A, Stadler HS, Sandoval-Guzmán T, van der Laan LJW, Kuipers EJ, Smits R, Bruno MJ, Fuhler GM, Clemons NJ, Peppelenbosch MP. HOXA13 in etiology and oncogenic potential of Barrett's esophagus. Nat Commun 2021; 12:3354. [PMID: 34099670 PMCID: PMC8184780 DOI: 10.1038/s41467-021-23641-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 05/06/2021] [Indexed: 12/13/2022] Open
Abstract
Barrett's esophagus in gastrointestinal reflux patients constitutes a columnar epithelium with distal characteristics, prone to progress to esophageal adenocarcinoma. HOX genes are known mediators of position-dependent morphology. Here we show HOX collinearity in the adult gut while Barrett's esophagus shows high HOXA13 expression in stem cells and their progeny. HOXA13 overexpression appears sufficient to explain both the phenotype (through downregulation of the epidermal differentiation complex) and the oncogenic potential of Barrett's esophagus. Intriguingly, employing a mouse model that contains a reporter coupled to the HOXA13 promotor we identify single HOXA13-positive cells distally from the physiological esophagus, which is mirrored in human physiology, but increased in Barrett's esophagus. Additionally, we observe that HOXA13 expression confers a competitive advantage to cells. We thus propose that Barrett's esophagus and associated esophageal adenocarcinoma is the consequence of expansion of this gastro-esophageal HOXA13-expressing compartment following epithelial injury.
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Affiliation(s)
- Vincent T Janmaat
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kateryna Nesteruk
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Auke P Verhaar
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bingting Yu
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rodrigo A Silva
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wayne A Phillips
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Surgery (St. Vincent's Hospital), The University of Melbourne, Melbourne, VIC, Australia
| | - Marcin Magierowski
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Physiology, Faculty of Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Anouk van de Winkel
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H Scott Stadler
- Department of Skeletal Biology, Shriners Hospital for Children, Portland, OR, USA
| | | | - Luc J W van der Laan
- Department of Surgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ron Smits
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gwenny M Fuhler
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicholas J Clemons
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
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32
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Sung JJY, Laine L, Kuipers EJ, Barkun AN. Towards personalised management for non-variceal upper gastrointestinal bleeding. Gut 2021; 70:818-824. [PMID: 33649044 DOI: 10.1136/gutjnl-2020-323846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/11/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023]
Abstract
Guidelines from national and international professional societies on upper gastrointestinal bleeding highlight the important clinical issues but do not always identify specific management strategies pertaining to individual patients. Optimal treatment should consider the personal needs of an individual patient and the pertinent resources and experience available at the point of care. This article integrates international guidelines and consensus into three stages of management: pre-endoscopic assessment and treatment, endoscopic evaluation and haemostasis and postendoscopic management. We emphasise the need for personalised management strategies based on patient characteristics, nature of bleeding lesions and the clinical setting including available resources.
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Affiliation(s)
- Joseph J Y Sung
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Loren Laine
- Section of Digestive Diseases, Yale School of Medicine and VA Connecticut Healthcare System, New Haven, Connecticut, USA
| | - Ernst J Kuipers
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alan N Barkun
- Gastroenterology, McGILL University health centre, Montreal, Quebec, Canada
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33
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Spaander MCW, Kuipers EJ. Editorial: machine learning models for gastric cancer risk prediction. Aliment Pharmacol Ther 2021; 53:943-944. [PMID: 33745175 DOI: 10.1111/apt.16303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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34
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Nieuwenburg SAV, Mommersteeg MC, Eikenboom EL, Yu B, den Hollander WJ, Holster IL, den Hoed CM, Capelle LG, Tang TJ, Anten MP, Prytz-Berset I, Witteman EM, ter Borg F, Burger JPW, Bruno MJ, Fuhler GM, Peppelenbosch MP, Doukas M, Kuipers EJ, Spaander MC. Factors associated with the progression of gastric intestinal metaplasia: a multicenter, prospective cohort study. Endosc Int Open 2021; 9:E297-E305. [PMID: 33655025 PMCID: PMC7892268 DOI: 10.1055/a-1314-6626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Gastric cancer (GC) is usually preceded by premalignant gastric lesions (GPLs) such as gastric intestinal metaplasia (GIM). Information on risk factors associated with neoplastic progression of GIM are scarce. This study aimed to identify predictors for progression of GIM in areas with low GC incidence. Patients and methods The Progression and Regression of Precancerous Gastric Lesions (PROREGAL) study includes patients with GPL. Patients underwent at least two upper endoscopies with random biopsy sampling. Progression of GIM means an increase in severity according to OLGIM (operative link on gastric intestinal metaplasia) during follow-up (FU). Family history and lifestyle factors were determined through questionnaires. Serum Helicobacter pylori infection, pepsinogens (PG), gastrin-17 and GC-associated single nucleotide polymorphisms (SNPs) were determined. Cox regression was performed for risk analysis and a chi-squared test for analysis of single nucleotide polymorphisms. Results Three hundred and eight patients (median age at inclusion 61 years, interquartile range (IQR: 17; male 48.4 %; median FU 48 months, IQR: 24) were included. During FU, 116 patients (37.7 %) showed progression of IM and six patients (1.9 %) developed high-grade dysplasia or GC. The minor allele (C) on TLR4 (rs11536889) was inversely associated with progression of GIM (OR 0.6; 95 %CI 0.4-1.0). Family history (HR 1.5; 95 %CI 0.9-2.4) and smoking (HR 1.6; 95 %CI 0.9-2.7) showed trends towards progression of GIM. Alcohol use, body mass index, history of H. pylori infection, and serological markers were not associated with progression. Conclusions Family history and smoking appear to be related to an increased risk of GIM progression in low GC incidence countries. TLR4 (rs11536889) showed a significant inverse association, suggesting that genetic information may play a role in GIM progression.
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Affiliation(s)
- S. A. V. Nieuwenburg
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M. C. Mommersteeg
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E. L. Eikenboom
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - B. Yu
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - I. Lisanne Holster
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Caroline M. den Hoed
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - L. G Capelle
- Meander Medical Centre, Amersfoort, the Netherlands
| | - Thjon J. Tang
- IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | | | | | | | - F. ter Borg
- Deventer Hospital, Deventer, The Netherlands
| | - Jordy P. W. Burger
- Department of Gastroenterology and Hepatology, Rijnstate, Arnhem, The Netherlands
| | - Marco J. Bruno
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - G. M. Fuhler
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Maikel P. Peppelenbosch
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michael Doukas
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ernst J. Kuipers
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Manon C.W. Spaander
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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35
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Dinmohamed AG, Cellamare M, Visser O, de Munck L, Elferink MAG, Westenend PJ, Wesseling J, Broeders MJM, Kuipers EJ, Merkx MAW, Nagtegaal ID, Siesling S. The impact of the temporary suspension of national cancer screening programmes due to the COVID-19 epidemic on the diagnosis of breast and colorectal cancer in the Netherlands. J Hematol Oncol 2020; 13:147. [PMID: 33148289 PMCID: PMC7609826 DOI: 10.1186/s13045-020-00984-1] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 01/04/2023] Open
Abstract
Oncological care was largely derailed due to the reprioritisation of health care services to handle the initial surge of COVID-19 patients adequately. Cancer screening programmes were no exception in this reprioritisation. They were temporarily halted in the Netherlands (1) to alleviate the pressure on health care services overwhelmed by the upsurge of COVID-19 patients, (2) to reallocate staff and personal protective equipment to support critical COVID-19 care, and (3) to mitigate the spread of COVID-19. Utilising data from the Netherlands Cancer Registry on provisional cancer diagnoses between 6 January 2020 and 4 October 2020, we assessed the impact of the temporary halt of national population screening programmes on the diagnosis of breast and colorectal cancer in the Netherlands. A dynamic harmonic regression model with ARIMA error components was applied to assess the observed versus expected number of cancer diagnoses per calendar week. Fewer diagnoses of breast and colorectal cancer were objectified amid the early stages of the initial COVID-19 outbreak in the Netherlands. This effect was most pronounced among the age groups eligible for cancer screening programmes, especially in breast cancer (age group 50–74 years). Encouragingly enough, the observed number of diagnoses ultimately reached and virtually remained at the level of the expected values. This finding, which emerged earlier in age groups not invited for cancer screening programmes, comes on account of the decreased demand for critical COVID-19 care since early April 2020, which, in turn, paved the way forward to resume screening programmes and a broad range of non-critical health care services, albeit with limited operating and workforce capacity. Collectively, transient changes in health-seeking behaviour, referral practices, and cancer screening programmes amid the early stages of the initial COVID-19 epidemic in the Netherlands conjointly acted as an accelerant for fewer breast and colorectal cancer diagnoses in age groups eligible for cancer screening programmes. Forthcoming research is warranted to assess whether the decreased diagnostic scrutiny of cancer during the COVID-19 pandemic resulted in stage migration and altered clinical management, as well as poorer outcomes.
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Affiliation(s)
- Avinash G Dinmohamed
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Matteo Cellamare
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Otto Visser
- Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Marloes A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Pieter J Westenend
- Department of Pathology, Albert Schweitzer Hospital, Dordrecht, The Netherlands.,Laboratory for Pathology Dordrecht, Dordrecht, The Netherlands
| | - Jelle Wesseling
- Divisions of Diagnostic Oncology and Molecular Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Ernst J Kuipers
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthias A W Merkx
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Iris D Nagtegaal
- PALGA Foundation, Houten, The Netherlands.,Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands. .,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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Waddingham W, Nieuwenburg SAV, Carlson S, Rodriguez-Justo M, Spaander M, Kuipers EJ, Jansen M, Graham DG, Banks M. Recent advances in the detection and management of early gastric cancer and its precursors. Frontline Gastroenterol 2020; 12:322-331. [PMID: 34249318 PMCID: PMC8223672 DOI: 10.1136/flgastro-2018-101089] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 04/02/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Despite declines in incidence, gastric cancer remains a disease with a poor prognosis and limited treatment options due to its often late stage of diagnosis. In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. There remains an East-West divide for this disease, with high incidence countries such as Japan seeing earlier diagnoses and reduced mortality, in part thanks to the success of a national screening programme. With missed cancers still prevalent at upper endoscopy in the West, and variable approaches to assessment of the high-risk stomach, the quality of endoscopy we provide must be a focus for improvement, with particular attention paid to the minority of patients at increased cancer risk. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. An endoscopy-led staging strategy would mean biopsies could be targeted to histologically confirm the endoscopic impression of premalignant lesions including atrophic gastritis, gastric intestinal metaplasia, dysplasia and early cancer. This approach to quality improvement will reduce missed diagnoses and, combined with the latest endoscopic resection techniques performed at expert centres, will improve early detection and ultimately patient outcomes. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions.
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Affiliation(s)
- William Waddingham
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK,Research Department of Pathology, UCL Cancer Institute, London, UK
| | - Stella A V Nieuwenburg
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sean Carlson
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Manon Spaander
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marnix Jansen
- Research Department of Pathology, UCL Cancer Institute, London, UK,Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - David G Graham
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew Banks
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
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Kuiper JG, Herk‐Sukel MPP, Lemmens VEPP, Kuipers EJ, Herings RMC. Proton pump inhibitors are not associated with an increased risk of colorectal cancer. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/ygh2.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Josephina G. Kuiper
- PHARMO Institute for Drug Outcomes Research Utrecht The Netherlands
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
| | - Myrthe P. P. Herk‐Sukel
- Department of Internal Medicine and Dermatology University Medical Center Utrecht Utrecht The Netherlands
| | - Valery E. P. P. Lemmens
- Department of Public Health Erasmus University Medical Center Rotterdam The Netherlands
- Netherlands Comprehensive Cancer Organisation Utrecht The Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and Hepatology Erasmus University Medical Center Rotterdam The Netherlands
| | - Ron M. C. Herings
- PHARMO Institute for Drug Outcomes Research Utrecht The Netherlands
- Department of Epidemiology and Biostatistics VU University Medical Center Amsterdam The Netherlands
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38
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Toes-Zoutendijk E, Kooyker AI, Dekker E, Spaander MCW, Opstal-van Winden AWJ, Ramakers C, Buskermolen M, van Vuuren AJ, Kuipers EJ, van Kemenade FJ, Velthuysen MLF, Thomeer MGJ, van Veldhuizen H, van Ballegooijen M, Nagtegaal ID, de Koning HJ, van Leerdam ME, Lansdorp-Vogelaar I, Otte J, Wiersma T, Masclee A, van Bergeijk J, Meijer G, de Graaf E, van Grevenstein W, Frasa M, Jacobs L, Stoker J, Vink G, Elferink M. Incidence of Interval Colorectal Cancer After Negative Results From First-Round Fecal Immunochemical Screening Tests, by Cutoff Value and Participant Sex and Age. Clin Gastroenterol Hepatol 2020; 18:1493-1500. [PMID: 31442598 DOI: 10.1016/j.cgh.2019.08.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2019] [Accepted: 08/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We evaluated the incidence of interval cancers between the first and second rounds of colorectal cancer (CRC) screening with the FOB-Gold fecal immunochemical test (FIT), and the effects of different cutoff values and patient sex and age. METHODS We collected data from participants in a population-based CRC screening program in the Netherlands who had a negative result from a first-round of FIT screening. We calculated the cumulative incidence of interval cancer after a negative result from a FIT and the sensitivity of the FIT for detection of CRC at a low (15 μg Hb/g feces) and high (47 μg Hb/g feces) cutoff value. RESULTS Among the 485,112 participants with a negative result from a FIT, 544 interval cancers were detected; 126 were in the 111,800 participants with negative results from a FIT with the low cutoff value and 418 were in the 373,312 FIT participants with negative results from a FIT with the high cutoff value. The mean age of participants tested with the low cutoff value was 72.0 years and the mean age of participants tested the high cutoff value was 66.7 years. The age-adjusted 2-year cumulative incidence of interval cancer after a negative result from a FIT were 9.5 per 10,000 persons at the low cutoff value vs 13.8 per 10,000 persons at the high cutoff value (P < .005). The age-adjusted sensitivity of the FIT for CRC were 90.5% for the low cutoff value vs 82.9% for the high cutoff (P < .0001). The FIT identified men with CRC with 87.4% sensitivity and women with CRC with 82.6% sensitivity (P < .001). CONCLUSIONS In an analysis of data from a FIT population-based screening program in the Netherlands, we found that incidence of interval CRC after a negative result from a FIT to be low. Although the sensitivity of detection of CRC decreased with a higher FIT cutoff value, it remained above 80%.
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Affiliation(s)
- Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Arthur I Kooyker
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Academic University Medical Centers, Amsterdam, the Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maaike Buskermolen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Maarten G J Thomeer
- Department of Radiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Harriët van Veldhuizen
- Department of Quality Improvement, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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Affiliation(s)
- Mário Dinis-Ribeiro
- Instituto Português de Oncologia do Porto, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ernst J Kuipers
- Departmentt of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Grobbee EJ, van der Vlugt M, van Vuuren AJ, Stroobants AK, Mallant-Hent RC, Lansdorp-Vogelaar I, Bossuyt PMM, Kuipers EJ, Dekker E, Spaander MCW. Diagnostic Yield of One-Time Colonoscopy vs One-Time Flexible Sigmoidoscopy vs Multiple Rounds of Mailed Fecal Immunohistochemical Tests in Colorectal Cancer Screening. Clin Gastroenterol Hepatol 2020; 18:667-675.e1. [PMID: 31419575 DOI: 10.1016/j.cgh.2019.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/06/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We compared the diagnostic yields of colonoscopy, flexible sigmoidoscopy, and fecal immunochemical tests (FITs) in colorectal cancer (CRC) screening. METHODS A total of 30,007 asymptomatic persons, 50-74 years old, were invited for CRC screening in the Netherlands. Participants were assigned to groups that received 4 rounds of FIT (mailed to 15,046 participants), once-only flexible sigmoidoscopy (n = 8407), or once-only colonoscopy (n = 6600). Patients with positive results from the FIT (≥10 μg Hb/g feces) were referred for colonoscopy. Patients who underwent flexible sigmoidoscopy were referred for colonoscopy if they had a polyp of ≥10 mm; adenoma with ≥25% villous histology or high-grade dysplasia; sessile serrated adenoma; ≥3 adenomas; ≥20 hyperplastic polyps; or invasive CRC. The primary outcome was number of advanced neoplasia detected (diagnostic yield) by each test. Secondary outcomes were number of colonoscopies needed to detect advanced neoplasia and number of interval CRCs found during each primary screening test. Patients with interval CRCs were found through linkage with Netherlands Cancer Registry. Advanced neoplasia were defined as CRC, adenomas ≥ 10 mm, adenomas with high-grade dysplasia, or adenomas with a villous component of at least 25%. RESULTS The cumulative participation rate was significantly higher for FIT screening (73%) than for flexible sigmoidoscopy (31%; P < .001) or colonoscopy (24%; P < .001). The percentage of colonoscopies among invitees was higher for colonoscopy (24%) compared to FIT (13%; P < .001) or flexible sigmoidoscopy (3%; P < .001). In the intention to screen analysis, the cumulative diagnostic yield of advanced neoplasia was higher with FIT screening (4.5%; 95% CI 4.2-4.9) than with colonoscopy (2.2%; 95% CI, 1.8-2.6) or flexible sigmoidoscopy (2.3%; 95% CI, 2.0-2.7). In the as-screened analysis, the cumulative yield of advanced neoplasia was higher for endoscopic screening with colonoscopy (9.1%; 95% CI, 7.7-10.7) or flexible sigmoidoscopy (7.4%; 95% CI, 6.5-8.5) than with the FIT (6.1%; 95% CI, 5.7-6.6). All 3 screening strategies detected a similar proportion of patients with CRC. Follow-up times differed for each test (median 8.3 years for FIT and flexible sigmoidoscopy and 5.8 years for colonoscopy). Proportions of patients that developed interval CRC were 0.13% for persons with a negative result from FIT, 0.09% for persons with a negative result from flexible sigmoidoscopy, and 0.01% for persons with a negative result from colonoscopy. CONCLUSIONS Mailed multiple-round FITs detect significantly more advanced neoplasia, on a population level, compared with once-only flexible sigmoidoscopy or colonoscopy screening. Significantly fewer colonoscopies are required by individuals screened by multiple FITs. Trialregister.nl numbers: first round, NTR1096; second round and additional invitees, NTR1512; fourth round, NTR5874; COCOS trial NTR1829.
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Affiliation(s)
- Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - An K Stroobants
- Clinical Chemistry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | | | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Patrick M M Bossuyt
- Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Affiliation(s)
- Ernst J Kuipers
- Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esmée J Grobbee
- Department of Gastroenterology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Komor MA, Bosch LJ, Coupé VM, Rausch C, Pham TV, Piersma SR, Mongera S, Mulder CJ, Dekker E, Kuipers EJ, van de Wiel MA, Carvalho B, Fijneman RJ, Jimenez CR, Meijer GA, de Wit M. Proteins in stool as biomarkers for non-invasive detection of colorectal adenomas with high risk of progression. J Pathol 2020; 250:288-298. [PMID: 31784980 PMCID: PMC7065084 DOI: 10.1002/path.5369] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/07/2019] [Accepted: 11/28/2019] [Indexed: 12/15/2022]
Abstract
Screening to detect colorectal cancer (CRC) in an early or premalignant state is an effective method to reduce CRC mortality rates. Current stool-based screening tests, e.g. fecal immunochemical test (FIT), have a suboptimal sensitivity for colorectal adenomas and difficulty distinguishing adenomas at high risk of progressing to cancer from those at lower risk. We aimed to identify stool protein biomarker panels that can be used for the early detection of high-risk adenomas and CRC. Proteomics data (LC-MS/MS) were collected on stool samples from adenoma (n = 71) and CRC patients (n = 81) as well as controls (n = 129). Colorectal adenoma tissue samples were characterized by low-coverage whole-genome sequencing to determine their risk of progression based on specific DNA copy number changes. Proteomics data were used for logistic regression modeling to establish protein biomarker panels. In total, 15 of the adenomas (15.8%) were defined as high risk of progressing to cancer. A protein panel, consisting of haptoglobin (Hp), LAMP1, SYNE2, and ANXA6, was identified for the detection of high-risk adenomas (sensitivity of 53% at specificity of 95%). Two panels, one consisting of Hp and LRG1 and one of Hp, LRG1, RBP4, and FN1, were identified for high-risk adenomas and CRCs detection (sensitivity of 66% and 62%, respectively, at specificity of 95%). Validation of Hp as a biomarker for high-risk adenomas and CRCs was performed using an antibody-based assay in FIT samples from a subset of individuals from the discovery series (n = 158) and an independent validation series (n = 795). Hp protein was significantly more abundant in high-risk adenoma FIT samples compared to controls in the discovery (p = 0.036) and the validation series (p = 9e-5). We conclude that Hp, LAMP1, SYNE2, LRG1, RBP4, FN1, and ANXA6 may be of value as stool biomarkers for early detection of high-risk adenomas and CRCs. © 2019 Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Malgorzata A Komor
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Linda Jw Bosch
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Veerle Mh Coupé
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Christian Rausch
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thang V Pham
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Sander R Piersma
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Sandra Mongera
- Department of Pathology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris Jj Mulder
- Department of Gastroenterology and Hepatology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mark A van de Wiel
- Department of Epidemiology and Biostatistics, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Beatriz Carvalho
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Remond Ja Fijneman
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Connie R Jimenez
- Department of Medical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Gerrit A Meijer
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Meike de Wit
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Kooyker AI, Toes-Zoutendijk E, Opstal-van Winden AWJ, Spaander MCW, Buskermolen M, van Vuuren HJ, Kuipers EJ, van Kemenade FJ, Ramakers C, Thomeer MGJ, Dekker E, Nagtegaal ID, de Koning HJ, van Leerdam ME, Lansdorp-Vogelaar I. The second round of the Dutch colorectal cancer screening program: Impact of an increased fecal immunochemical test cut-off level on yield of screening. Int J Cancer 2020; 147:1098-1106. [PMID: 31853977 PMCID: PMC7383838 DOI: 10.1002/ijc.32839] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/18/2022]
Abstract
The Dutch colorectal cancer (CRC) screening program started in 2014, inviting the target population biennially to perform a fecal immunochemical test (FIT). We obtained prospectively collected data from the national screening information‐system to present the results of the second round (2016) and evaluate the impact of increasing the FIT cut‐off halfway through the first round from 15 to 47 μg Hb/g feces on outcomes in the second round. Second round screening was done with a 47 μg Hb/g feces FIT cut‐off. Participants were classified based on first round participation status as either FIT (15,47) or FIT (47,47) participants, and previous nonparticipants. In total, 348,891 (75.9%) out of 459,740 invitees participated in the second round. Participation rates were 93.4% among previous participants and 21.0% among previous non‐participants. FIT(47,47) participants had a significantly higher detection rate of AN (15.3 vs. 10.4 per 1,000 participants) compared to FIT(15,47) participants in the second round, while their cumulative detection rate of AN over two rounds was significantly lower (45.6 vs. 52.6 per 1,000 participants). Our results showed that participation in the Dutch CRC screening program was consistently high and that second round detection rates depended on the first round FIT cut‐off. The cumulative detection over two rounds was higher among FIT(15,47) participants. These findings suggest that a substantial part of, but not all the missed findings in the first round due to the increased FIT cut‐off were detected in the subsequent round. What's new? In 2014, the Netherlands implemented colorectal cancer (CRC) screening based on non‐invasive fecal immunochemical testing (FIT), which offers a practical approach for population‐based CRC detection. In the Dutch program's first round, to match local resources, FIT cut‐off was increased, resulting in reduced positivity rates and reduced colonoscopy referrals, at the cost of missing advanced neoplasias. The current study shows that many of these missed advanced neoplasias were detected in subsequent screening, suggesting that increased FIT cut‐off had marginal impact on screening outcome. The findings could benefit other CRC screening programs in establishing effective FIT cut‐offs.
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Affiliation(s)
- Arthur I Kooyker
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maaike Buskermolen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Chris Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maarten G J Thomeer
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - Academic Medical Center, Amsterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Grobbee EJ, Lam SY, Fuhler GM, Blakaj B, Konstantinov SR, Bruno MJ, Peppelenbosch MP, Kuipers EJ, Spaander MC. First steps towards combining faecal immunochemical testing with the gut microbiome in colorectal cancer screening. United European Gastroenterol J 2019; 8:293-302. [PMID: 32213018 PMCID: PMC7184657 DOI: 10.1177/2050640619890732] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Many countries use faecal immunochemical testing (FIT) to screen for colorectal cancer. There is increasing evidence that faecal microbiota play a crucial role in colorectal cancer carcinogenesis. We assessed the possibility of measuring faecal microbial features in FIT as potential future biomarkers in colorectal cancer screening. Methods Bacterial stability over time and the possibility of bacterial contamination were evaluated using quantitative polymerase chain reaction analysis. Positive FIT samples (n = 200) of an average-risk screening cohort were subsequently analysed for universal 16S, and bacteria. Escherichia coli (E. coli), Fusobacterium nucleatum (F. nucleatum), Bacteroidetes and Faecalibacterium prausnitzii (F. prausnitzii) by qPCR. The results were compared with colonoscopy findings. Results Faecal microbiota in FIT were stably measured up to six days for E. coli (p = 0.53), F. nucleatum (p = 0.30), Bacteroidetes (p = 0.05) and F. prausnitzii (p = 0.62). Overall presence of bacterial contamination in FIT controls was low. Total bacterial load (i.e. 16S) was significantly higher in patients with colorectal cancer and high-grade dysplasia (p = 0.006). For the individual bacteria tested, no association was found with colonic lesions. Conclusions These results show that the faecal microbial content can be measured in FIT samples and remains stable for six days. Total bacterial load was higher in colorectal cancer and high-grade dysplasia. These results pave the way for further research to determine the potential role of microbiota assessment in FIT screening.
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Affiliation(s)
- Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Suk Yee Lam
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Gwenny M Fuhler
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Blerdi Blakaj
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Sergey R Konstantinov
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Maikel P Peppelenbosch
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Manon Cw Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Ann Intern Med 2019; 171:805-822. [PMID: 31634917 PMCID: PMC7233308 DOI: 10.7326/m19-1795] [Citation(s) in RCA: 259] [Impact Index Per Article: 51.8] [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: 01/28/2023] Open
Abstract
DESCRIPTION This update of the 2010 International Consensus Recommendations on the Management of Patients With Nonvariceal Upper Gastrointestinal Bleeding (UGIB) refines previous important statements and presents new clinically relevant recommendations. METHODS An international multidisciplinary group of experts developed the recommendations. Data sources included evidence summarized in previous recommendations, as well as systematic reviews and trials identified from a series of literature searches of several electronic bibliographic databases from inception to April 2018. Using an iterative process, group members formulated key questions. Two methodologists prepared evidence profiles and assessed quality (certainty) of evidence relevant to the key questions according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Group members reviewed the evidence profiles and, using a consensus process, voted on recommendations and determined the strength of recommendations as strong or conditional. RECOMMENDATIONS Preendoscopic management: The group suggests using a Glasgow Blatchford score of 1 or less to identify patients at very low risk for rebleeding, who may not require hospitalization. In patients without cardiovascular disease, the suggested hemoglobin threshold for blood transfusion is less than 80 g/L, with a higher threshold for those with cardiovascular disease. Endoscopic management: The group suggests that patients with acute UGIB undergo endoscopy within 24 hours of presentation. Thermocoagulation and sclerosant injection are recommended, and clips are suggested, for endoscopic therapy in patients with high-risk stigmata. Use of TC-325 (hemostatic powder) was suggested as temporizing therapy, but not as sole treatment, in patients with actively bleeding ulcers. Pharmacologic management: The group recommends that patients with bleeding ulcers with high-risk stigmata who have had successful endoscopic therapy receive high-dose proton-pump inhibitor (PPI) therapy (intravenous loading dose followed by continuous infusion) for 3 days. For these high-risk patients, continued oral PPI therapy is suggested twice daily through 14 days, then once daily for a total duration that depends on the nature of the bleeding lesion. Secondary prophylaxis: The group suggests PPI therapy for patients with previous ulcer bleeding who require antiplatelet or anticoagulant therapy for cardiovascular prophylaxis.
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Affiliation(s)
- Alan N Barkun
- McGill University, Montreal, Quebec, Canada (A.N.B.)
| | - Majid Almadi
- McGill University, Montreal, Quebec, Canada, and King Saud University, Riyadh, Saudi Arabia (M.A.)
| | - Ernst J Kuipers
- Erasmus University Medical Center, Rotterdam, the Netherlands (E.J.K.)
| | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut, and VA Connecticut Healthcare System, West Haven, Connecticut (L.L.)
| | - Joseph Sung
- Chinese University of Hong Kong, Hong Kong SAR (J.S., F.K.C., J.L.)
| | - Frances Tse
- McMaster University, Hamilton, Ontario, Canada (F.T., G.I.L., J.D., J.K.M.)
| | | | | | - Xavier Calvet
- Hospital Parc Taulí de Sabadell, University of Barcelona, Sabadell, Spain, and CiberEHD (Instituto de Salud Carlos III), Madrid, Spain (X.C.)
| | - Francis K L Chan
- Chinese University of Hong Kong, Hong Kong SAR (J.S., F.K.C., J.L.)
| | - James Douketis
- McMaster University, Hamilton, Ontario, Canada (F.T., G.I.L., J.D., J.K.M.)
| | - Robert Enns
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada (R.E.)
| | - Ian M Gralnek
- Technion-Israel Institute of Technology, Emek Medical Center, Afula, Israel (I.M.G.)
| | | | - Dennis Jensen
- University of California, Los Angeles, Los Angeles, California (D.J.)
| | - James Lau
- Chinese University of Hong Kong, Hong Kong SAR (J.S., F.K.C., J.L.)
| | - Gregory Y H Lip
- University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom, and Aalborg University, Aalborg, Denmark (G.Y.L.)
| | - Romaric Loffroy
- Dijon-Bourgogne University Hospital, Dijon, France (R.L., M.B.)
| | | | | | - Nageshwar Reddy
- Asian Institute of Gastroenterology, Hyderabad, India (N.R.)
| | - John R Saltzman
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (J.R.S.)
| | - John K Marshall
- McMaster University, Hamilton, Ontario, Canada (F.T., G.I.L., J.D., J.K.M.)
| | - Marc Bardou
- Dijon-Bourgogne University Hospital, Dijon, France (R.L., M.B.)
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46
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Vuik FER, Nieuwenburg SAV, Bardou M, Lansdorp-Vogelaar I, Dinis-Ribeiro M, Bento MJ, Zadnik V, Pellisé M, Esteban L, Kaminski MF, Suchanek S, Ngo O, Májek O, Leja M, Kuipers EJ, Spaander MCW. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut 2019; 68:1820-1826. [PMID: 31097539 PMCID: PMC6839794 DOI: 10.1136/gutjnl-2018-317592] [Citation(s) in RCA: 399] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/29/2019] [Accepted: 03/31/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The incidence of colorectal cancer (CRC) declines among subjects aged 50 years and above. An opposite trend appears among younger adults. In Europe, data on CRC incidence among younger adults are lacking. We therefore aimed to analyse European trends in CRC incidence and mortality in subjects younger than 50 years. DESIGN Data on age-related CRC incidence and mortality between 1990 and 2016 were retrieved from national and regional cancer registries. Trends were analysed by Joinpoint regression and expressed as annual percent change. RESULTS We retrieved data on 143.7 million people aged 20-49 years from 20 European countries. Of them, 187 918 (0.13%) were diagnosed with CRC. On average, CRC incidence increased with 7.9% per year among subjects aged 20-29 years from 2004 to 2016. The increase in the age group of 30-39 years was 4.9% per year from 2005 to 2016, the increase in the age group of 40-49 years was 1.6% per year from 2004 to 2016. This increase started earliest in subjects aged 20-29 years, and 10-20 years later in those aged 30-39 and 40-49 years. This is consistent with an age-cohort phenomenon. Although in most European countries the CRC incidence had risen, some heterogeneity was found between countries. CRC mortality did not significantly change among the youngest adults, but decreased with 1.1%per year between 1990 and 2016 and 2.4% per year between 1990 and 2009 among those aged 30-39 years and 40-49 years, respectively. CONCLUSION CRC incidence rises among young adults in Europe. The cause for this trend needs to be elucidated. Clinicians should be aware of this trend. If the trend continues, screening guidelines may need to be reconsidered.
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Affiliation(s)
- Fanny ER Vuik
- Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Stella AV Nieuwenburg
- Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marc Bardou
- Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands,Centre d’investigations Clinique INSERM 1432, CHU Dijon-Bourgogne, Dijon, France
| | | | - Mário Dinis-Ribeiro
- Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal,CINTESIS, Porto Faculty of Medicine, University of Porto, Porto, Portugal
| | - Maria J Bento
- North Region Cancer Registry (RORENO), Department of Epidemiology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Vesna Zadnik
- Epidemiology and Cancer Registry, Institute of Oncology, Ljubljana, Slovenia
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Laura Esteban
- Catalan Cancer Plan, Catalan Institute of Oncology, L’Hospitalet del Llobregat, Barcelona, Spain
| | - Michal F Kaminski
- Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland,Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Stepan Suchanek
- Internal Medicine, 1st Faculty of Medicine, Charles University, Military University Hospital, Prague, Czech Republic
| | - Ondřej Ngo
- Faculty of Medicine, Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Ondřej Májek
- Faculty of Medicine, Masaryk University, Institute of Biostatistics and Analyses, Brno, Czech Republic,Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Marcis Leja
- Institute of Clinical and Preventive Medicine & Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Ernst J Kuipers
- Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manon CW Spaander
- Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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47
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Nieuwenburg SAV, Waddingham WW, Graham D, Rodriguez-Justo M, Biermann K, Kuipers EJ, Banks M, Jansen M, Spaander MCW. Accuracy of endoscopic staging and targeted biopsies for routine gastric intestinal metaplasia and gastric atrophy evaluation study protocol of a prospective, cohort study: the estimate study. BMJ Open 2019; 9:e032013. [PMID: 31537576 PMCID: PMC6756576 DOI: 10.1136/bmjopen-2019-032013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Patients with chronic atrophic gastritis (CAG) and intestinal metaplasia (IM) are at risk of developing gastric adenocarcinoma. Their diagnosis and management currently rely on histopathological guidance after random endoscopic biopsy sampling (Sydney biopsy strategy). This approach has significant flaws such as under-diagnosis, poor reproducibility and poor correlation between endoscopy and histology. This prospective, international multicentre study aims to establish whether endoscopy-led risk stratification accurately and reproducibly predicts CAG and IM extent and disease stage. METHODS AND ANALYSIS Patients with CAG and/or IM on standard white light endoscopy (WLE) will be prospectively identified and invited to undergo a second endoscopy performed by an expert endoscopist using enhanced endoscopic imaging techniques with virtual chromoendoscopy. Extent of CAG/IM will be endoscopically staged with enhanced imaging and compared with standard WLE. Histopathological risk stratification through targeted biopsies will be compared with endoscopic disease staging and to random biopsy staging on WLE as a reference. At least 234 patients are required to show a 10 % difference in sensitivity and accuracy between enhanced imaging endoscopy-led staging and the current biopsy-led staging protocol of gastric atrophy with a power (beta) of 80 % and a 0.05 probability of a type I error (alpha). ETHICS AND DISSEMINATION The study was approved by the respective Institutional Review Boards (Netherlands: MEC-2018-078; UK: 19/LO/0089). The findings will be published in peer-reviewed journals and presented at scientific meetings. TRIAL REGISTRATION NUMBER NTR7661; Pre-results.
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Affiliation(s)
- Stella A V Nieuwenburg
- Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - William W Waddingham
- Endoscopy, University College London Hospital, London, UK
- UCL Cancer Institute, University College London, London, UK
| | - David Graham
- Endoscopy, University College London Hospital, London, UK
| | | | - Katharina Biermann
- Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ernst J Kuipers
- Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Matthew Banks
- Endoscopy, University College London Hospital, London, UK
| | - Marnix Jansen
- Endoscopy, University College London Hospital, London, UK
- Pathology, University College London Hospital, London, UK
| | - Manon C W Spaander
- Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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48
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Banks M, Graham D, Jansen M, Gotoda T, Coda S, di Pietro M, Uedo N, Bhandari P, Pritchard DM, Kuipers EJ, Rodriguez-Justo M, Novelli MR, Ragunath K, Shepherd N, Dinis-Ribeiro M. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut 2019; 68:1545-1575. [PMID: 31278206 PMCID: PMC6709778 DOI: 10.1136/gutjnl-2018-318126] [Citation(s) in RCA: 297] [Impact Index Per Article: 59.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/06/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022]
Abstract
Gastric adenocarcinoma carries a poor prognosis, in part due to the late stage of diagnosis. Risk factors include Helicobacter pylori infection, family history of gastric cancer-in particular, hereditary diffuse gastric cancer and pernicious anaemia. The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia. The key to early detection of cancer and improved survival is to non-invasively identify those at risk before endoscopy. However, although biomarkers may help in the detection of patients with chronic atrophic gastritis, there is insufficient evidence to support their use for population screening. High-quality endoscopy with full mucosal visualisation is an important part of improving early detection. Image-enhanced endoscopy combined with biopsy sampling for histopathology is the best approach to detect and accurately risk-stratify GA and GIM. Biopsies following the Sydney protocol from the antrum, incisura, lesser and greater curvature allow both diagnostic confirmation and risk stratification for progression to cancer. Ideally biopsies should be directed to areas of GA or GIM visualised by high-quality endoscopy. There is insufficient evidence to support screening in a low-risk population (undergoing routine diagnostic oesophagogastroduodenoscopy) such as the UK, but endoscopic surveillance every 3 years should be offered to patients with extensive GA or GIM. Endoscopic mucosal resection or endoscopic submucosal dissection of visible gastric dysplasia and early cancer has been shown to be efficacious with a high success rate and low rate of recurrence, providing that specific quality criteria are met.
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Affiliation(s)
- Matthew Banks
- University College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Research Department of Targeted Intervention, University College London, London, UK
| | - David Graham
- University College London Hospital, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London Division of Biosciences, London, UK
| | - Marnix Jansen
- Department of Histopathology, University College London, London, UK
| | - Takuji Gotoda
- Gastroenterology, Nihon University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | | | - Massimiliano di Pietro
- MRC Cancer Unit, University of Cambridge, Cambridge, UK.,Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Endoscopic Training and Learning Center, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | | | - D Mark Pritchard
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | | | - Marco R Novelli
- Department of Histopathology, University College London, London, UK
| | - Krish Ragunath
- Nottingham Digestive Diseases Centre, Nottingham University Hospital, Nottingham, UK
| | - Neil Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham General Hospital, Cheltenham, Gloucestershire, UK
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49
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Bleijenberg A, Klotz D, Løberg M, Dekker E, Adami HO, Kuipers EJ, Holme Ø, Kalager M, Emilsson L, Kleist B, Løvdal L, Regula J, Løberg EM, IJspeert J, Bretthauer M. Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe. Endoscopy 2019; 51:750-758. [PMID: 31195423 DOI: 10.1055/a-0916-8598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Because individuals with serrated polyps and adenomas are at increased risk of developing new polyps and colorectal cancer (CRC), surveillance after resection is justified. After adenoma resection, most international guidelines are consistent, but recommendations for surveillance after serrated polyp resection vary. The United States Multi-Society Taskforce on CRC (US-MSTF) base surveillance intervals on serrated polyp subtype (traditional serrated adenoma, sessile serrated polyp, hyperplastic polyps), while the European Society of Gastrointestinal Endoscopy (ESGE) guidelines do not take serrated polyp subtype into account. We evaluated the implications of this difference in a primary colonoscopy screening cohort. METHODS We included participants from a large colonoscopy screening trial. In a post-hoc simulation, assuming full protocol adherence, we determined the surveillance interval for each subject based on their polyp burden, using the most recent US-MSTF and ESGE guidelines. RESULTS We included 5323 participants, of whom 1228 had one or more serrated polyps. In 5201 of all participants (98 %; Cohen's kappa 0.90) and in 1106 of those with serrated polyps (90 %; Cohen's kappa 0.80), both guidelines recommended identical surveillance intervals. Recommendations for a 3-year surveillance interval were identical between the two guidelines. All 122 subjects with discordant recommendations would receive a follow-up colonoscopy after 10 years using ESGE guidance and after 5 years using US-MSTF guidance. CONCLUSION Despite the different criteria used to determine surveillance after serrated polyp resection, most individuals are recommended identical colonoscopy surveillance intervals whether following the ESGE or US-MSTF guidelines. This suggests that surveillance recommendations do not need to consider the serrated polyp subtype.
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Affiliation(s)
- Arne Bleijenberg
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Dagmar Klotz
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Evelien Dekker
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hans Olov Adami
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Øyvind Holme
- University of Oslo and Cancer Registry of Norway, Oslo, and Sorlandet Hospital Trust, Kristiansand, Norway
| | - Mette Kalager
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Louise Emilsson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Health Management and Health Economy, Institute of Health and Society, University of Oslo, Norway
| | - Britta Kleist
- Department of Pathology, Soerlandet Sykehus HF, Kristiansand, Norway
| | - Leif Løvdal
- Department of Pathology, Soerlandet Sykehus HF, Kristiansand, Norway
| | - Jaroslaw Regula
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, and Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.,Department of Oncological Gastroenterology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Else M Løberg
- Department of Pathology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Joep IJspeert
- Amsterdam UMC, University of Amsterdam, Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Departments of Pathology and Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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50
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Schreuders EH, Grobbee EJ, Nieuwenburg SAV, Kapidzic A, van Roon AHC, van Vuuren AJ, Lansdorp-Vogelaar I, Spijker WWJ, Izelaar K, Bruno MJ, Kuipers EJ, Spaander MCW. Multiple rounds of one sample versus two sample faecal immunochemical test-based colorectal cancer screening: a population-based study. Lancet Gastroenterol Hepatol 2019; 4:622-631. [PMID: 31196734 DOI: 10.1016/s2468-1253(19)30176-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/25/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Faecal immunochemical test (FIT)-based colorectal cancer screening requires successive rounds for maximum preventive effect. Advanced neoplasia can bleed intermittently and thus might be missed by single faecal sampling. Few studies have been done on two sample FIT (2-FIT) screening over multiple rounds. Therefore, we compared multiple rounds of one sample FIT (1-FIT) with 2-FIT screening with respect to participation, positive predictive value (PPV), diagnostic yield, and interval colorectal cancer. METHODS In this population-based study, a random selection of asymptomatic individuals aged 50-74 years in the Rotterdam-Rijnmond region, Netherlands, were invited by post for four rounds (every 2 years) of 1-FIT or 2-FIT screening. Key exclusion criteria were a history or colorectal cancer or inflammatory bowel disease, colon imaging in the previous 2 years, and life expectancy of less than 5 years. Per round, invitees received one or two FITs to sample either one or two consecutive bowel movements. OC-Sensor Micro (Eiken Chemical Co., Ltd, Japan) FITs were used by all participants, except the fourth round of screening for the 1-FIT cohort, for which participants used either an OC-Sensor or a FOB-Gold (Sentinel Diagnostics, Milan, Italy). A faecal haemoglobin cutoff concentration of 10 μg/g of faeces in at least one test was used for referral for colonoscopy. FINDINGS Between 2006 and 2015, of 10 008 invited individuals for the 1-FIT cohort, 9787 were eligible for inclusion, of whom 7310 participated at least once in four successive rounds. Of 3197 invited individuals for the 2-FIT cohort, 3131 were eligible for inclusion, and 2269 participated at least once in four successive rounds. In the 1-FIT screening cohort, 74·7% (7310 of 9787) of invitees participated at least once versus 72·5% (2269 of 3131) of invitees in the 2-FIT cohort (p=0·013). Among participants who participated at least once, the cumulative positivity rate over four rounds was 19·2% (1407 of 7310) for the 1-FIT cohort versus 28·5% (647 of 2269) for the 2-FIT cohort (p<0·0001). The cumulative PPV for advanced neoplasia was 33·0% (432 of 1308 colonoscopies) for the 1-FIT cohort versus 24·2% (147 of 607 colonoscopies) for the 2-FIT cohort (p<0·0001). The cumulative diagnostic yield of advanced neoplasia among invited individuals was 4·4% (432 of 9787) for 1-FIT versus 4·7% (147 of 3131) for 2-FIT screening (p=0·46)). FIT interval colorectal cancers were detected in eight (0·1%) of 7310 participants in the 1-FIT cohort and two (0·1%) of 2269 with 2-FIT screening (p=1·00). INTERPRETATION Four rounds of 2-FIT screening with a low faecal haemoglobin cutoff level did not result in a significant increase in diagnostic yield or a decrease in interval colorectal cancers compared with 1-FIT, despite higher colonoscopy demand. Therefore, 1-FIT colorectal cancer screening programmes should be preferred. FUNDING None.
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Affiliation(s)
- Eline H Schreuders
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Esmée J Grobbee
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Stella A V Nieuwenburg
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Atija Kapidzic
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Aafke H C van Roon
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Wolfert W J Spijker
- Regional Organization for Population Screening South-West Netherlands, Rotterdam, Netherlands
| | - Kirsten Izelaar
- Regional Organization for Population Screening South-West Netherlands, Rotterdam, Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Ernst J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands.
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