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Quaye AN, Hisey WM, Mackenzie TA, Robinson CM, Richard JM, Anderson JC, Warters RD, Butterly LF. Association between Colonoscopy Sedation Type and Polyp Detection: A Registry-based Cohort Study. Anesthesiology 2024; 140:1088-1097. [PMID: 38629957 PMCID: PMC11096037 DOI: 10.1097/aln.0000000000004955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Colorectal cancer is a leading cause of cancer-related death. Adenomas and serrated polyps are precursors of colorectal cancer, with serrated polyps being more difficult to detect during colonoscopy. The relationship between propofol use and polyp detection remains unclear. The authors investigated the association of propofol-based versus mild-moderate sedation on adenoma and serrated polyp detection during colonoscopy. METHODS This retrospective cohort study used observational data from the New Hampshire Colonoscopy Registry. Patients aged greater than 50 yr with screening or surveillance colonoscopies between January 1, 2015, and February 28, 2020, were included. Exclusions were diagnostic examinations, no sedation, missing pathology data, and poor bowel preparation. Multivariate logistic regression was used to evaluate differences in polyp detection between propofol and moderate sedation in the full sample while adjusting for covariates. Propensity score adjustment and clustering at the endoscopist level were used in a restricted sample analysis that included endoscopists and facilities with between 5% and 95% propofol sedation use. RESULTS A total of 54,063 colonoscopies were analyzed in the full sample and 18,998 in the restricted sample. Serrated polyp prevalence was significantly higher using propofol (9,957 of 29,312; 34.0% [95% CI, 33.4 to 34.5%]) versus moderate sedation (6,066 of 24,751; 24.5% [95% CI, 24.0 to 25.1%]) in the full sample and restricted samples (1,410 of 4,661; 30.3% [95% CI, 28.9 to 31.6%] vs. 3,690 of 14,337; 25.7% [95% CI, 25.0 to 26.5%]). In the full sample multivariate logistic regression, propofol was associated with higher neoplasm (adjusted odds ratio, 1.25 [95% CI, 1.21 to 1.29]), adenoma (odds ratio, 1.07 [95% CI, 1.03 to 1.11]), and serrated polyp detection (odds ratio, 1.51 [95% CI, 1.46 to 1.57]). In the restricted sample using inverse probability of treatment weighted propensity score adjustment and clustering at the endoscopist level, an attenuated but statistically significant effect size was observed for serrated polyps (odds ratio, 1.13 [95% CI, 1.07 to 1.19]), but not for adenomas (odds ratio, 1.00 [95% CI, 0.95 to 1.05]) or any neoplastic lesion (odds ratio, 1.03 [95% CI, 0.98 to 1.08]). CONCLUSIONS Propofol sedation during colonoscopy may be associated with improved detection of serrated polyps, but not adenomas. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Aurora N Quaye
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, Maine; Division of Anesthesiology, Spectrum Healthcare Partners, South Portland, Maine; Assistant Professor of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts
| | - William M Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire
| | - Todd A Mackenzie
- Professor of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Christina M Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire
| | - Janelle M Richard
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, Maine
| | - Joseph C Anderson
- Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; White River Junction VA Medical Center, White River Junction, Vermont
| | - Robert D Warters
- Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, Maine; Division of Anesthesiology, Spectrum Healthcare Partners, South Portland, Maine
| | - Lynn F Butterly
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire; Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Popescu Crainic I, Djinbachian R, Rex DK, Barkun A, Shaukat A, East J, Hassan C, Mori Y, Pohl H, Rastogi A, Sharma P, Anderson JC, Taghiakbari M, Medawar E, von Renteln D. Expert endoscopist assessment of colorectal polyp size using virtual scale endoscopy, visual or snare-based estimation: a prospective video-based study. Scand J Gastroenterol 2024; 59:608-614. [PMID: 38333956 DOI: 10.1080/00365521.2024.2308519] [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: 11/20/2023] [Accepted: 01/15/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND AIMS Accurate polyp size estimation during colonoscopy has an impact on clinical decision-making. A laser-based virtual scale endoscope (VSE) is available to allow measuring polyp size using a virtual adaptive scale. This study evaluates video-based polyp size measurement accuracy among expert endoscopists using either VSE or visual assessment (VA) with either snare as reference size or without any reference size information. METHODS A prospective, video-based study was conducted with 10 expert endoscopists. Video sequences from 90 polyps with known reference size (fresh specimen measured using calipers) were distributed on three different slide sets so that each slide set showed the same polyp only once with either VSE, VA or snare-based information. A slide set was randomly assigned to each endoscopist. Endoscopists were asked to provide size estimation based on video review. RESULTS Relative accuracies for VSE, VA, and snare-based estimation were 75.1% (95% CI [71.6-78.5]), 65.0% (95% CI [59.5-70.4]) and 62.0% (95% CI [54.8-69.0]), respectively. VSE yielded significantly higher relative accuracy compared to VA (p = 0.002) and to snare (p = 0.001). A significantly lower percentage of polyps 1-5 mm were misclassified as >5 mm using VSE versus VA and snare (6.52% vs. 19.6% and 17.5%, p = 0.004) and a significantly lower percentage of polyps >5 mm were misclassified as 1-5 mm using VSE versus VA and snare (11.4% vs. 31.9% and 14.9%, p = 0.038). CONCLUSIONS Endoscopists estimate polyp size with the highest accuracy when virtual adaptive scale information is displayed. Using a snare to assist sizing did not improve measurement accuracy compared to displaying visual information alone.
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Affiliation(s)
- Ioana Popescu Crainic
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Roupen Djinbachian
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, IN University Medical Center, Indianapolis, Indiana, USA
| | - Alan Barkun
- Division of Gastroenterology, McGill University Health Centre (MUHC), Montreal, Québec, Canada
| | - Aasma Shaukat
- Division of Gastroenterology and Hepatology, NYU Grossman School of Medicine, New York City, New York, USA
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK
- Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Cesare Hassan
- Division of Gastroenterology, Regina Margherita Hospital, Rome, Italy
| | - Yuichi Mori
- Division of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Heiko Pohl
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Division of Gastroenterology, White River Junction Veteran Affairs Medical Center, White River Junction, Vermont, USA
| | - Amit Rastogi
- Division of Gastroenterology, University of KS School of Medicine, Kansas City, Kansas, USA
| | - Prateek Sharma
- Division of Gastroenterology, University of KS School of Medicine, Kansas City, Kansas, USA
- Division of Gastroenterology, Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Joseph C Anderson
- Division of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Mahsa Taghiakbari
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Edgard Medawar
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, Montreal University Hospital Research Center, Montreal, Québec, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Québec, Canada
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Anderson JC, Rex DK, Mackenzie TA, Hisey W, Robinson CM, Butterly LF. Endoscopist adenomas-per-colonoscopy detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2024; 99:787-795. [PMID: 37993057 PMCID: PMC11039365 DOI: 10.1016/j.gie.2023.11.014] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/13/2023] [Accepted: 11/11/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND AND AIMS Adenomas per colonoscopy (APC) may be a better measure of colonoscopy quality than adenoma detection rate (ADR) because it credits endoscopists for each detected adenoma. There are few data examining the association between APC and postcolonoscopy colorectal cancer (PCCRC) incidence. We used data from the New Hampshire Colonoscopy Registry to examine APC and PCCRC risk. METHODS We included New Hampshire Colonoscopy Registry patients with an index examination and at least 1 follow-up event, either a colonoscopy or a colorectal cancer (CRC) diagnosis. Our outcome was PCCRC defined as any CRC diagnosed ≥6 months after an index examination. The exposure variable was endoscopist-specific APC quintiles of .25, .40, .50, and .70. Cox regression was used to model the hazard of PCCRC on APC, controlled for age, sex, year of index examination, index findings, bowel preparation, and having more than 1 surveillance examination. RESULTS In 32,535 patients, a lower hazard for PCCRC (n = 178) was observed for higher APCs as compared to APCs of <.25 (reference): .25 to <.40: hazard ratio (HR), .35; 95% confidence interval (CI), .22-.56; .40 to <.50: HR, .31; 95% CI, .20-.49; .50 to <.70: HR, .20; 95% CI, .11-.36; and ≥.70: HR, .19; 95% CI, .09-.37. When examining endoscopists with an ADR of at least 25%, an APC of <.50 was associated with a significantly higher hazard than an APC of ≥.50 (HR, 1.65; 95% CI, 1.06-2.56). A large proportion of endoscopists-one-fifth (32 of 152; 21.1%)-had an ADR of ≥25% but an APC of <.50. CONCLUSIONS Our novel data demonstrating lower PCCRC risk in examinations performed by endoscopists with higher APCs suggest that APC could be a useful quality measure. Quality improvement programs may identify important deficiencies in endoscopist detection performance by measuring APC for endoscopists with an ADR of ≥25%.
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Affiliation(s)
- Joseph C Anderson
- Geisel School of Medicine at Dartmouth, Hanover, NH
- White River Junction VAMC, White River Junction VT
| | - Douglas K Rex
- Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana
| | | | - William Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- NH Colonoscopy Registry, Lebanon, NH
| | - Christina M Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- NH Colonoscopy Registry, Lebanon, NH
| | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- NH Colonoscopy Registry, Lebanon, NH
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McAuliffe T, Anderson JC, Larson RJ, Robertson DJ. Systematic scoping review: Use of the faecal immunochemical test residual buffer to enhance colorectal cancer screening. Aliment Pharmacol Ther 2024; 59:1033-1048. [PMID: 38534182 DOI: 10.1111/apt.17947] [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: 07/08/2023] [Revised: 08/07/2023] [Accepted: 03/03/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The faecal immunochemical test (FIT) is an inexpensive and convenient modality to screen for colorectal cancer. However, its one-time sensitivity for detecting colorectal cancer and cancer precursors is limited. There is growing interest in using the non-haemoglobin contents of FIT residual buffer to enhance colonic neoplasia detection. AIM To establish from the literature a framework to catalogue candidate biomarkers within FIT residual buffer for non-invasive colorectal cancer screening. METHODS The search strategy evaluated PubMed, Scopus, Web of Science, Embase, and Google Scholar for publications through 25 October 2023, with search terms including FIT, buffer, OC-sensor, biomarkers, microbiome, microRNA (miR), colon, rectum, screening, neoplasm, and early detection. Studies employing home-based collection samples using quantitative FIT first processed for haemoglobin were included. One author reviewed all articles; a second author completed a 20% full-text audit to ensure adherence to eligibility criteria. RESULTS A broad search yielded 1669 studies and application of eligibility criteria identified 18 relevant studies. Multiple protein, DNA/RNA, and microbiome biomarkers (notably haptoglobin, miR-16, miR-27a-3p, miR-92a, miR-148a-3p, miR-223, miR-421, let-7b-5p, and Tyzzerella 4) were associated with colorectal neoplasia. Furthermore, studies highlighted the short-term stability of biomarkers for clinical use and long-term stability for research purposes. CONCLUSIONS This scoping review summarises the framework and progress of research on stability of biomarkers in FIT residual buffer and their associations with colorectal neoplasia to guide opportunities for further confirmatory studies to enhance colorectal cancer screening.
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Affiliation(s)
| | - Joseph C Anderson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Robin J Larson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Douglas J Robertson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA
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van Keulen KE, Papanikolaou IS, Mak TWC, Apostolopoulos P, Neumann H, Delconte G, Furnari M, Peters Y, Lau JYW, Polymeros D, Schrauwen RWN, Cavalcoli F, Koukoulioti E, Triantafyllou K, Anderson JC, Pohl H, Rex DK, Siersema PD. Comparison of adenoma miss rate and adenoma detection rate between conventional colonoscopy and colonoscopy with second-generation distal attachment cuff: a multicenter, randomized, back-to-back trial. Gastrointest Endosc 2024; 99:798-808.e3. [PMID: 37993062 DOI: 10.1016/j.gie.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 10/27/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND AND AIMS Endocuff Vision (Olympus Europe, Hamburg, Germany) has been designed to enhance mucosal visualization, thereby improving detection of (pre-)malignant colorectal lesions. This multicenter, international, back-to-back, randomized colonoscopy trial compared the adenoma detection rate (ADR) and adenoma miss rate (AMR) between Endocuff Vision-assisted colonoscopy (EVC) and conventional colonoscopy (CC). METHODS Patients aged 40 to 75 years referred for non-immunochemical fecal occult blood test-based screening, surveillance, or diagnostic colonoscopy were included at 10 hospitals and randomized into 4 groups: group 1, 2 × CC; group 2, CC followed by EVC; group 3, EVC followed by CC; and group 4, 2 × EVC. Primary outcomes included ADR and AMR. RESULTS A total of 717 patients were randomized, of whom 661 patients (92.2%) had 1 and 646 (90.1%) patients had 2 completed back-to-back colonoscopies. EVC did not significantly improve ADR compared to CC (41.1%; [95% confidence interval (CI), 36.1-46.3] vs 35.5% [95% CI, 30.7-40.6], respectively; P = .125), but EVC did reduce AMR by 11.7% (29.6% [95% CI, 23.6-36.5] vs 17.9% [95% CI, 12.5-23.5], respectively; P = .049). AMR of 2 × CC compared to 2 × EVC was also not significantly different (25.9% [95% CI, 19.3-33.9] vs 18.8% [95% CI, 13.9-24.8], respectively; P = .172). Only 3.7% of the polyps missed during the first procedures had advanced pathologic features. Factors affecting risk of missing adenomas were age (P = .002), Boston Bowel Preparation Scale (P = .008), and region where colonoscopy was performed (P < .001). CONCLUSIONS Our trial shows that EVC reduces the risk of missing adenomas but does not lead to a significantly improved ADR. Remarkably, 25% of adenomas are still missed during conventional colonoscopies, which is not different from miss rates reported 25 years ago; reassuringly, advanced features were only found in 3.7% of these missed lesions. (Clinical trial registration number: NCT03418948.).
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Affiliation(s)
- Kelly E van Keulen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ioannis S Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
| | - Tony W C Mak
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hongkong, Hongkong, China
| | | | - Helmut Neumann
- Department of Gastroenterology and Hepatology, University Medical Center Mainz, Mainz, Germany
| | - Gabriele Delconte
- Department of Diagnostic Endoscopy and Endoscopic Surgery, Istituto Nazionale Tumori, Milano, Italy
| | - Manuele Furnari
- Division of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Yonne Peters
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - James Y W Lau
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hongkong, Hongkong, China
| | - Dimitrios Polymeros
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
| | - Ruud W N Schrauwen
- Department of Gastroenterology, Bernhoven Hospital, Uden, The Netherlands
| | - Federica Cavalcoli
- Department of Diagnostic Endoscopy and Endoscopic Surgery, Istituto Nazionale Tumori, Milano, Italy
| | - Eleni Koukoulioti
- Department of Gastroenterology, 417 Army Veterans Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University, Attikon University General Hospital, Athens, Greece
| | - Joseph C Anderson
- Department of Gastroenterology, Gastroenterology, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Heiko Pohl
- Department of Gastroenterology, Gastroenterology, Veterans Affairs Medical Center, White River Junction, Vermont, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
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Patel SG, May FP, Anderson JC, Burke CA, Dominitz JA, Gross SA, Jacobson BC, Shaukat A, Robertson DJ. Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults. Ann Intern Med 2024; 177:542. [PMID: 38621270 DOI: 10.7326/l24-0012] [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: 04/17/2024] Open
Affiliation(s)
- Swati G Patel
- University of Colorado Anschutz Medical Center, Denver, Colorado
| | - Folasade P May
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Joseph C Anderson
- VA Medical Center White River Junction, White River Junction, Vermont, and University of Connecticut School of Medicine, Farmington, Connecticut
| | | | | | | | - Brian C Jacobson
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aasma Shaukat
- New York University Grossman School of Medicine, New York, New York
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Anderson JC, Robertson DJ. Fecal Immunochemical Test Screening: Maximizing Success by Minimizing Failure. Cancer Epidemiol Biomarkers Prev 2024; 33:183-185. [PMID: 38317627 DOI: 10.1158/1055-9965.epi-23-1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024] Open
Abstract
Implementing fecal immunochemical testing (FIT) through clinic based opportunistic screening or programmatic mailing is not as straightforward as it seems. Liu and colleagues present data for 56,980 individuals who submitted a FIT in a safety net hospital system. In 10.2% (N = 5,819), the test was deemed unsatisfactory. These data demonstrate that there is significant room for improvement in clinical practice regarding colorectal cancer screening with FIT. The high rate of 10% for unsatisfactory FIT tests is higher than the 5% benchmark suggested by the U.S. Multi-Society Task Force on colorectal cancer screening. To maximize FIT success, there needs to be a preoccupation with failure at the system level that results in reducing the number of FIT tests that are rejected. Completing a stool test independently at home is not easy. The medical system needs to help and support individuals in completing the test every step of the way. Suggestions include patient related tips such as labelling and mailing the tests. There are also suggestions for the ordering clinician including administrative tracking to notify clinicians when a FIT has not been performed or is rejected. Papers like this get us focused exactly where we need to be to improve FIT-based screening. See related article by Liu et al., p. 215.
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Affiliation(s)
- Joseph C Anderson
- University of Connecticut School of Medicine, Farmington, Connecticut
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- The Geisel School of Medicine at Dartmouth Medical, Hanover, New Hampshire
| | - Douglas J Robertson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont
- The Geisel School of Medicine at Dartmouth Medical, Hanover, New Hampshire
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Taghiakbari M, Anderson JC, von Renteln D, Hirschmann S, Jobse B, Pohl H. Extent of normal polyp resection margin: a possible quality measure for polyp resection. Gut 2024; 73:216-218. [PMID: 38050099 DOI: 10.1136/gutjnl-2023-330727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/12/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Mahsa Taghiakbari
- Division of Gastroenterology, Montreal University Hospital Research Center (CHUM), Montreal, Québec, Canada
| | - Joseph C Anderson
- Department of Gastroenterology, VA Medical Center, White River Junction, VT, USA
- Medicine, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Daniel von Renteln
- Division of Gastroenterology Medicine, Depertment of Medicine, Centre Hospitalier de L'Universite de Montreal (CHUM), Montreal, Québec, Canada
| | - Scott Hirschmann
- Department of Pathology, VA Medical Center, White River Junction, VT, USA
| | - Bruce Jobse
- Department of Research, VA Medical Center, Bedford, Massachusetts, USA
| | - Heiko Pohl
- Gastroenterology and Hepatology, White River Junction VA Medical Center, White River Junction, Vermont, USA
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9
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Vaziri H, Anderson JC. Colorectal Screening During the COVID-19 Pandemic: Delayed but Not Forgotten. Dig Dis Sci 2023; 68:4282-4284. [PMID: 37794296 DOI: 10.1007/s10620-023-08124-8] [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] [Received: 09/03/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Haleh Vaziri
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA.
- The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
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Anderson JC, Butterly LF. Assessing Risk of Index Serrated Polyps. Clin Gastroenterol Hepatol 2023:S1542-3565(23)00863-7. [PMID: 37924854 DOI: 10.1016/j.cgh.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Joseph C Anderson
- Section of Gastroenterology, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut; Section of Gastroenterology, Department of Medicine, White River Junction VAMC, White River Junction, Vermont; Section of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
| | - Lynn F Butterly
- Section of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Gastroenterology, Department of Medicine, NH Colonoscopy Registry, Lebanon, New Hampshire; Section of Gastroenterology and Hepatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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11
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Anderson JC, Rex DK, Mackenzie TA, Hisey W, Robinson CM, Butterly LF. Higher Serrated Polyp Detection Rates Are Associated With Lower Risk of Postcolonoscopy Colorectal Cancer: Data From the New Hampshire Colonoscopy Registry. Am J Gastroenterol 2023; 118:1927-1930. [PMID: 37417792 PMCID: PMC10841069 DOI: 10.14309/ajg.0000000000002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION We used New Hampshire Colonoscopy Registry data to examine the association between postcolonoscopy colorectal cancer (PCCRC) and sessile serrated detection rates (SSLDRs). METHODS We included patients with either a colonoscopy or a CRC diagnosis in the NH State Cancer Registry. PCCRC was any CRC diagnosed ≥ 6 months after index examination. RESULTS Of 26,901 patients, 162 were diagnosed with PCCRC. The hazard ratio for PCCRC was lowest for patients whose endoscopists had the highest SSLDR quintile (≥6%) (hazard ratio 0.29; 95% confidence interval 0.16-0.50). DISCUSSION Endoscopists with higher SSLDRs had lower risks of PCCRC. These data validate SSLDR as a clinically relevant quality measure.
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Affiliation(s)
- Joseph C Anderson
- Geisel School of Medicine at Dartmouth, Hanover, NH
- White River Junction VAMC, White River Junction VT
| | - Douglas K Rex
- Indiana University School of Medicine, Department of Medicine, Division of Gastroenterology and Hepatology, Indianapolis, Indiana
| | | | - William Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- NH Colonoscopy Registry, Lebanon, NH
| | - Christina M Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- NH Colonoscopy Registry, Lebanon, NH
| | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- NH Colonoscopy Registry, Lebanon, NH
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12
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Anderson JC, Bilal M, Burke CA, Gaidos JK, Lopez R, Oxentenko AS, Surawicz CM. Burnout Among US Gastroenterologists and Fellows in Training: Identifying Contributing Factors and Offering Solutions. J Clin Gastroenterol 2023; 57:1063-1069. [PMID: 36477385 DOI: 10.1097/mcg.0000000000001781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/13/2022] [Accepted: 09/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Consequences of physician burnout include medical errors, higher rate of staff turnover, and decreased patient satisfaction. We examined the prevalence of burnout and identified the contributing factors in gastroenterologists and fellows in training. METHODS We performed 3 separate surveys through the American College of Gastroenterology. (1) A national survey of practicing gastroenterologists in the United States that measured burnout and contributing factors, (2) a survey of gastroenterology fellows in training to determine self-identified burnout, as well as mitigating and exacerbating factors, and (3) a follow-up survey of fellows during the COVID-19 pandemic. RESULTS One thousand and twenty-one persons responded (9.2% response rate) to the first survey, including 756 individuals who completed the Maslach Burnout Inventory survey. Overall, the prevalence of high burnout was 49.3%. Factors associated with high burnout included female sex, younger age, shorter duration in practice, considering the electronic health record non-user-friendly, 2 or more hours of patient-related work at home per day, 8 or more hours of outpatient time per day, 6 or more inpatient consults per day, taking call with procedures 10 or more times per year, and having children at home. With regard to lifestyle factors, taking 20 days or more of vacation time was associated with a lower rate of burnout. The level of burnout for fellows was observed to be high (42.7% in survey 2 and 35.3% in survey 3). CONCLUSIONS Burnout is high in gastroenterologists and fellows in training. Specific contributing factors were both systems based and personal and provide insight into changes that can be made to address burnout.
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Affiliation(s)
- Joseph C Anderson
- Department of Veterans Affairs Medical Center, Division of Gastroenterology and Hepatology, The Geisel School of Medicine at Dartmouth, Hanover, NH
- University of Connecticut School of Medicine, Farmington
| | - Mohammad Bilal
- The Division of Gastroenterology VA Medical Center, University of Minnesota Medical School, Minneapolis, MN
| | - Carol A Burke
- Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic
| | - Jill K Gaidos
- Division of Digestive Disease, Yale School of Medicine, New Haven, CT
| | - Rocio Lopez
- Center for Populations Health Research, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | - Amy S Oxentenko
- Department of Medicine, Division of Gastroenterology, Mayo Clinic, Phoenix, AZ
| | - Christina M Surawicz
- Division of Gastroenterology, University of Washington School of Medicine, Seattle WA
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13
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Rex DK, Ladabaum U, Anderson JC, Shaukat A, Butterly LF, Dominitz JA, Kaltenbach T, Levin TR, Hassan C. Does Screening Colonoscopy Have a Future in the United States? Clin Gastroenterol Hepatol 2023; 21:3005-3010. [PMID: 37536529 DOI: 10.1016/j.cgh.2023.05.034] [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] [Received: 04/17/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont; Division of Gastroenterology and Hepatology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Aasma Shaukat
- New York University Grossman School of Medicine, New York Harbor Veterans Affairs Medical Center, New York, New York
| | - Lynn F Butterly
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jason A Dominitz
- National Gastroenterology and Hepatology Program, Veterans Health Administration, Washington, District of Columbia; Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Tonya Kaltenbach
- Veterans Affairs San Francisco Healthcare System, San Francisco, California; Division of Gastroenterology, Department of Medicine, University of California San Francisco, San Francisco, California
| | | | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rozzano, Milan, Italy
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14
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Lee KJ, Chkheidze R, Alrefai H, Margaroli C, Gaggar A, Nguyen T, Anderson JC, Bash R, Miller CR, Willey CD. Spatially Resolved Whole Transcriptome Analysis of Histologically-Characterized Tissue Microarray of Patient-Matched Primary and Recurrent Glioblastomas to Identify Underlying Mechanisms of Treatment Resistance. Int J Radiat Oncol Biol Phys 2023; 117:e127. [PMID: 37784683 DOI: 10.1016/j.ijrobp.2023.06.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Glioblastoma multiforme (GBM) is a lethal CNS malignancy. Radiation therapy increases overall survival, but tumors often recur in high-radiation dose regions. Additionally, recent investigations have underscored the importance of intra-tumoral heterogeneity as a driver of GBM biology. The purpose of this investigation is to characterize transcriptome differences in primary and recurrent GBM patient clinical samples using a digital spatial profiling approach to better appreciate treatment resistance mechanisms. MATERIALS/METHODS To address the lack of understanding of molecular mechanisms of resistance in GBM, patient-matched primary and recurrent GBM pathological specimens were identified within the brain tissue biorepository and tissue cores were selected for generation of a tissue microarray (TMA). Hematoxylin and eosin staining with histomorphological (cellular tumor, pseudopalisading necrosis, invasive edge, and perivascular inflammation) scoring were performed in a blinded fashion for every core. This array was then molecularly characterized using digital spatial profiling of the transcriptome. Quality assurance including filtering of lowly expressed genes followed by downstream analyses of the data were performed using the manufacturer's recommended methods within their Bioconductor library. Gene Set Enrichment Analysis (GSEA) was then performed on the ranked gene lists. RESULTS After recommended filtering, 6171 genes and 248 regions of interest remained for downstream analysis representing 22 unique patients across four different tumor histomorphological types. Significance testing revealed 679 genes that were differentially expressed between primary and recurrent tumor samples (at FDR<1%). On GSEA analysis, the chromosomal positional locus that contains genes most strongly up-regulated is 12q14, a locus that was previously identified as genomically amplified in multiple patient-derived xenograft lines after radiation selection. Additionally, recurrent tumors display a transcriptional profile more similar to the mesenchymal subtype, whereas primary tumors have a more classical transcriptional phenotype. The epithelial-to-mesenchymal transition pathway is particularly strongly up-regulated in recurrent tumors. CONCLUSION Recurrent selection at previously identified genomic loci and molecular pathways underscores a possible conserved set of pathways for treatment resistance. This analysis has yielded a set of gene and molecular pathways that will guide future work in our lab targeting treatment resistance using novel therapeutics and radiation techniques in GBM. Future directions include assessing the feasibility of mapping these clinical samples onto our previously generated panel of comprehensively characterized patient-derived xenograft lines.
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Affiliation(s)
- K J Lee
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - T Nguyen
- The University of Alabama at Birmingham, Birmingham, AL
| | - J C Anderson
- The University of Alabama at Birmingham, Birmingham, AL
| | - R Bash
- University of Alabama at Birmingham, Birmingham, AL
| | | | - C D Willey
- University of Alabama at Birmingham Department of Radiation Oncology, Birmingham, AL
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15
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Butterly LF, Hisey WM, Robinson CM, Limburg PJ, Kneedler BL, Anderson JC. What do 'false-positive' stool tests really mean? Data from the New Hampshire colonoscopy registry. Prev Med Rep 2023; 35:102309. [PMID: 37449002 PMCID: PMC10336791 DOI: 10.1016/j.pmedr.2023.102309] [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: 02/27/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
We utilized the population-based New Hampshire Colonoscopy Registry to calculate false discovery rates (FDR) and positive predictive values (PPVs) using three 'positive' colonoscopy definitions. Understanding the frequency of meaningful 'true positive' mt-sDNA and Fecal Immunochemical Test (FIT) results can optimize the use of these colorectal cancer (CRC) screening tests. We calculated FDR (positive stool test followed by negative colonoscopy divided by all positive stool tests) and PPV for mt-sDNA and FIT cohorts using the following definitions: 1) DeeP-C Study (CRC, adenomas/serrated polyps ≥ 1 cm, villous/High Grade Dysplasia); 2) < 10 year US Multi-Society Task Force (USMSTF) follow-up: DeeP-C findings & ≥1 sessile serrated polyps (SSPs) < 1 cm (with/without dysplasia) or ≥ 1 tubular adenomas < 1 cm. 3) Clinically Significant: DeeP-C + USMSTF + clinically significant serrated polyps: traditional serrated adenomas, SSPs, hyperplastic polyps (HPs) > 1 cm, and 5-9 mm proximal HPs. The sample included 549 mt-sDNA + and 410 FIT + and patients (mean age 66.4, 43.0% male). Using the most limited definition of positive colonoscopy, DeeP-C, FDR was 71.9% for mt-sDNA + and 81.7% for FIT +. Using the USMSTF definition, FDR decreased substantially: mt-sDNA+:33.2% and FIT+:47.6%. Adding all CSSPs resulted in the lowest FDR: mt-sDNA+:32.2% and FIT+:47.1%. Decreasing FDRs corresponded to increasing PPVs: mt-sDNA+:28.1% and FIT+:18.3% (DeeP-C definition) and mt-sDNA+:67.8% and FIT+:52.9% (DeeP-C + USMSTF + CSSP) (Table 1). FDRs decreased substantially when the definition of positive exams included all significant precancerous findings. These data present a comprehensive understanding of false positive outcomes at colonoscopies following positive stool tests, which to our knowledge is the first such analysis.
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Affiliation(s)
- Lynn F. Butterly
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- NH Colonoscopy Registry, Lebanon, NH, United States
| | - William M. Hisey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- NH Colonoscopy Registry, Lebanon, NH, United States
| | - Christina M. Robinson
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- NH Colonoscopy Registry, Lebanon, NH, United States
| | - Paul J. Limburg
- Mayo Clinic, Rochester, MN, United States
- Exact Sciences, Madison, WI, United States
| | | | - Joseph C. Anderson
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- White River Junction VAMC White River Junction VT, United States
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16
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El Zoghbi M, Shaukat A, Hassan C, Anderson JC, Repici A, Gross SA. Artificial Intelligence-Assisted Optical Diagnosis: A Comprehensive Review of Its Role in Leave-In-Situ and Resect-and-Discard Strategies in Colonoscopy. Clin Transl Gastroenterol 2023; 14:e00640. [PMID: 37747097 PMCID: PMC10584286 DOI: 10.14309/ctg.0000000000000640] [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: 06/20/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023] Open
Abstract
Colorectal cancer screening plays a vital role in early detection and removal of precancerous adenomas, contributing to decreased mortality rates. Most polyps found during colonoscopies are small and unlikely to harbor advanced neoplasia or invasive cancer, leading to the development of "leave-in-situ" and "resect-and-discard" approaches. These strategies could lead to significant cost savings and efficiencies, but their implementation has been hampered by concerns around financial incentives, medical-legal risks, and local rules for tissue handling. This article reviews the potential of artificial intelligence to enhance the accuracy of polyp diagnosis through computer-aided diagnosis (CADx). While the adoption of CADx in optical biopsy has shown mixed results, it has the potential to significantly improve the management of colorectal polyps. Several studies reviewed in this article highlight the varied results of CADx in optical biopsy for colorectal polyps. Although artificial intelligence does not consistently outperform expert endoscopists, it has the potential to serve as a beneficial secondary reader, aiding in accurate optical diagnosis and increasing the confidence of the endoscopist. These studies indicate that although CADx holds great potential, it is yet to fully meet the performance thresholds necessary for clinical implementation.
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Affiliation(s)
- Maysaa El Zoghbi
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Aasma Shaukat
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Endoscopy Unit, Milan, Italy
| | - Joseph C. Anderson
- White River Junction VAMC, University of Connecticut School of Medicine, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Endoscopy Unit, Milan, Italy
| | - Seth A. Gross
- NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
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17
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Anderson JC, Rex DK. Performing High-Quality, Safe, Cost-Effective, and Efficient Basic Colonoscopy in 2023: Advice From Two Experts. Am J Gastroenterol 2023; 118:1779-1786. [PMID: 37463252 DOI: 10.14309/ajg.0000000000002407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
Based on published evidence and our expert experience, we provide recommendations to maximize the efficacy, safety, efficiency, and cost-effectiveness of routine colonoscopy. High-quality colonoscopy begins with colon preparation using a split or same-day dose and preferably a low-volume regimen for optimal patient tolerance and compliance. Successful cecal intubation can be achieved by choosing the correct colonoscope and using techniques to facilitate navigation through challenges such as severe angulations and redundant colons. Safety is a primary goal, and complications such as perforation and splenic rupture can be prevented by avoiding pushing through fixed resistance and avoiding loops in proximal colon. Furthermore, barotrauma can be avoided by converting to water filling only (no gas insufflation) in every patient with a narrowed, angulated sigmoid. Optimal polyp detection relies primarily on compulsive attention to inspection as manifested by adequate inspection time, vigorous probing of the spaces between haustral folds, washing and removing residual debris, and achieving full distention. Achieving minimum recommended adenoma detection rate thresholds (30% in men and 20% in women) is mandatory, and colonoscopists should aspire to adenoma detection rate approaching 50% in screening patients. Distal attachments can improve mucosal exposure and increase detection while shortening withdrawal times. Complete resection of polyps complements polyp detection in preventing colorectal cancer. Cold resection is the preferred method for all polyps < 10 mm. For effective cold resection, an adequate rim of normal tissue should be captured in the snare. Finally, cost-effective high-quality colonoscopy requires the procedure not be overused, as demonstrated by following updated United States Multi Society Task Force on Colorectal Cancer postpolypectomy surveillance recommendations.
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Affiliation(s)
- Joseph C Anderson
- Division of Gastroenterology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Division of Gastroenterology, Department of Medicine, White River Junction VAMC, White River Junction, Vermont, USA
- Division of Gastroenterology, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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18
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Bilal M, Feld LD, Hernandez LV, Feld AD, Anderson JC, Bloomfeld RS. Professionalism in the Management of Endoscopic Adverse Events: Consensus Document From the American College of Gastroenterology Professionalism Committee. Am J Gastroenterol 2023; 118:1725-1730. [PMID: 37589497 DOI: 10.14309/ajg.0000000000002474] [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] [Received: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Mohammad Bilal
- Division of Gastroenterology & Hepatology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren D Feld
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lyndon V Hernandez
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- GI Associates, Racine, Kenosha, and Milwaukee, Wisconsin, USA
| | - Andrew D Feld
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Division of Gastroenterology, Kaiser Permanente, Seattle, Washington, USA
| | - Joseph C Anderson
- Division of Gastroenterology and Hepatology, Department of Veterans Affairs Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Richard S Bloomfeld
- Section of Gastroenterology, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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Djinbachian R, Lafontaine ML, Anderson JC, Pohl H, Dufault T, Boivin M, Bouin M, von Renteln D. Risk of total metachronous advanced neoplasia at surveillance colonoscopy after detection of serrated lesions: a matched case-cohort study. Endoscopy 2023; 55:728-736. [PMID: 36702132 DOI: 10.1055/a-2020-6797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND : Serrated lesions are potential colorectal cancer precursors. This study evaluated the presence of total metachronous advanced neoplasia (T-MAN) at follow-up in patients with index serrated lesions compared with a matched cohort without serrated lesions. METHODS : Patients aged 45-74 years with serrated lesions were matched 2:1 by sex, age, synchronous polyps, and timing of index colonoscopy, to patients without serrated lesions. The primary outcome was T-MAN (advanced adenoma or high-risk serrated lesion) at follow-up. Secondary outcomes included presence of T-MAN stratified by synchronous polyps and serrated lesion characteristics. RESULTS : 1425 patients were included (475 patients, 642 serrated lesions; 950 controls; median follow-up 2.9 versus 3.6 years). Patients with serrated lesions had greater risk of T-MAN than those without (hazard ratio [HR] 6.1, 95 %CI 3.9-9.6). Patients with serrated lesions and high-risk adenoma (HRA) had higher risk of T-MAN than those with HRA alone (HR 2.6, 95 %CI 1.4-4.7); similarly, patients with serrated lesions plus low-risk adenoma (LRA) had higher risk than those with LRA alone (HR 7.0, 95 %CI 2.8-18.4), as did patients with serrated lesions without adenoma compared with no adenoma (HR 14.9, 95 %CI 6.5-34.0). Presence of proximal sessile serrated lesion (SSL; HR 9.3, 95 %CI 5.4-15.9), large SSL (HR 17.8, 95 %CI 7.4-43.3), and proximal large SSL (HR 25.0, 95 %CI 8.8-71.3), but not distal SSL, were associated with greater risk for T-MAN. CONCLUSION : Patients with serrated lesions had higher risk for T-MAN regardless of synchronous adenomas. Patients with serrated lesions and HRA, and those with large or proximal SSLs, were at greatest risk.
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Affiliation(s)
- Roupen Djinbachian
- Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Marie-Lyssa Lafontaine
- University of Montreal, Faculty of Medicine and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Joseph C Anderson
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
- Division of Gastroenterology, VA Medical Center, White River Junction, Vermont, United States
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States
- Division of Gastroenterology, VA Medical Center, White River Junction, Vermont, United States
| | - Talia Dufault
- University of Montreal, Faculty of Medicine and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Michel Boivin
- Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Mickael Bouin
- Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
| | - Daniel von Renteln
- Division of Gastroenterology, Montreal University Hospital Center (CHUM) and Montreal University Hospital Research Center (CRCHUM), Montreal, Canada
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Liu MC, Anderson JC, Hisey W, MacKenzie TA, Robinson CM, Butterly LF. Using New Hampshire Colonoscopy Registry data to assess United States and European post-polypectomy surveillance guidelines. Endoscopy 2023; 55:423-431. [PMID: 36316016 PMCID: PMC10292179 DOI: 10.1055/a-1970-5377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Our goal was to compare the updated European Society of Gastrointestinal Endoscopy (ESGE) and United States Multi-Society Task Force on Colorectal Cancer (USMSTF) high risk groups in predicting metachronous advanced neoplasia on first follow-up colonoscopy and long-term colorectal cancer (CRC). METHODS We compared advanced metachronous neoplasia risk (serrated polyps ≥ 1 cm or with dysplasia, advanced adenomas [≥ 1 cm, villous, high grade dysplasia], CRC) on first surveillance colonoscopy in patients with high risk findings according to ESGE versus USMSTF guidelines. We also compared the positive and negative predictive values (PPV, NPV) of both guidelines for metachronous neoplasia. RESULTS The risk for metachronous neoplasia in our sample (n = 20 458) was higher in the high risk USMSTF (3 year) (13.6 %; 95 %CI 12.3-14.9) and ESGE groups (13.6 %; 95 %CI 12.3-15.0) compared with the lowest risk USMSTF (5.1 %; 95 %CI 4.7-5.5; P < 0.001) and ESGE categories (6.3 %; 95 %CI 6.0-6.7; P < 0.001), respectively. Adding other groups such as USMSTF 5-10-year and 3-5-year groups to the 3-year category resulted in minimal change in the PPV and NPV for metachronous advanced neoplasia. High risk ESGE (hazard ratio [HR] 3.03, 95 %CI 1.97-4.65) and USMSTF (HR 3.07, 95 %CI 2.03-4.66) designations were associated with similar long-term CRC risk (CRC per 100 000 person-years: USMSTF 3-year group 3.54, 95 %CI 2.68-4.68; ESGE high risk group: 3.43, 95 %CI 2.57-4.59). CONCLUSION Performance characteristics for the ESGE and USMSTF recommendations are similar in predicting metachronous advanced neoplasia and long-term CRC. The addition of risk groups, such as the USMSTF 5-10-year and 3-5-year groups to the USMSTF 3-year category did not alter the PPV or NPV significantly.
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Affiliation(s)
- Margaret C. Liu
- Department of Gastroenterology and Hepatology,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Mayo Clinic Arizona, Gastroenterology, Scottsdale, Arizona, United States
| | - Joseph C. Anderson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
- Section of Gastroenterology, White River Junction VAMC, White River Junction, Vermont, United States
- University of Connecticut Health Center, Gastro Farmington, Connecticut, United States
| | - William Hisey
- Department of Gastroenterology and Hepatology,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Todd A. MacKenzie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire,United States
| | - Christina M. Robinson
- Department of Gastroenterology and Hepatology,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Lynn F. Butterly
- Department of Gastroenterology and Hepatology,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
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21
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Djinbachian R, Lafontaine ML, Anderson JC, Pohl H, Dufault T, Boivin M, Bouin M, von Renteln D. A232 RISK OF TOTAL METACHRONOUS ADVANCED NEOPLASIA AT SURVEILLANCE COLONOSCOPY AFTER DETECTION OF SERRATED LESIONS: A MATCHED COHORT STUDY. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991256 DOI: 10.1093/jcag/gwac036.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Serrated lesions (SLs), including sessile serrated lesions (SSL) and traditional serrated adenomas (TSA) have become subject of increased interest for their role as CRC precursors. Purpose Study aim was to evaluate the risk to develop total metachronous advanced neoplasia (T-MAN) at follow-up in patients with index SL compared to a matched cohort without SL. Method Patients 45-74y with SLs were identified through pathology database search. SL patients were matched 2:1 by sex; age; synchronous polyps (high-risk adenoma [HRA], low-risk adenoma [LRA], no-adenoma); timing of index, to patients without SL. Primary outcome was risk of T-MAN (advanced adenoma or high-risk SL) at follow-up. Secondary outcomes included risk of T-MAN stratified by synchronous polyps and SL characteristics. Result(s) 1425 patients were included (475 patients, 642 SLs; 950 controls (mean follow-up 2.9 vs 3.9y). The SL group had greater risk of T-MAN compared to the non-SL group [Hazard-ratio (HR)=6.12 (95%confidence-interval (CI)3.91-9.58)]. Patients with SL+HRA had higher risk of T-MAN compared to HRA alone [HR=2.62 (95%CI 1.45-4.71)], as well as patients with SL+LRA compared to LRA alone [HR=7.03 (95%CI 2.78-18.44)], and SL without adenoma compared to no-adenoma [HR=14.87 (95%CI 6.51-33.95)]. Presence of proximal SSL (HR=9.30), large SSL (HR=17.87) and proximal large SSL (HR=24.99), but not distal SSL, was associated with greater risk for T-MAN. Conclusion(s) Patients with SLs are at greater risk for developing T-MAN regardless of synchronous adenomas. Patients with SL and HRA, and those with large or proximal SSLs appear to be at greatest risk for T-MAN. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; ACG Disclosure of Interest R. Djinbachian Grant / Research support from: Grant from the American College of Gastroenterology for the conduction of this project, M.-L. Lafontaine: None Declared, J. Anderson: None Declared, H. Pohl: None Declared, T. Dufault: None Declared, M. Boivin: None Declared, M. Bouin: None Declared, D. von Renteln Grant / Research support from: Daniel von Renteln is supported by a “Fonds de Recherche du Québec Santé” (FRQS) career development award and has received research funding from ERBE, Ventage, Pendopharm, Fujifilm, and Pentax., Consultant of: Boston Scientific and Pendopharm,
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Affiliation(s)
| | | | | | - H Pohl
- Dartmouth Geisel School of Medicine, Hanover
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22
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Anderson JC, Hisey WM, Robinson CM, Limburg PJ, Kneedler BL, Butterly LF. Serrated Polyp Yield at Colonoscopy in Patients with Positive FIT, Positive mt-sDNA, and Colonoscopy Only: Data from the New Hampshire Colonoscopy Registry. Cancer Epidemiol Biomarkers Prev 2023; 32:226-232. [PMID: 36409472 PMCID: PMC9900318 DOI: 10.1158/1055-9965.epi-22-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stool-based screening with fecal immunochemical (FIT) or multitarget-stool DNA (mt-sDNA) tests is associated with increased colonoscopy polyp yield. mt-sDNA includes methylated markers, which improve detection of serrated polyps (SP) versus FIT. We compared SP detection in colonoscopies performed for positive FIT or mt-sDNA tests, as well as in colonoscopies without a preceding stool test, using the New Hampshire Colonoscopy Registry, a comprehensive statewide population-based registry. METHODS Across the three groups, we compared the frequency of clinically relevant SPs (CRSP: sessile SPs, hyperplastic polyps ≥10 mm, and traditional serrated adenomas). We also compared SP size, histology, number, and bulk (combined sizes). RESULTS Our sample included 560 mt-sDNA+ (age ± SD: 66.5 ± 7.9), 414 FIT+ (age ± SD: 66.3 ± 8.8), and 59,438 colonoscopy-only patients (age ± SD: 61.7 ± 8.0). mt-sDNA+ patients were more likely to have a higher yield of CRSPs and CRSP bulk than FIT+ (P < 0.0001) or colonoscopy-only patients (P < 0.0001). More mt-sDNA+ patients had CRSPs without large adenomas or colorectal cancers (17.9% vs. 9.9% of FIT+ and 8% of colonoscopy-only patients). After adjusting for synchronous large adenomas, colorectal cancers, and other risk factors, mt-sDNA+ patients were more likely (OR, 1.82; 95% CI, 1.18-2.85) than FIT+ patients to have CRSPs. CONCLUSIONS mt-sDNA+ patients had a higher SP yield than FIT+ or colonoscopy-only patients, particularly in the absence of synchronous large adenomas or colorectal cancer. IMPACT Our results suggest that screening with mt-sDNA tests could improve colorectal cancer screening by identifying more patients at increased risk from the serrated pathway.
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Affiliation(s)
- Joseph C Anderson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,White River Junction VAMC, WRJ, Vermont
| | - William M Hisey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,NH Colonoscopy Registry, Lebanon, New Hampshire
| | - Christina M Robinson
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,NH Colonoscopy Registry, Lebanon, New Hampshire
| | - Paul J Limburg
- Mayo Clinic, Rochester, Minnesota.,Exact Sciences Corporation, Madison, Wisconsin
| | | | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.,Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,NH Colonoscopy Registry, Lebanon, New Hampshire
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23
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Anderson JC, Robinson CM, Butterly LF. Response. Gastrointest Endosc 2023; 97:380-381. [PMID: 36669826 DOI: 10.1016/j.gie.2022.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Joseph C Anderson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Christina M Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
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24
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Taghiakbari M, Pohl H, Djinbachian R, Anderson JC, Metellus D, Barkun AN, Bouin M, von Renteln D. What size cutoff level should be used to implement optical polyp diagnosis? Endoscopy 2022; 54:1182-1190. [PMID: 35668663 DOI: 10.1055/a-1843-9535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND : The risk of advanced pathology increases with polyp size, as does the potential for mismanagement when optical diagnosis is used. This study aimed to evaluate the proportion of patients who would be assigned inadequate surveillance intervals when different size cutoffs are adopted for use of optical diagnosis. METHODS : In a post hoc analysis of three prospective studies, the use of optical diagnosis was evaluated for three polyp size groups: 1-3, 1-5, and 1-10 mm. The primary outcome was the proportion of patients in whom advanced adenomas were found and optical diagnosis resulted in delayed surveillance. Secondary outcomes included agreements between surveillance intervals based on high confidence optical diagnosis and pathology outcomes, reduction in histopathological examinations, and proportion of patients who could receive an immediate surveillance recommendation. RESULTS : We included 3374 patients (7291 polyps ≤ 10 mm) undergoing complete colonoscopies (median age 66.0 years, 75.2 % male, 29.6 % for screening). The percentage of patients with advanced adenomas and either 2- or 7-year delayed surveillance intervals (n = 79) was 3.8 %, 15.2 %, and 25.3 % for size cutoffs of 1-3, 1-5, and 1-10 mm polyps, respectively (P < 0.001). Surveillance interval agreements between pathology and optical diagnosis for the three groups were 97.2 %, 95.5 %, and 94.2 %, respectively. Total reductions in pathology examinations for the three groups were 33.5 %, 62.3 %, and 78.2 %, respectively. CONCLUSION : A 3-mm cutoff for clinical implementation of optical diagnosis resulted in a very low risk of delayed management of advanced neoplasia while showing high surveillance interval agreement with pathology and a one-third reduction in overall requirement for pathology examinations.
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Affiliation(s)
- Mahsa Taghiakbari
- University of Montreal, Montreal, Quebec, Canada.,University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada
| | - Heiko Pohl
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States.,VA Medical Center, Whiter River Junction, Vermont, United States
| | - Roupen Djinbachian
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.,Division of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Joseph C Anderson
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, United States.,VA Medical Center, Whiter River Junction, Vermont, United States
| | - Danny Metellus
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.,Division of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Alan N Barkun
- Division of Gastroenterology, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Mickael Bouin
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.,Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Daniel von Renteln
- University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, Canada.,Division of Gastroenterology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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25
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Anderson JC, Hisey W, Mackenzie TA, Robinson CM, Srivastava A, Meester RGS, Butterly LF. Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2022; 96:310-317. [PMID: 35276209 PMCID: PMC9296608 DOI: 10.1016/j.gie.2022.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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] [Received: 10/31/2021] [Accepted: 03/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5 mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR. METHODS We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination. RESULTS One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRs of 3% to <9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39-.83) or 9% or higher (HR, .39; 95% CI, .20-.78) relative to those with CSSDRs under 3%. CONCLUSIONS Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to <9% had statistically lower risk of PCCRC than CSSDRs of <3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.
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Affiliation(s)
- Joseph C. Anderson
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
- White River Junction VAMC, White River Junction, Vermont, USA
| | - William Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Todd A. Mackenzie
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Christina M. Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Amitabh Srivastava
- Department of Pathology, Memorial Sloane Kettering Cancer Center, New York, New York, USA
| | - Reinier G. S. Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lynn F. Butterly
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
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26
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Sachdev R, Valori RM, Anderson JC. Improving outcomes in polypectomy. Gastrointest Endosc 2022; 96:298-300. [PMID: 35701260 DOI: 10.1016/j.gie.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/11/2022]
Affiliation(s)
- Rishabh Sachdev
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Roland M Valori
- Gloucestershire Hospitals, National Health Service Foundation Trust, Gloucester, UK
| | - Joseph C Anderson
- Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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27
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Rex DK, Anderson JC, Pohl H, Lahr RE, Judd S, Antaki F, Lilley K, Castelluccio PF, Vemulapalli KC. Cold versus hot snare resection with or without submucosal injection of 6- to 15-mm colorectal polyps: a randomized controlled trial. Gastrointest Endosc 2022; 96:330-338. [PMID: 35288147 DOI: 10.1016/j.gie.2022.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/03/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Cold snare resection of colorectal lesions has been found to be safe and effective for an expanding set of colorectal lesions. In this study, we sought to understand the efficacy of simple cold snare resection and cold EMR versus hot snare resection and hot EMR for colorectal lesions 6 to 15 mm in size. METHODS At 3 U.S. centers, 235 patients with 286 colorectal lesions 6 to 15 mm in size were randomized to cold snaring, cold EMR, hot snaring, or hot EMR for nonpedunculated colorectal lesions 6 to 15 mm in size. The primary outcome was complete resection determined by 4 biopsy samples from the defect margin and 1 biopsy sample from the center of the resection defect. RESULTS The overall incomplete resection rate was 2.4% (95% confidence interval [CI], .8%-7.5%). All 7 incompletely removed polyps were 10 to 15 mm in size and removed by hot EMR (n = 4, 6.2%), hot snare (n = 2, 2.2%), or cold EMR (n = 1, 1.8%). Cold snaring had no incomplete resections, required less procedural time than the other methods, and was not associated with serious adverse events. CONCLUSIONS Cold snaring is a dominant resection technique for nonpedunculated colorectal lesions 6 to 15 mm in size. (Clinical trial registration number: NCT03462706.).
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Affiliation(s)
- Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Heiko Pohl
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rachel E Lahr
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Stephanie Judd
- Division of Gastroenterology and Hepatology, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Fadi Antaki
- Division of Gastroenterology and Hepatology, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Kirthi Lilley
- Division of Gastroenterology and Hepatology, John D. Dingell Veterans Affairs Medical Center and Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter F Castelluccio
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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28
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Anderson JC, Robinson CM, Hisey W, Limburg PJ, Butterly LF. Colonoscopy Findings in FIT+ and mt-sDNA+ Patients versus in Colonoscopy-only Patients: New Hampshire Colonoscopy Registry Data. Cancer Prev Res (Phila) 2022; 15:455-464. [PMID: 35378546 PMCID: PMC9662869 DOI: 10.1158/1940-6207.capr-21-0581] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/01/2022] [Accepted: 03/30/2022] [Indexed: 01/07/2023]
Abstract
Few studies compare fecal immunochemical test (FIT) and multi-target stool DNA (mt-sDNA) outcomes in practice. We compared colonoscopy yield following FIT+ or mt-sDNA+ tests to colonoscopies without preceding stool tests in the comprehensive population-based New Hampshire Colonoscopy Registry (NHCR). Outcomes were any neoplasia and an ordered outcome: adenocarcinoma, advanced neoplasia (adenoma/serrated polyp ≥ 1 cm/villous/high-grade dysplasia), nonadvanced neoplasia, or normal. Our total sample included 306 mt-sDNA+ (average age ± SD 67.0 ± 7.9), 276 FIT+ (66.6 ± 8.7), and 50,990 colonoscopy-only patients (61.8 ± 8.1). Among average-risk patients (N = 240 mt-sDNA+, N = 194 FIT+, N = 26,221 colonoscopy only), mt-sDNA+ patients had a higher risk for any neoplasia (67.1%) compared with FIT+ (54.6%, P = 0.00098) or colonoscopy (40.8%, P < 0.0001). Severity of findings and histology subtypes differed across the three groups (P < 0.0001 for both), with a higher yield of advanced findings in mt-sDNA+ patients. In particular, clinically relevant serrated polyps (hyperplastic polyps ≥10 mm/traditional serrated adenomas/sessile serrated polyps) were detected at a higher frequency in mt-sDNA+ patients as compared with FIT+ or colonoscopy-only patients. Even after adjustment, patients with positive mt-sDNA [OR = 2.82; 95% confidence interval (CI), 2.00-4.02] or FIT+ tests (OR = 1.67; 95% CI, 1.19-2.36) were more likely to have histologically more advanced findings than colonoscopy alone. At follow-up colonoscopy, mt-sDNA+ tests were more likely to predict neoplasia than FIT+, largely due to increased detection of serrated polyps. Prevention Relevance: Colorectal cancer screening options include colonoscopy and stool-based tests, including the fecal immunochemical test (FIT) and the multi-target stool DNA (mt-sDNA) test which, if positive, must be followed by a colonoscopy. Assessing "real-world" outcomes of colonoscopies following positive stool tests can inform their clinical use. See related Spotlight, p. 417.
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Affiliation(s)
- Joseph C. Anderson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- White River Junction VAMC
| | - Christina M. Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- NH Colonoscopy Registry, Lebanon, New Hampshire
| | - William Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- NH Colonoscopy Registry, Lebanon, New Hampshire
| | | | - Lynn F. Butterly
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- NH Colonoscopy Registry, Lebanon, New Hampshire
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29
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Meester RGS, Anderson JC. Long-Term Risk for Colorectal Cancer in Patients With Index Serrated Polyps. Gastroenterology 2022; 162:2108-2110. [PMID: 35122765 DOI: 10.1053/j.gastro.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Reinier G S Meester
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Joseph C Anderson
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; White River Junction VAMC, White River Junction, Vermont; University of Connecticut School of Medicine, Farmington, Connecticut
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30
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Boland CR, Idos GE, Durno C, Giardiello FM, Anderson JC, Burke CA, Dominitz JA, Gross S, Gupta S, Jacobson BC, Patel SG, Shaukat A, Syngal S, Robertson DJ. Diagnosis and Management of Cancer Risk in the Gastrointestinal Hamartomatous Polyposis Syndromes: Recommendations From the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2022; 162:2063-2085. [PMID: 35487791 DOI: 10.1053/j.gastro.2022.02.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The gastrointestinal hamartomatous polyposis syndromes are rare, autosomal dominant disorders associated with an increased risk of benign and malignant intestinal and extraintestinal tumors. They include Peutz-Jeghers syndrome, juvenile polyposis syndrome, the PTEN hamartoma tumor syndrome (including Cowden's syndrome and Bannayan-Riley-Ruvalcaba syndrome), and hereditary mixed polyposis syndrome. Diagnoses are based on clinical criteria and, in some cases, confirmed by demonstrating the presence of a germline pathogenic variant. The best understood hamartomatous polyposis syndrome is Peutz-Jeghers syndrome, caused by germline pathogenic variants in the STK11 gene. The management is focused on prevention of bleeding and mechanical obstruction of the small bowel by polyps and surveillance of organs at increased risk for cancer. Juvenile polyposis syndrome is caused by a germline pathogenic variant in either the SMAD4 or BMPR1A genes, with differing clinical courses. Patients with SMAD4 pathogenic variants may have massive gastric polyposis, which can result in gastrointestinal bleeding and/or protein-losing gastropathy. Patients with SMAD4 mutations usually have the simultaneous occurrence of hereditary hemorrhagic telangiectasia (juvenile polyposis syndrome-hereditary hemorrhagic telangiectasia overlap syndrome) that can result in epistaxis, gastrointestinal bleeding from mucocutaneous telangiectasias, and arteriovenous malformations. Germline pathogenic variants in the PTEN gene cause overlapping clinical phenotypes (known as the PTEN hamartoma tumor syndromes), including Cowden's syndrome and related disorders that are associated with an increased risk of gastrointestinal and colonic polyposis, colon cancer, and other extraintestinal manifestations and cancers. Due to the relative rarity of the hamartomatous polyposis syndromes, recommendations for management are based on few studies. This U.S Multi-Society Task Force on Colorectal Cancer consensus statement summarizes the clinical features, assesses the current literature, and provides guidance for diagnosis, assessment, and management of patients with the hamartomatous polyposis syndromes, with a focus on endoscopic management.
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Affiliation(s)
- C Richard Boland
- Division of Gastroenterology, University of California-San Diego School of Medicine, San Diego, California
| | - Gregory E Idos
- Divisions of Gastroenterology and Clinical Cancer Genomics, Center for Precision Medicine, City of Hope National Medical Center, Duarte, California
| | - Carol Durno
- The Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Francis M Giardiello
- Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Seth Gross
- Division of Gastroenterology and Hepatology, New York University Langone Health, New York, New York
| | - Samir Gupta
- Veterans Affairs Medical Center, San Diego, California; University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Brian C Jacobson
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Swati G Patel
- University of Colorado School of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Brigham and Women's Hospital, Boston Massachusetts; Dana-Farber Cancer Institute, Boston Massachusetts; Harvard Medical School, Boston Massachusetts
| | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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31
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Boland CR, Idos GE, Durno C, Giardiello FM, Anderson JC, Burke CA, Dominitz JA, Gross S, Gupta S, Jacobson BC, Patel SG, Shaukat A, Syngal S, Robertson DJ. Diagnosis and management of cancer risk in the gastrointestinal hamartomatous polyposis syndromes: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2022; 95:1025-1047. [PMID: 35487765 DOI: 10.1016/j.gie.2022.02.044] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The gastrointestinal hamartomatous polyposis syndromes are rare, autosomal dominant disorders associated with an increased risk of benign and malignant intestinal and extraintestinal tumors. They include Peutz-Jeghers syndrome, juvenile polyposis syndrome, the PTEN hamartoma tumor syndrome (including Cowden's syndrome and Bannayan-Riley-Ruvalcaba syndrome), and hereditary mixed polyposis syndrome. Diagnoses are based on clinical criteria and, in some cases, confirmed by demonstrating the presence of a germline pathogenic variant. The best understood hamartomatous polyposis syndrome is Peutz-Jeghers syndrome, caused by germline pathogenic variants in the STK11 gene. The management is focused on prevention of bleeding and mechanical obstruction of the small bowel by polyps and surveillance of organs at increased risk for cancer. Juvenile polyposis syndrome is caused by a germline pathogenic variant in either the SMAD4 or BMPR1A genes, with differing clinical courses. Patients with SMAD4 pathogenic variants may have massive gastric polyposis, which can result in gastrointestinal bleeding and/or protein-losing gastropathy. Patients with SMAD4 mutations usually have the simultaneous occurrence of hereditary hemorrhagic telangiectasia (juvenile polyposis syndrome-hereditary hemorrhagic telangiectasia overlap syndrome) that can result in epistaxis, gastrointestinal bleeding from mucocutaneous telangiectasias, and arteriovenous malformations. Germline pathogenic variants in the PTEN gene cause overlapping clinical phenotypes (known as the PTEN hamartoma tumor syndromes), including Cowden's syndrome and related disorders that are associated with an increased risk of gastrointestinal and colonic polyposis, colon cancer, and other extraintestinal manifestations and cancers. Due to the relative rarity of the hamartomatous polyposis syndromes, recommendations for management are based on few studies. This U.S. Multi-Society Task Force on Colorectal Cancer consensus statement summarizes the clinical features, assesses the current literature, and provides guidance for diagnosis, assessment, and management of patients with the hamartomatous polyposis syndromes, with a focus on endoscopic management.
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Affiliation(s)
- C Richard Boland
- Division of Gastroenterology, University of California-San Diego School of Medicine, San Diego, California.
| | - Gregory E Idos
- Divisions of Gastroenterology and Clinical Cancer Genomics, Center for Precision Medicine, City of Hope National Medical Center, Duarte, California
| | - Carol Durno
- The Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Francis M Giardiello
- Division of Gastroenterology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut, Farmington, Connecticut
| | - Carol A Burke
- Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio
| | - Jason A Dominitz
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington
| | - Seth Gross
- Division of Gastroenterology and Hepatology, New York University Langone Health, New York, New York
| | - Samir Gupta
- Veterans Affairs Medical Center, San Diego, California; University of California San Diego, La Jolla, California; Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Brian C Jacobson
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Swati G Patel
- University of Colorado School of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Aasma Shaukat
- Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Sapna Syngal
- Brigham and Women's Hospital, Boston Massachusetts; Dana-Farber Cancer Institute, Boston Massachusetts; Harvard Medical School, Boston Massachusetts
| | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Anderson JC, Robinson CM, Hisey WM, Edwards DK, Kneedler BL, Berger BM, Butterly LF. Colorectal Neoplasia Detection in Individuals With Positive Multitarget Stool DNA Tests: Data From the New Hampshire Colonoscopy Registry. J Clin Gastroenterol 2022; 56:419-425. [PMID: 33973962 DOI: 10.1097/mcg.0000000000001554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/17/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND The US Preventive Services Task Force (USPSTF) includes multitarget stool DNA (mt-sDNA) testing as a colorectal cancer (CRC) screening option in average-risk individuals, but data on colonoscopy outcomes after positive mt-sDNA tests in community settings are needed. AIM The aim of this study was to investigate colonoscopy outcomes and quality following positive mt-sDNA in the population-based New Hampshire Colonoscopy Registry. METHODS We compared colonoscopy outcomes and quality between age-matched, sex-matched, and risk-matched patients from 30 endoscopy practices with and without a preceding positive mt-sDNA test. Main outcomes were colonoscopy findings of CRC, advanced noncancerous neoplasia, nonadvanced neoplasia, or normal examination. Quality measures included withdrawal time, bowel preparation quality, examination completion, and percentage of average-risk individuals with normal colonoscopies receiving a USPSTF-recommended 10 year rescreening interval. RESULTS Individuals with positive mt-sDNA tests (N=306, average age 67.0 y; 61.8% female) were significantly more likely than colonoscopy-only patients (N=918, 66.2 y; 61.8% female) to have CRC (1.3% vs. 0.4%) or advanced noncancerous neoplasia (27.1% vs. 8.2%) (P<0.0001). Neoplasia was found in 68.0% of patients having colonoscopy after a positive mt-sDNA test, (positive predictive value, was 68.0%), versus 42.3% of patients with colonoscopy only (P<0.0001). No significant differences in colonoscopy quality measures were observed between cohorts. CONCLUSIONS Colonoscopy after a positive mt-sDNA test was more frequently associated with CRC and colorectal neoplasia than colonoscopy alone. Positive mt-sDNA tests can enrich the proportion of colonoscopies with clinically relevant findings. Follow-up recommendations suggest that endoscopists do not inappropriately shorten rescreening intervals in mt-sDNA-positive patients with normal colonoscopy. These findings support the clinical utility of mt-sDNA for CRC screening in community practice.
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Affiliation(s)
| | - Christina M Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center
- NH Colonoscopy Registry, Lebanon, NH
| | | | | | | | | | - Lynn F Butterly
- Geisel School of Medicine at Dartmouth, Hanover
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center
- NH Colonoscopy Registry, Lebanon, NH
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Pollard S, Anderson JC, Bah F, Mateus M, Sidhu M, Simmons D. Non-Lethal Blood Sampling of Fish in the lab and Field With Methods for Dried Blood Plasma Spot Omic Analyses. Front Genet 2022; 13:795348. [PMID: 35401689 PMCID: PMC8988233 DOI: 10.3389/fgene.2022.795348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
There is global acknowledgment that humane methods in animal research are a priority, but few environmental effects monitoring programs use nonlethal methods for fish. The goal of the present study was to determine the impacts of sampling small volumes of blood in larger-bodied fish on survival and healing. In addition to evaluating survival following blood sampling, we evaluated the utility of dried blood spots as an alternative for sample processing and storage in the field. In our approach, we housed 80 rainbow trout (Oncorhynchus mykiss) in our flow-through aquatic facility. We then anaesthetized using MS-222 and sampled 1 μl/g bw of blood via puncture of the caudal vasculature. We tested four different post-blood sampling treatments on the puncture wound: 1. application of liquid bandage; 2. a swab of betadine; 3. a swab of fish mucous; and 4. compared survival outcomes to a group where no post-treatment was performed (negative control). Overall, we observed 90% survival among all treatments, with the most effective approach being the negative control (100% survival). Based upon these results, we repeated the blood sampling with no-post treatment by housing 20 rainbow trout (not previously tested upon) in cages at a nearby creek and monitored survival for 2 weeks post sampling. The survival rate was 95% with full healing of the puncture site in all subjects. In addition to this, we tested the efficacy of dry blood spotting on proteomic, lipidomic and amino acid analysis as an alternative method for blood sample processing and storage. It was found that dried plasma spotting using parafilm in conjunction with a modified Bligh-Dyer extraction offered the best balance for good recovery of protein, lipid and amino acids relative to wet plasma and Noviplex dried plasma spot cards. In this article, we will present the detailed results of these combined studies and describe what we have determined to be the safest non-lethal blood sampling protocol.
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Affiliation(s)
- S Pollard
- Aquatic Omics Laboratory, Department of Biology, Ontario Tech University, Oshawa, ON, Canada
| | - J C Anderson
- Aquatic Omics Laboratory, Department of Biology, Ontario Tech University, Oshawa, ON, Canada
| | - F Bah
- Aquatic Omics Laboratory, Department of Biology, Ontario Tech University, Oshawa, ON, Canada
| | - M Mateus
- Aquatic Omics Laboratory, Department of Biology, Ontario Tech University, Oshawa, ON, Canada
| | - M Sidhu
- Aquatic Omics Laboratory, Department of Biology, Ontario Tech University, Oshawa, ON, Canada
| | - Dbd Simmons
- Aquatic Omics Laboratory, Department of Biology, Ontario Tech University, Oshawa, ON, Canada
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Patel SG, May FP, Anderson JC, Burke CA, Dominitz JA, Gross SA, Jacobson BC, Shaukat A, Robertson DJ. Updates on Age to Start and Stop Colorectal Cancer Screening: Recommendations From the U.S. Multi-Society Task Force on Colorectal Cancer. Gastroenterology 2022; 162:285-299. [PMID: 34794816 DOI: 10.1053/j.gastro.2021.10.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [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: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
This document is a focused update to the 2017 colorectal cancer (CRC) screening recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. This update is restricted to addressing the age to start and stop CRC screening in average-risk individuals and the recommended screening modalities. Although there is no literature demonstrating that CRC screening in individuals under age 50 improves health outcomes such as CRC incidence or CRC-related mortality, sufficient data support the U.S. Multi-Society Task Force to suggest average-risk CRC screening begin at age 45. This recommendation is based on the increasing disease burden among individuals under age 50, emerging data that the prevalence of advanced colorectal neoplasia in individuals ages 45 to 49 approaches rates in individuals 50 to 59, and modeling studies that demonstrate the benefits of screening outweigh the potential harms and costs. For individuals ages 76 to 85, the decision to start or continue screening should be individualized and based on prior screening history, life expectancy, CRC risk, and personal preference. Screening is not recommended after age 85.
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Affiliation(s)
- Swati G Patel
- University of Colorado Anschutz Medical Center, Aurora, Colorado; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.
| | - Folasade P May
- Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Joseph C Anderson
- VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; University of Connecticut School of Medicine, Farmington, Connecticut
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System and the University of Washington, Seattle, Washington
| | | | | | - Aasma Shaukat
- GI Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Patel SG, May FP, Anderson JC, Burke CA, Dominitz JA, Gross SA, Jacobson BC, Shaukat A, Robertson DJ. Updates on age to start and stop colorectal cancer screening: recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2022; 95:1-15. [PMID: 34794803 DOI: 10.1016/j.gie.2021.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
This document is a focused update to the 2017 colorectal cancer (CRC) screening recommendations from the U.S. Multi-Society Task Force on Colorectal Cancer, which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy. This update is restricted to addressing the age to start and stop CRC screening in average-risk individuals and the recommended screening modalities. Although there is no literature demonstrating that CRC screening in individuals under age 50 improves health outcomes such as CRC incidence or CRC-related mortality, sufficient data support the U.S. Multi-Society Task Force to suggest average-risk CRC screening begin at age 45. This recommendation is based on the increasing disease burden among individuals under age 50, emerging data that the prevalence of advanced colorectal neoplasia in individuals ages 45 to 49 approaches rates in individuals 50 to 59, and modeling studies that demonstrate the benefits of screening outweigh the potential harms and costs. For individuals ages 76 to 85, the decision to start or continue screening should be individualized and based on prior screening history, life expectancy, CRC risk, and personal preference. Screening is not recommended after age 85.
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Affiliation(s)
- Swati G Patel
- University of Colorado Anschutz Medical Center, Aurora, Colorado, USA; Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Folasade P May
- Division of Gastroenterology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA; Vatche and Tamar Manoukian Division of Digestive Diseases and Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Joseph C Anderson
- VA Medical Center, White River Junction, Vermont, USA and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | - Jason A Dominitz
- VA Puget Sound Health Care System and the University of Washington, Seattle, Washington, USA
| | | | | | - Aasma Shaukat
- GI Section, Minneapolis VA Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - Douglas J Robertson
- VA Medical Center, White River Junction, Vermont, USA and the Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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Anderson JC, Mattar SG, Greenway FL, Lindquist RJ. Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis. Obes Sci Pract 2021; 7:646-656. [PMID: 34631141 PMCID: PMC8488448 DOI: 10.1002/osp4.516] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/29/2021] [Accepted: 04/11/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The ketone bodies β-hydroxybutyrate (BOHB) and acetone are generated as a byproduct of the fat metabolism process. In healthy individuals, ketone body levels are ∼0.1 mM for BOHB and ∼1 part per million for breath acetone (BrAce). These levels can increase dramatically as a consequence of a disease process or when used therapeutically for disease treatment. For example, increased ketone body concentration during weight loss is an indication of elevated fat metabolism. Ketone body measurement is relatively inexpensive and can provide metabolic insights to help guide disease management and optimize weight loss. METHODS This review of the literature provides metabolic mechanisms and typical concentration ranges of ketone bodies, which can give new insights into these conditions and rationale for measuring ketone bodies. RESULTS Diseases such as heart failure and ketoacidosis can affect caloric intake and macronutrient management, which can elevate BOHB 30-fold and BrAce 1000-fold. Other diseases associated with obesity, such as brain dysfunction, cancer, and diabetes, may cause dysfunction because of an inability to use glucose, excessive reliance on glucose, or poor insulin signaling. Elevating ketone body concentrations (e.g., nutritional ketosis) may improve these conditions by forcing utilization of ketone bodies, in place of glucose, for fuel. During weight loss, monitoring ketone body concentration can demonstrate program compliance and can be used to optimize the weight-loss plan. CONCLUSIONS The role of ketone bodies in states of pathologic and therapeutic ketosis indicates that accurate measurement and monitoring of BOHB or BrAce will likely improve disease management. Bariatric surgery is examined as a case study for monitoring both types of ketosis.
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Affiliation(s)
- Joseph C. Anderson
- Department of BioengineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Samer G. Mattar
- Department of SurgeryBaylor College of MedicineHoustonTexasUSA
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Karnes WE, Johnson DA, Berzin TM, Gross SA, Vargo JJ, Sharma P, Zachariah R, Samarasena JB, Anderson JC. A Polyp Worth Removing: A Paradigm for Measuring Colonoscopy Quality and Performance of Novel Technologies for Polyp Detection. J Clin Gastroenterol 2021; 55:733-739. [PMID: 34334765 DOI: 10.1097/mcg.0000000000001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Leaving no significant polyp behind while avoiding risks due to unnecessary resections is a commonsense strategy to safely and effectively prevent colorectal cancer (CRC) with colonoscopy. It also alludes to polyps worth removing and, therefore, worth finding. The majority of "worthy" precancerous polyps are adenomas, which for over 2 decades, have received the most attention in performance research and metrics. Consequently, the detection rate of adenomas is currently the only validated, outcome-based measure of colonoscopy demonstrated to correlate with reduced risk of postcolonoscopy CRC. However, a third or more of postcolonoscopy CRCs originate from sessile serrated polyps (SSPs), which are notoriously difficult to find, diagnose and completely resect. Among serrated polyps, the agreement among pathologists differentiating SSPs from non-neoplastic hyperplastic polyps is moderate at best. This lack of ground truth precludes SSPs from consideration in primary metrics of colonoscopy quality or performance of novel polyp detection technologies. By instead leveraging the distinct endoscopic and clinical features of serrated polyps, including those considered important due to proximal location and larger size, clinically significant serrated polyps represent serrated polyps worth removing, enriched with subtle precancerous SSPs. With the explosion of technologies to assist polyp detection, now is the time to broaden benchmarks to include clinically significant serrated polypss alongside adenomas, a measure that is relevant both for assessing the performance of endoscopists, and for assessing new polyp detection technologies.
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Affiliation(s)
- William E Karnes
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA
| | - David A Johnson
- Gastroenterology Division, Eastern VA Medical School, Norfolk, VA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - John J Vargo
- Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, OH
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, MO
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS
| | - Robin Zachariah
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA
| | - Jason B Samarasena
- Digestive Health Institute, University of California, Irvine Medical Center, Orange, CA
| | - Joseph C Anderson
- White River Junction VAMC, Geisel School of Medicine at Dartmouth College, University of Connecticut School of Medicine, Farmington, CT
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Pohl H, Anderson JC, Aguilera-Fish A, Calderwood AH, Mackenzie TA, Robertson DJ. Recurrence of Colorectal Neoplastic Polyps After Incomplete Resection. Ann Intern Med 2021; 174:1377-1384. [PMID: 34370514 PMCID: PMC10805136 DOI: 10.7326/m20-6689] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 12/11/2022] Open
Abstract
BACKGROUND Incomplete resection of neoplastic polyps is considered an important reason for the development of colorectal cancer. However, there are no data on the natural history of polyps that were incompletely removed. OBJECTIVE To examine the risk for metachronous neoplasia during surveillance colonoscopy after documented incomplete polyp resection. DESIGN Observational cohort study of patients who participated in the CARE (Complete Adenoma REsection) study (2009 to 2012). SETTING 2 academic medical centers. PATIENTS Patients who had resection of a 5- to 20-mm neoplastic polyp, had a documented complete or incomplete resection, and had a surveillance examination. MEASUREMENTS Segment metachronous neoplasia, defined as the proportion of colon segments with at least 1 neoplastic polyp at first surveillance examination, was measured. Segment metachronous neoplasia was compared between segments with a prior incomplete polyp resection (incomplete segments) and those with a prior complete resection (complete segments), accounting for clustering of segments within patients. RESULTS Of 233 participants in the original study, 166 (71%) had at least 1 surveillance examination. Median time to surveillance was shorter after incomplete versus complete resection (median, 17 vs. 45 months). The risk for any metachronous neoplasia was greater in segments with incomplete versus complete resection (52% vs. 23%; risk difference [RD], 28% [95% CI, 9% to 47%]; P = 0.004). Incomplete segments also had a greater number of neoplastic polyps (mean, 0.8 vs. 0.3; RD, 0.50 [CI, 0.1 to 0.9]; P = 0.008) and greater risk for advanced neoplasia (18% vs. 3%; RD, 15% [CI, 1% to 29%]; P = 0.034). Incomplete resection was the strongest independent factor associated with metachronous neoplasia (odds ratio, 3.0 [CI, 1.12 to 8.17]). LIMITATION Potential patient selection bias due to incomplete follow-up. CONCLUSION This natural history study found a statistically significantly greater risk for future neoplasia and advanced neoplasia in colon segments after incomplete resection compared with segments with complete resection. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Heiko Pohl
- Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth-Hitchcock Medical Center and Dartmouth Geisel School of Medicine, Hanover, New Hampshire (H.P.)
| | - Joseph C Anderson
- Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire (J.C.A., D.J.R.)
| | | | - Audrey H Calderwood
- Dartmouth-Hitchcock Medical Center and Dartmouth Geisel School of Medicine, Hanover, New Hampshire (A.H.C.)
| | | | - Douglas J Robertson
- Veterans Affairs Medical Center, White River Junction, Vermont, and Dartmouth Geisel School of Medicine, Hanover, New Hampshire (J.C.A., D.J.R.)
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Bhatt AA, Kurtz RM, Kennedy TA, Miller-Thomas MM, Anderson JC, Edgar L, Wood CP. The Updated Neuroradiology Milestones: Synapsing from 1.0 to 2.0. AJNR Am J Neuroradiol 2021; 42:E48-E52. [PMID: 33926899 DOI: 10.3174/ajnr.a7123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Accreditation Council for Graduate Medical Education is currently in the process of specialty-by-specialty revision of the Milestones. As a result, the Neuroradiology Milestones 2.0 Workgroup was created to refine a system of competency-based assessments for fellow educational growth and development. Strengths of the new Milestones include decreased complexity and uniformity within a subcompetency as it relates to a specific educational development trajectory. The Supplemental Guide serves to decrease clutter in the Milestones 2.0 document and provides a more practical resource for guidance. This article serves to review the history of the Neuroradiology Milestones, followed by a summary of the timeline of events and discussions of the workgroup for development of Neuroradiology Milestones 2.0 and a synopsis of major changes. The plan is for the updated Neuroradiology Milestones to take effect in 2021 or 2022 based on public commentary.
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Affiliation(s)
- A A Bhatt
- From the Department of Radiology (A.A.B.), Mayo Clinic Jacksonville, Jacksonville, Florida
| | - R M Kurtz
- Department of Radiology (R.M.K.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - T A Kennedy
- School of Medicine and Public Health (T.A.K.), The University of Wisconsin, Madison, Wisconsin
| | - M M Miller-Thomas
- Mallinckrodt Institute of Radiology (M.M.M.-T.), Washington University in St. Louis, St. Louis, Missouri
| | - J C Anderson
- Department of Radiology (J.C.A.), Oregon Health & Science University, Portland, Oregon
| | - L Edgar
- Milestones Development (L.E.), Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - C P Wood
- Department of Radiology (C.P.W.), Mayo Clinic Rochester, Rochester, Minnesota
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Anderson JC. Techniques for Detection and Complete Resection of Sessile Serrated Polyps. Gastroenterol Hepatol (N Y) 2021; 17:384-386. [PMID: 34602902 PMCID: PMC8475259] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Joseph C Anderson
- Dartmouth Geisel School of Medicine Hanover, New Hampshire White River Junction VA Medical Center White River Junction, Vermont UConn Health Center Farmington, Connecticut
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Liu MC, Anderson JC. Evaluating the 2020 UK Surveillance Colonoscopy Guidelines on CRC Incidence After Polypectomy. Gastroenterology 2021; 161:724-726. [PMID: 34004160 DOI: 10.1053/j.gastro.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Margaret C Liu
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut
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Perine J, Anderson JC, Kruger GR, Abi-Akar F, Overmyer J. Effect of nozzle selection on deposition of thiamethoxam in Actara® spray drift and implications for off-field risk assessment. Sci Total Environ 2021; 772:144808. [PMID: 33770886 DOI: 10.1016/j.scitotenv.2020.144808] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
Off-target drift during pesticide spray applications represents a potential pathway for the introduction of active ingredient into field-adjacent water, soils, and/or vegetation. This study investigated the extent of downwind spray drift deposition of thiamethoxam (as a model insecticide) from an application of Actara® 25WG using standard nozzles (TeeJet XR11003, DG11004, and AIXR11002) onto a fallow field test site in the Midwestern USA. Single broadcast applications at a target rate of 96 g a.i./ha were made uniformly via tractor boom to a mowed stubble plot at a spray volume of 93.5 L/ha. Sampling devices (stainless steel disks, filter paper, and stainless steel rods) were located upwind of the spray swath (as negative control samples), within the spray swath (filter paper only), and downwind (all samplers), perpendicular to the spray swath from 12.5 to 400 ft. (3.8 to 122 m) from the edge of the treated field. Comparison of measured residues from the three types of samplers indicated that filter paper generally had greater variability in results than metal disks. When nozzles were compared, the AIXR11002 air induction nozzle produced less off-field deposition than other nozzles tested. Measured downwind concentrations of thiamethoxam from disk samplers were used to predict distances for mitigating potential effects to honey bees. Based on field-derived models, downwind distances from the spray swath required to reduce exposure levels below levels of concern for honey bees varied from <1 ft. to 148 ft. (0.3 to 45 m) depending on the hazard endpoint and nozzle used. These distances were considerably lower than those predicted using the AgDRIFT model, particularly for distances further downwind. At 400 ft. (122 m), AgDRIFT over-predicted the calculated concentrations by up to a factor of 4.8, 7.2, and 10 for DG11004, XR11003, and AIXR11002, respectively. These data suggest that the AgDRIFT model is less reliable for predicting spray deposition at further downwind distances, with implications for risk assessment.
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Affiliation(s)
- J Perine
- Syngenta Crop Protection, LLC, Greensboro, NC 27409, United States of America.
| | - J C Anderson
- Environmental Consultant, Winnipeg, MB R3N0T8, Canada
| | - G R Kruger
- University of Nebraska-Lincoln, North Platte, NE 69101, United States of America
| | - F Abi-Akar
- Waterborne Environmental, Inc., Leesburg, VA 20175, United States of America
| | - J Overmyer
- Syngenta Crop Protection, LLC, Greensboro, NC 27409, United States of America
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Abstract
Introduction: While colorectal cancer (CRC) incidence and mortality have decreased for older adults, the rates are increasing in adults younger than 50 years of age in the United States as well as globally. In response to strong epidemiologic evidence as well as sophisticated models, the American Cancer Society (ACS) has recommended screening adults for CRC starting at age 45. Understanding the factors associated with the rise of incidence in adults younger than age 50 may help to identify those adults who may be at greatest risk.Areas covered: In this review, we provide an overview of the recent literature and discuss possible explanations for the increase in CRC in young adults including obesity and other recognized CRC risk factors, delay in diagnosis of symptomatic patients (<50 years of age), and review perspectives on the current and future status of the field.Expert opinion: Currently there are little data regarding risk factors for CRC in average risk young adults who are asymptomatic. With potential endorsement of screening at 45 years of age by US Preventive Services Task Force, more data regarding clinical and molecular risk factors associated with CRC in young adults will be available.
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Affiliation(s)
- Obaida Dairi
- Department of Veterans Affairs Medical Center, White River Junction, VT and the Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, VT and the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, CT, USA.,New Hampshire Colonoscopy Registry, Lebanon, NH, USA
| | - Lynn F Butterly
- New Hampshire Colonoscopy Registry, Lebanon, NH, USA.,Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Kedrin D, Butterly LF, Anderson JC. Risk for individuals with index small (<1 cm) hyperplastic polyps. Gastrointest Endosc 2021; 93:1408-1410. [PMID: 33840463 DOI: 10.1016/j.gie.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/06/2021] [Indexed: 02/08/2023]
Affiliation(s)
| | - Lynn F Butterly
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA; The University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Brain RA, Anderson JC, Hanson ML. Acute and early life-stage toxicity of atrazine in sheepshead minnow (Cyprinodon variegatus). Ecotoxicol Environ Saf 2021; 218:112303. [PMID: 33975221 DOI: 10.1016/j.ecoenv.2021.112303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/25/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
Given the limited data available for estuarine/marine fish species and potential risk of being exposed to the herbicide atrazine, additional toxicity data regarding sensitive life-stages are needed. As such, this work sought to characterize: 1) the acute larval toxicity, and 2) early life-stage toxicity of technical atrazine in the model marine species sheepshead minnow (Cyprinodon variegatus). Atrazine was observed to be slightly to moderately toxic towards C. variegatus under acute conditions (as per U.S. EPA 2017 criteria). After 96 h exposure, mortality rates of 5%, 15%, 35%, and 90% were observed among fish exposed to atrazine at 4.6, 7.6, 13, and 22 mg a.i./L, respectively. Sub-lethal effects were observed among surviving fish exposed to > 3.2 mg a.i/L. The 96 h LC50 was 13 mg a.i./L and the NOEC was 3.2 mg a.i./L. In the 33 d early-life stage test, mean embryo survival rates in 0.15, 0.30, 0.57, 1.1, and 2.2 mg a.i./L treatments ranged from 71% to 79% and were not different from survival in the control (78%). Following 28 d post-hatch exposure (Day 33), mean larval survival ranged from 98% to 100% in all treatments and the control. Larval length and wet weight were the most sensitive indicators of the toxicity of atrazine to early life-stage sheepshead minnow. The NOEC for growth was 1.1 mg a.i./L and the LOEC was 2.2 mg a.i./L. Based on these, the MATC for atrazine to sheepshead minnow embryos and larvae was estimated to be 1.6 mg a.i./L. These results were consistent with previous investigations in sheepshead minnow and other marine fish species. Based on the results, atrazine would not be expected to pose unacceptable risks for sheepshead minnow early life-stages at environmentally relevant concentrations.
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Affiliation(s)
- R A Brain
- Syngenta Crop Protection, LLC, Greensboro, NC 27409, USA.
| | - J C Anderson
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - M L Hanson
- Department of Environment and Geography, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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Saade R, Tsang T, Kmeid M, Miller D, Fu Z, Litynski J, Young P, Anderson JC, Lee H, Tadros M. Overutilization of surgical resection for benign colorectal polyps: analysis from a tertiary care center. Endosc Int Open 2021; 9:E706-E712. [PMID: 33937512 PMCID: PMC8062229 DOI: 10.1055/a-1380-3017] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022] Open
Abstract
Background and study aims Adequate removal of precancerous polyps is an independent factor in colorectal cancer prevention. Despite advances in polypectomy techniques, there is an increasing rate of surgery for benign polyps. We assessed whether surgical resection is properly utilized for benign colorectal polyps. Patients and methods We identified 144 patients with surgical resection for benign colorectal polyps. Polyp location, size and the indication for and type of surgery were obtained. For the purposes of this analysis, we assumed that gastroenterologists should assess polyp size accurately, endoscopically resect polyps < 2 cm, and treat incompletely excised polyps on follow-up. Results A total of 118 patients (82 %) were referred to surgery without attempted endoscopic removal. In 26 (22 %) of 118, the macroscopic polyp size was < 2 cm (23 in right, 3 in the left colon) and 18 (15 %; 14 in the right, four in the left colon) were found to have had size overestimation during endoscopy. Twenty-two (15 %) of 144 underwent surgical resection for incomplete endoscopic resection of adenomas (16 in the right, 6 in the left colon); 12 (54.5 %) had a residual polyp size of < 2 cm (10 in the right colon; 2 in the left colon). In-hospital mortality was 0.7 % and morbidity was 20.1 %. Conclusions Of the patients, 41 % could have potentially avoided surgical intervention (37 polyps < 2 cm and/or size overestimations precluding endoscopic polypectomy and 22 incomplete resections). When including polyps with size ≥ 2 to < 4 cm, the percentage of patients with avoidable surgery reached 80 %. This confirms the need to develop standardized quality metrics for endoscopic polypectomies and for better overall training of endoscopists performing these procedures. Given the risks of surgery, referral to an experienced gastroenterologist should be considered as a first step.
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Affiliation(s)
- Rayan Saade
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
| | - Tyler Tsang
- Albany Medical College, Albany, New York, United States
| | - Michel Kmeid
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
| | - David Miller
- Albany Medical College, Albany, New York, United States
| | - Zhiyan Fu
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
| | - James Litynski
- Gastroenterology, Albany Medical Center, Albany, New York, United States
| | - Patrick Young
- Gastroenterology Service, Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Joseph C. Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, United States, and The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States,Division of Gastroenterology and Hepatology University of Connecticut School of Medicine, Farmington, Connecticut, United States
| | - Hwajeong Lee
- Pathology and Laboratory Medicine, Albany Medical Center, Albany, New York, United States
| | - Micheal Tadros
- Gastroenterology, Albany Medical Center, Albany, New York, United States
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Desai M, Anderson JC, Kaminski M, Thoguluva Chandrasekar V, Fathallah J, Hassan C, Lieberman D, Sharma P. Sessile serrated lesion detection rates during average risk screening colonoscopy: A systematic review and meta-analysis of the published literature. Endosc Int Open 2021; 9:E610-E620. [PMID: 33869735 PMCID: PMC8043815 DOI: 10.1055/a-1352-4095] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
Background and study aims Sessile serrated lesion (SSL) detection rate has been variably reported and unlike adenoma detection rate (ADR) is not currently a quality indicator for screening colonoscopy. Composite detection rates of SSL in patients undergoing average risk screening colonoscopy are not available. Methods Electronic database search (Medline, Embase and Cochrane) was conducted for studies reporting detection rates of serrated polyps (SSL, Hyperplastic polyp, traditional serrated adenoma) among average risk subjects undergoing screening colonoscopy. Primary outcomes were pooled SDR (SSL detection rate) and proximal serrated polyp detection rate (PSPDR). Pooled proportion rates were calculated with 95 %CI with assessment of heterogeneity (I 2 ). Publication bias, regression test and 95 %prediction interval were calculated. Results A total of 280,370 screening colonoscopies among average risk subjects that were eligible with 48.9 % males and an average age of 58.7 years (± 3.2). The pooled SDR was available from 16 studies: 2.5 % (1.8 %-3.4 %) with significant heterogeneity (I 2 = 98.66 %) and the 95 % prediction interval ranging from 0.6 % to 9.89 %. When analysis was restricted to large (n > 1000) and prospective studies (n = 4), SDR was 2 % (1.1 %-3.3 %). Pooled PSPDR was 10 % (8.5 %-11.8 %; 12 studies). There was evidence of publication bias ( P < 0.01). Conclusion Definitions of SSL have been varying over years and there exists significant heterogeneity in prevalence reporting of serrated polyps during screening colonoscopy. Prevalence rate of 2 % for SSL and 10 % for proximal serrated polyps could serve as targets while robust high-quality data is awaited to find a future benchmark showing reduction in colorectal cancer arising from serrated pathway.
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, United States
| | - Joseph C. Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont, United States,The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
| | - Michael Kaminski
- Department of Gastroenterological Oncology, the Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland,Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland,Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Jihan Fathallah
- Department of Gastroenterology and hepatology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - David Lieberman
- Department of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon, United States
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, United States,Department of Gastroenterology and hepatology, University of Kansas Medical Center, Kansas City, Kansas, United States
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Liu JY, Anderson JC, Franklin JS, Gesek FA, Soybel DI. Nudging patients and surgeons to change ambulatory surgery pain management: Results from an opioid buyback program. Surgery 2021; 170:485-492. [PMID: 33676733 DOI: 10.1016/j.surg.2021.01.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Optimal postoperative opioid stewardship combines adequate pain medication to control expected discomfort while avoiding abuse and community diversion of unused prescribed opioids. We hypothesized that an opioid buyback program would motivate patients to return unused opioids, and surgeons will use that data to calibrate prescribing. METHODS Prospective cohort study of postambulatory surgery pain management at a level II Veterans Affairs rural hospital (2017-2019). Eligible patients were offered $5/unused opioid pill ($50 limit) returned to our Veterans Affairs hospital for proper disposal. After 6 months, buyback data was shared with each surgical specialty. RESULTS Overall, 934 of 1,880 (49.7%) eligible ambulatory surgery patients were prescribed opioids and invited to participate in the opioid buyback. We had 281 patients (30%) return 3,165 unused opioid pills; this return rate remained constant over the study period. In 2017, 62.4% of patients were prescribed an opioid; after data was shared with providers, prescriptions for opioids were reduced to 50.7% and 38.3% of eligible patients in 2018 and 2019, respectively (P < .0001). The median morphine milligram equivalents prescribed also decreased from 108.8 morphine milligram equivalents in 2017 to 75.0 morphine milligram equivalents in 2018 and sustained at 75.0 morphine milligram equivalents in 2019 (P < .001). Surgical providers, surgeries performed, patient characteristics, and 30-day refill rates were similar throughout the study period. CONCLUSION A small financial incentive resulted in patients returning unused opioids after ambulatory surgery. Feedback to surgeons regarding opioids returned reduced the proportion of patients prescribed an opioid and the amount of opioid after ambulatory surgery without an increase in refills.
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Affiliation(s)
- Jean Y Liu
- VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH.
| | - Joseph C Anderson
- VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH; University of Connecticut School of Medicine, Farmington, CT
| | - Julie S Franklin
- VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH. https://twitter.com/JulieFr87732501
| | - Frank A Gesek
- VA Medical Center, White River Junction, VT. https://twitter.com/FrankGesek
| | - David I Soybel
- VA Medical Center, White River Junction, VT; The Geisel School of Medicine at Dartmouth College, Hanover, NH. https://twitter.com/DSoybel
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Tadros M, Mago S, Miller D, Ungemack JA, Anderson JC, Swede H. The rise of proximal colorectal cancer: a trend analysis of subsite specific primary colorectal cancer in the SEER database. Ann Gastroenterol 2021; 34:559-567. [PMID: 34276196 PMCID: PMC8276357 DOI: 10.20524/aog.2021.0608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths. Given the significant prevalence of CRC, regular preventative screening is required. CRCs in different locations of the colon have variable molecular pathogenesis, gross appearance, and general disease outcomes. While the overall incidence of CRC has been decreasing, the decrease in proximally located CRC significantly lags behind the other forms of CRC. The objective of this study was to establish independent risk factors for proximal CRC for better identification of populations at risk for closer CRC monitoring and observation. Methods A time-trend analysis was conducted using data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database from 1973-2007, comparing patient characteristics (age, sex, race/ethnicity, year of diagnosis, age of diagnosis, tumor grade, tumor stage, and urban-rural setting) between CRCs originating in different locations. Results Analysis demonstrated that black race, female sex, age over 60, and being diagnosed in the 21st century (rather than 20th) were associated with an increased risk of proximal CRC compared to CRCs originating in other locations. Conclusions Our study showed that black race, female sex, and age over 60 independently increased the likelihood of proximal CRC diagnosis. Furthermore, CRC trends identify an increasing proportion of all CRCs being of proximal origin. It is imperative that patients undergo regularly scheduled complete colonoscopies by trained endoscopists, especially if they belong to the high-risk groups previously identified.
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Affiliation(s)
- Micheal Tadros
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical College, Albany, New York (Micheal Tadros, David Miller)
| | - Sheena Mago
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut (Sheena Mago)
| | - David Miller
- Department of Medicine, Division of Gastroenterology-Hepatology, Albany Medical College, Albany, New York (Micheal Tadros, David Miller)
| | - Jane A Ungemack
- Community Medicine and Health Care, University of Connecticut Health Center, Farmington, Connecticut (Jane A Ungemack, Helen Swede)
| | - Joseph C Anderson
- Department of Medicine, Division of Gastroenterology, Dartmouth Geisel School of Medicine, Hanover, New Hampshire (Joseph C. Anderson), USA
| | - Helen Swede
- Community Medicine and Health Care, University of Connecticut Health Center, Farmington, Connecticut (Jane A Ungemack, Helen Swede)
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50
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Liu MC, Anderson JC. Long-Term Outcomes of Patients with Serrated Polyposis Syndrome. Gastroenterology 2021; 160:962-964. [PMID: 33307031 DOI: 10.1053/j.gastro.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Margaret C Liu
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joseph C Anderson
- Department of Veterans Affairs Medical Center, White River Junction, Vermont; The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Division of Gastroenterology and Hepatology, University of Connecticut School of Medicine, Farmington, Connecticut
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