1
|
Viñas T, Gomis Á, Ruiz de la Cuesta E, Gracia E, Jover R, Shalygina S, Ramia JM, Carbonell S. Jejunal gangliocytic paraganglioma. Gastroenterol Hepatol 2024; 47:501-503. [PMID: 38072360 DOI: 10.1016/j.gastrohep.2023.12.004] [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] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 01/01/2024]
Affiliation(s)
- Tamara Viñas
- Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica, Alicante, España.
| | - Álvaro Gomis
- Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España
| | - Emilio Ruiz de la Cuesta
- Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica, Alicante, España
| | - Ester Gracia
- Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica, Alicante, España
| | - Rodrigo Jover
- Servicio de Aparato Digestivo, Hospital General Universitario Dr. Balmis, Alicante, España; Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, España
| | - Svetlana Shalygina
- Servicio de Anatomía Patológica, Hospital General Universitario Dr. Balmis, Alicante, España
| | - José Manuel Ramia
- Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica, Alicante, España; Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, España
| | - Silvia Carbonell
- Servicio de Cirugía General, Hospital General Universitario Dr. Balmis, Alicante, España; ISABIAL, Instituto de Investigación Sanitaria y Biomédica, Alicante, España
| |
Collapse
|
2
|
Ferlitsch M, Hassan C, Bisschops R, Bhandari P, Dinis-Ribeiro M, Risio M, Paspatis GA, Moss A, Libânio D, Lorenzo-Zúñiga V, Voiosu AM, Rutter MD, Pellisé M, Moons LMG, Probst A, Awadie H, Amato A, Takeuchi Y, Repici A, Rahmi G, Koecklin HU, Albéniz E, Rockenbauer LM, Waldmann E, Messmann H, Triantafyllou K, Jover R, Gralnek IM, Dekker E, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024. Endoscopy 2024. [PMID: 38670139 DOI: 10.1055/a-2304-3219] [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: 04/28/2024]
Abstract
1: ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).Strong recommendation, high quality of evidence. 2: ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.Strong recommendation, moderate quality of evidence. 3: ESGE recommends CSP, to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of small polyps (6-9 mm).Strong recommendation, high quality of evidence. 4: ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10-19 mm in size.Strong recommendation, high quality of evidence. 5: ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).Strong recommendation, high quality of evidence. 6: ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.Weak recommendation, moderate quality of evidence. 7: Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.Weak recommendation, low quality evidence. 8: ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.Strong recommendation, high quality of evidence. 9: ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.Strong recommendation, moderate quality of evidence. 10: ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.Strong recommendation, high quality of evidence. 11: ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.Strong recommendation, moderate quality of evidence.
Collapse
Affiliation(s)
- Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Department of Gastroenterology, Evangelical Hospital, Vienna, Austria
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium
| | - Pradeep Bhandari
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Mauro Risio
- Department of Pathology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy
| | - Gregorios A Paspatis
- Gastroenterology Department, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Alan Moss
- Department of Gastroenterology, Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Vincente Lorenzo-Zúñiga
- Endoscopy Unit, La Fe University and Polytechnic Hospital / IISLaFe, Valencia, Spain
- Department of Medicine, Catholic University of Valencia, Valencia, Spain
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthew D Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Department of Gastroenterology, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leon M G Moons
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Halim Awadie
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department, Ospedale A. Manzoni, Lecco, Italy
| | - Yoji Takeuchi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Gabriel Rahmi
- Hepatogastroenterology and Endoscopy Department, Hôpital européen Georges Pompidou, Paris, France
- Laboratoire de Recherches Biochirurgicales, APHP-Centre Université de Paris, Paris, France
| | - Hugo U Koecklin
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Teknon Medical Center, Barcelona, Spain
| | - Eduardo Albéniz
- Gastroenterology Department, Hospital Universitario de Navarra (HUN); Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Lisa-Maria Rockenbauer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Waldmann
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodastrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| |
Collapse
|
3
|
Baile‐Maxía S, Mangas‐Sanjuan C, Sala‐Miquel N, Barquero C, Belda G, García‐del‐Castillo G, García‐Herola A, Penalva JC, Picó M, Poveda M, de‐Vera F, Zapater P, Jover R. Incidence, characteristics, and predictive factors of post-colonoscopy colorectal cancer. United European Gastroenterol J 2024; 12:309-318. [PMID: 38234220 PMCID: PMC11017761 DOI: 10.1002/ueg2.12512] [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: 08/21/2023] [Accepted: 10/27/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Post-colonoscopy colorectal cancer (PCCRC) is colorectal cancer (CRC) diagnosed after a colonoscopy in which no cancer is found. OBJECTIVE As PCCRC has become an important quality indicator, we determined its rates, characteristics, and index colonoscopy-related predictive factors. METHODS We carried out a multicenter, observational, retrospective study between 2015 and 2018. Rates were calculated for PCCRC developing up to 10 years after colonoscopy. PCCRC was categorized according to the most plausible explanation using World Endoscopy Organization methodology. Our PCCRC population was compared to a control cohort without CRC matched 1:4 by sex, age, index colonoscopy date, indication, endoscopist, and hospital. RESULTS One hundred seven PCCRC and 2508 detected CRC were diagnosed among 101,524 colonoscopy (0.1%), leading to rates of 0.4%, 2.2%, 3.1%, and 4.1% at 1, 3, 5, and 10 years, respectively. PCCRC was in right (42.4%), left (41.4%), and transverse (16.4%) colon with 31.5% at stage I, 24.7% stage II, 32.6% stage III, and 11.2% stage IV. Twenty point three percent were classified as incomplete resection, 5.4% as unresected lesions, 48.6% as missed lesions with adequate colonoscopy, and 25.7% as missed lesions with inadequate colonoscopy. The median time from colonoscopy to PCCRC was 42 months. Previous inadequate preparation (OR 3.05, 95%CI 1.73-5.36) and piecemeal polypectomy (OR 19.89, 95%CI 8.67-45.61) were independently associated with PCCRC. CONCLUSIONS In our population, 4.1% of CRC cases were PCCRC. Most of these lesions were in right colon and attributable to lesions not visualized despite adequate bowel cleansing. Previous inadequate cleansing and piecemeal polypectomy were associated with PCCRC.
Collapse
Affiliation(s)
- Sandra Baile‐Maxía
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| | - Carolina Mangas‐Sanjuan
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| | - Noelia Sala‐Miquel
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| | - Claudia Barquero
- Gastroenterology DepartmentHospital Universitario de TorreviejaTorreviejaSpain
| | - Germán Belda
- Gastroenterology DepartmentHospital Universitario Vega BajaOrihuelaSpain
| | | | | | | | - María‐Dolores Picó
- Gastroenterology DepartmentHospital General Universitario de ElcheElcheSpain
| | | | - Félix de‐Vera
- Gastroenterology DepartmentHospital General Universitario de EldaEldaSpain
| | - Pedro Zapater
- Clinical Pharmacology UnitHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Universidad Miguel HernándezIDIBECIBERehdAlicanteSpain
| | - Rodrigo Jover
- Gastroenterology DepartmentHospital General Universitario Dr. BalmisInstituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL)Departamento de Medicina Clínica, Universidad Miguel HernándezAlicanteSpain
| |
Collapse
|
4
|
Córdova H, Barreiro-Alonso E, Castillo-Regalado E, Cubiella J, Delgado-Guillena P, Díez Redondo P, Galdín M, García-Rodríguez A, Hernández L, Huerta A, Jover R, Núñez H, Rodríguez-D'Jesús A, Seoane A, Surís G, Tejedor-Tejada J, Jiménez Sánchez J, Martín F, Moreira L, Carballal S, Rivero L, Da Fieno A, Casanova G, Luzko Scheid I, Llach J, Fernández-Esparrach G. Applicability of the Barcelona scale to assess the quality of cleanliness of mucosa at esophagogastroduodenoscopy. Gastroenterol Hepatol 2024; 47:246-252. [PMID: 37236304 DOI: 10.1016/j.gastrohep.2023.05.011] [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] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND OBJECTIVES There are few scales with prospective validation for the assessment of the upper gastrointestinal mucosal cleanliness during an esophagogastroduodenoscopy (EGD). The aim of this study was to develop a valid and reproducible cleanliness scale for use during an EGD. METHODS We developed a cleanliness scale (Barcelona scale) with a score (0-2 points) of five segments of the upper gastrointestinal tract with thorough cleaning techniques (esophagus, fundus, body, antrum, and duodenum). First, 125 photos (25 of each area) were assessed, and a score was assigned to each image by consensus among 7 experts endoscopists. Subsequently, 100 of the 125 images were selected and the inter- and intra-observer variability of 15 previously trained endoscopists was evaluated using the same images at two different times. RESULTS In total, 1500 assessments were performed. In 1336/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.83 (0.45-0.96). In the second evaluation, in 1330/1500 observations (89%) there was agreement with the consensus score, with a mean kappa value of 0.82 (0.45-0.93). The intra-observer variability was 0.89 (0.76-0.99). CONCLUSIONS The Barcelona cleanliness scale is a valid measure and reproducible with minimal training. Its application in clinical practice is a significant step to standardize the quality of the EGD.
Collapse
Affiliation(s)
- Henry Córdova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Eva Barreiro-Alonso
- Department of Gastroenterology, Hospital Universitario Central de Asturias and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edgar Castillo-Regalado
- Endoscopy Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Hospital Universitario de Ourense. Research Group in Gastrointestinal Oncology-Ourense. CIBERehd, Ourense, Spain
| | | | | | | | - Ana García-Rodríguez
- Servicio de Digestivo, Unidad de Endoscopia, Hospital de Viladecans, Barcelona, Spain
| | | | - Alain Huerta
- Hospital Universitario de Galdakao, Biocruces Bizkaia, Departamento Medicina UPV-EHU Leioa, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Henar Núñez
- Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Agustín Seoane
- Digestive Department, Endoscopy Unit, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Gerard Surís
- Servicio de Digestivo, Unidad de Endoscopia, Hospital de Viladecans, Barcelona, Spain
| | | | | | | | - Leticia Moreira
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Sabela Carballal
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Angella Da Fieno
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gherzon Casanova
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Irina Luzko Scheid
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Joan Llach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, Hospital Clínic of Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
5
|
Carballal S, Balaguer F, Bujanda L, Capellá G, González Santiago S, Jover R, Moreira L, Pineda M, Ruiz-Ponte C, Sánchez Heras AB, Serrano Blanch R, Soto JL, Vidal Tocino R, Cubiella J. Use of multi-gene panels in patients at high risk of hereditary digestive cancer: position statement of AEG, SEOM, AEGH and IMPaCT-GENÓMICA consortium. Gastroenterol Hepatol 2024; 47:293-318. [PMID: 37315767 DOI: 10.1016/j.gastrohep.2023.06.004] [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] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
This position statement, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Oncología Médica, the Asociación Española de Genética Humana and the IMPaCT-Genómica Consortium aims to establish recommendations for use of multi-gene panel testing in patients at high risk of hereditary gastrointestinal and pancreatic cancer. To rate the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We reached a consensus among experts using a Delphi method. The document includes recommendations on clinical scenarios where multi-gene panel testing is recommended in colorectal cancer, polyposis syndromes, gastric and pancreatic cancer, as well as the genes to be considered in each clinical scenario. Recommendations on the evaluation of mosaicisms, counseling strategies in the absence of an index subject and, finally, constitutional analysis after identification of pathogenic tumor variants are also made.
Collapse
Affiliation(s)
- Sabela Carballal
- Servicio de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, España.
| | - Francesc Balaguer
- Servicio de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, España
| | - Luis Bujanda
- Servicio de Aparato Digestivo, Hospital Universitario Donostia, Instituto Biodonostia. Universidad del País Vasco (UPV/EHU), CIBEREHD, San Sebastián, Guipúzcoa, España
| | - Gabriel Capellá
- Programa de Cáncer Hereditario, Instituto Catalán de Oncología, Programa ONCOBELL, IDIBELL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), L'Hospitalet de Llobregat, Barcelona, España
| | | | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria de Alicante (ISABIAL), Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, España
| | - Leticia Moreira
- Servicio de Gastroenterología, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, España
| | - Marta Pineda
- Programa de Cáncer Hereditario, Instituto Catalán de Oncología, Programa ONCOBELL, IDIBELL, Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), L'Hospitalet de Llobregat, Barcelona, España
| | - Clara Ruiz-Ponte
- Fundación Pública Galega de Medicina Xenómica (SERGAS), Instituto de Investigación Sanitaria de Santiago (IDIS), Grupo de Medicina Xenomica (USC), Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERer), Santiago de Compostela, La Coruña, España
| | - Ana Beatriz Sánchez Heras
- Unidad de Consejo Genético en Cáncer, Servicio de Oncología Médica, Hospital General Universitario de Elche, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Elche, Alicante, España
| | - Raquel Serrano Blanch
- Unidad de Consejo Genético en Cáncer, Unidad de Gestión Clínica de Oncología Médica, H.U. Reina Sofía de Córdoba. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), CIBERONC, Universidad de Córdoba (UCO), Córdoba, España
| | - José Luis Soto
- Unidad de Genética Molecular, Hospital General Universitario de Elche, FISABIO, Elche, Alicante, España
| | - Rosario Vidal Tocino
- Servicio de Oncología Médica, Complejo Asistencial Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - Joaquín Cubiella
- Servicio de Aparato Digestivo, Hospital Universitario de Ourense, Grupo de Investigación en Oncología Digestiva-Ourense (GIODO), CIBEREHD, Ourense, España.
| |
Collapse
|
6
|
Medina‐Prado L, Sala‐Miquel N, Aicart‐Ramos M, López‐Cardona J, Ponce‐Romero M, Ortíz O, Pellisé M, Aguilera L, Díez‐Redondo P, Núñez‐Rodríguez H, Seoane A, Domper‐Arnal M, Borao‐Laguna C, González‐Bernardo Ó, Suárez A, Muñoz‐Tornero M, Bustamante‐Balén M, Soutullo‐Castiñeiras C, Balleste‐Peris B, Esteban P, Jiménez‐Gómez M, Albert M, Lucas J, Valdivieso‐Cortázar E, López‐Serrano A, Solano M, Tejedor‐Tejada J, Trelles M, Zapater P, Jover R. Effect of the SARS-CoV-2 pandemic on colorectal cancer diagnosis and prognosis. Cancer Med 2024; 13:e6923. [PMID: 38491824 PMCID: PMC10943366 DOI: 10.1002/cam4.6923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/23/2023] [Accepted: 12/21/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND AND STUDY AIMS Our aim was to determine the impact of the SARS-CoV-2 pandemic on the diagnosis and prognosis of colorectal cancer (CRC). PATIENTS AND METHODS This prospective cohort study included individuals diagnosed with CRC between March 13, 2019 and June 20, 2021 across 21 Spanish hospitals. Two time periods were compared: prepandemic (from March 13, 2019 to March 13, 2020) and pandemic (from March 14, 2020 to June 20, 2021, lockdown period and 1 year after lockdown). RESULTS We observed a 46.9% decrease in the number of CRC diagnoses (95% confidence interval (CI): 45.1%-48.7%) during the lockdown and 29.7% decrease (95% CI: 28.1%-31.4%) in the year after the lockdown. The proportion of patients diagnosed at stage I significantly decreased during the pandemic (21.7% vs. 19.0%; p = 0.025). Centers that applied universal preprocedure SARS-CoV-2 PCR testing experienced a higher reduction in the number of colonoscopies performed during the pandemic post-lockdown (34.0% reduction; 95% CI: 33.6%-34.4% vs. 13.7; 95% CI: 13.4%-13.9%) and in the number of CRCs diagnosed (34.1% reduction; 95% CI: 31.4%-36.8% vs. 26.7%; 95% CI: 24.6%-28.8%). Curative treatment was received by 87.5% of patients diagnosed with rectal cancer prepandemic and 80.7% of patients during the pandemic post-lockdown period (p = 0.002). CONCLUSIONS The COVID-19 pandemic has led to a decrease in the number of diagnosed CRC cases and in the proportion of stage I CRC. The reduction in the number of colonoscopies and CRC diagnoses was higher in centers that applied universal SARS-CoV-2 PCR screening before colonoscopy. In addition, the COVID-19 pandemic has affected curative treatment of rectal cancers.
Collapse
Affiliation(s)
- Lucía Medina‐Prado
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Noelia Sala‐Miquel
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | | | | | | | | | | | - Lara Aguilera
- Hospital Vall d'Hebron. Gastroenterology department vall d'Hebron Research InstituteBarcelonaSpain
| | | | | | - Agustín Seoane
- Hospital del Mar Medical Research Institute (IMIM), Gastroenterology departmentBarcelonaSpain
| | - María‐José Domper‐Arnal
- Hospital Clínico Universitario Lozano Blesa. Instituto de investigación sanitaria de Aragón (IIS Aragón)ZaragozaSpain
| | - Cristina Borao‐Laguna
- Hospital Clínico Universitario Lozano Blesa. Instituto de investigación sanitaria de Aragón (IIS Aragón)ZaragozaSpain
| | | | - Adolfo Suárez
- Hospital Universitario Central de AsturiasOviedoSpain
| | | | | | | | | | - Pilar Esteban
- Hospital Morales Meseguer. Instituto Murciano de Investigación Biosanitaria (IMIB)MuricaSpain
| | | | - Marc Albert
- Hospital Universitari de Girona Doctor Josep TruetaGironaSpain
| | - Javier Lucas
- Hospital Universitario Fundación AlcorcónAlcorconSpain
| | | | | | | | | | | | - Pedro Zapater
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| |
Collapse
|
7
|
Bernabeu P, Belén-Galipienso O, van-der Hofstadt C, Gutiérrez A, Madero-Velázquez L, García del Castillo G, García-Sepulcre MF, Aguas M, Zapater P, Rodríguez-Marín J, Ruiz-Cantero MT, Cameo JI, Jover R, Sempere L. Psychological burden and quality of life in newly diagnosed inflammatory bowel disease patients. Front Psychol 2024; 15:1334308. [PMID: 38348263 PMCID: PMC10859525 DOI: 10.3389/fpsyg.2024.1334308] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
Objective Psychological factors, such as stress, anxiety, and depression, are frequently related to inflammatory bowel disease (IBD). However, few studies have examined these factors in patients newly diagnosed with IBD. The aim of the present study was to test the psychological burden in patients with a recent diagnosis of IBD and the factors related to this psychological burden. Methods We performed a prospective, multi-center, observational study in patients with a new diagnosis of IBD (≤6 months). The patients were recruited from four different Spanish hospitals. Clinical and demographic characteristics were collected. Patients were evaluated using the Hospital Anxiety and Depression Scale and quality of life questionnaire for patients with inflammatory bowel disease (IBDQ-32). The Scale of Stress Perceived by the Disease was used to assess stressful life events. Results We included 156 patients newly diagnosed with IBD [69 women; 80 Crohn's disease (CD) and 76 ulcerative colitis (UC)], with a mean age of 42.3 (SD 16.21) years. A total of 37.2% of patients had symptoms of anxiety and 17.3% had symptoms of depression. Quality of life was affected in 30.1% of patients. Factors related to anxiety in early IBD were being a woman and having CD. The only factor related to depression was the presence of comorbidity. Being a woman and having suffered previous stressful life events were factors related to impaired quality of life. Conclusion Anxiety, depression, and impaired quality of life are frequent in patients with a recent diagnosis of IBD. This psychological burden is greater in women.
Collapse
Affiliation(s)
- Purificación Bernabeu
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Olivia Belén-Galipienso
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carlos van-der Hofstadt
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Health Psychology, Miguel Hernández University, Alicante, Spain
| | - Ana Gutiérrez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Lucía Madero-Velázquez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | | | - Mariam Aguas
- Gastroenterology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Pedro Zapater
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Pharmacology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, University Miguel Hernández de Elche, Alicante, Spain
| | - Jesús Rodríguez-Marín
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María-Teresa Ruiz-Cantero
- Public Health Department, University of Alicante, Alicante, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José I. Cameo
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, University Miguel Hernández de Elche, Alicante, Spain
| | - Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| |
Collapse
|
8
|
Brotons A, Mangas-Sanjuan C, Cubiella J, Cid-Gómez L, Díez-Redondo P, Seoane A, García-Mateo S, Suárez A, Nicolás-Pérez D, Lumbreras B, Mira JJ, Sola-Vera J, Jover R. Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP): A valuable quality tool for all colonoscopies. Gastroenterol Hepatol 2024; 47:1-13. [PMID: 36841528 DOI: 10.1016/j.gastrohep.2023.02.003] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION The Colonoscopy Satisfaction and Safety Questionnaire based on Patient experience (CSSQP) was recently developed and validated within a Bowel Cancer Screening Program. We aimed to identify factor related to patient experience through the CSSQP, including all indications for colonoscopy. Indicators of satisfaction and perceived safety with colonoscopy were also assessed to compare the different centers. METHODS Multicenter study in nine Spanish hospitals. Consecutive patients who had undergone a colonoscopy completed the CSSQP adding a novel item on bowel preparation. Factors related to patient experiences and data from non-respondents were analyzed. RESULTS Of 2200 patients, 1753 filled out the questionnaire (response rate 79.7%, sample error 2%). Patients whose colonoscopy indication was a primary colorectal cancer screening (OR: 1.68, 95% CI: 1.15-2.44, p=0.007) or due to a +FIT (OR: 1.73, 95% CI: 1.18-2.53) reported higher satisfaction than patients with gastrointestinal symptoms. In addition, college-educated patients (OR: 2.11, 95% CI: 1.25-3.56) were more likely to report better overall satisfaction than patients with lower education level. Significant differences were observed in the majority of the CSSQP items between centers. Safety incidents were reported by 35 (2%) patients, and 176 (10%) patients reported that they received insufficient information. CONCLUSION The CSSQP identifies several significant factors on satisfaction and perceived safety in patients referred for colonoscopy for any reason. The CSSQP also allows comparison of patient-identified colonoscopy quality indicators between centers.
Collapse
Affiliation(s)
- Alicia Brotons
- Department of Gastroenterology, Hospital General Universitario de Elche, Elche, Spain; Department of Gastroenterology, Vega Baja Hospital of Orihuela, Spain.
| | - Carolina Mangas-Sanjuan
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain
| | - Lucía Cid-Gómez
- Department of Gastroenterology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica, Xerencia Integrada de Vigo, Vigo, Spain
| | | | - Agustín Seoane
- Department of Gastroenterology, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain
| | - Sandra García-Mateo
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Aragon Health Research Institute, Zaragoza, Spain
| | - Adolfo Suárez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Blanca Lumbreras
- Department of Public Health, Miguel Hernández University, Elche, Spain; CIBERESP, CIBER in Epidemiology and Public Health, Spain
| | - José Joaquín Mira
- Department of Health Psychology, Miguel Hernández University, Elche, Spain
| | - Javier Sola-Vera
- Department of Gastroenterology, Hospital General Universitario de Elche, Elche, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| |
Collapse
|
9
|
Gallardo-Gómez M, Costas-Ríos L, Garcia-Prieto CA, Álvarez-Rodríguez L, Bujanda L, Barrero M, Castells A, Balaguer F, Jover R, Esteller M, Tardío Baiges A, González-Carreró Fojón J, Cubiella J, De Chiara L. Serum DNA methylome of the colorectal cancer serrated pathway enables non-invasive detection. Mol Oncol 2023. [PMID: 38129291 DOI: 10.1002/1878-0261.13573] [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] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/07/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023] Open
Abstract
The clinical relevance of the colorectal cancer serrated pathway is evident, but the screening of serrated lesions remains challenging. We aimed to characterize the serum methylome of the serrated pathway and to evaluate circulating cell-free DNA (cfDNA) methylomes as a potential source of biomarkers for the non-invasive detection of serrated lesions. We collected serum samples from individuals with serrated adenocarcinoma (SAC), traditional serrated adenomas, sessile serrated lesions, hyperplastic polyps and individuals with no colorectal findings. First, we quantified cfDNA methylation with the MethylationEPIC array. Then, we compared the methylation profiles with tissue and serum datasets. Finally, we evaluated the utility of serum cfDNA methylation biomarkers. We identified a differential methylation profile able to distinguish high-risk serrated lesions from no serrated neoplasia, showing concordance with tissue methylation from SAC and sessile serrated lesions. Serum methylation profiles are pathway-specific, clearly separating serrated lesions from conventional adenomas. The combination of ninjurin 2 (NINJ2) and glutamate-rich 1 (ERICH1) methylation discriminated high-risk serrated lesions and SAC with 91.4% sensitivity (64.4% specificity), while zinc finger protein 718 (ZNF718) methylation reported 100% sensitivity for the detection of SAC (96% specificity). This is the first study exploring the serum methylome of serrated lesions. Differential methylation of cfDNA can be used for the non-invasive detection of colorectal serrated lesions.
Collapse
Affiliation(s)
- María Gallardo-Gómez
- CINBIO, Universidade de Vigo, Spain
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain
| | - Lara Costas-Ríos
- CINBIO, Universidade de Vigo, Spain
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Spain
| | - Carlos A Garcia-Prieto
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Spain
- Life Sciences Department, Barcelona Supercomputing Center (BSC), Spain
| | - Lara Álvarez-Rodríguez
- CINBIO, Universidade de Vigo, Spain
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Maialen Barrero
- Department of Oncology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Spain
- Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Spain
| | - Antoni Tardío Baiges
- Department of Pathology, Hospital Álvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, Vigo, Spain
| | | | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain
| | - Loretta De Chiara
- CINBIO, Universidade de Vigo, Spain
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Spain
| |
Collapse
|
10
|
Sempere L, Bernabeu P, Cameo J, Gutiérrez A, García MG, García MF, Aguas M, Belén O, Zapater P, Jover R, van-der Hofstadt C, Ruiz-Cantero MT. Gender Biases and Diagnostic Delay in Inflammatory Bowel Disease: Multicenter Observational Study. Inflamm Bowel Dis 2023; 29:1886-1894. [PMID: 36719111 PMCID: PMC10697413 DOI: 10.1093/ibd/izad001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Female gender could be a cause of diagnostic delay in inflammatory bowel disease (IBD). The aim of this study was to investigate the diagnostic delay in women vs men and potential causes. METHODS This multicenter cohort study included 190 patients with recent diagnosis of IBD (disease duration <7 months). Reconstruction of the clinical presentation and diagnostic process was carried out in conjunction with the semistructured patient interview, review, and electronic medical records. RESULTS The median time from symptom onset to IBD diagnosis was longer in women than in men: 12.6 (interquartile range, 3.7-31) vs 4.5 (2.2-9.8) months for Crohn's disease (CD; P = .008) and 6.1 (3-11.2) vs 2.7 (1.5-5.6) months for ulcerative colitis (UC; P = .008). Sex was an independent variable related to the time to IBD diagnosis in Cox regression analysis. The clinical presentation of IBD was similar in both sexes. Women had a higher percentage of misdiagnosis than men (CD, odds ratio [OR], 3.9; 95% confidence [CI], 1.5-9.9; UC, OR 3.0; 95% CI, 1.2-7.4). Gender inequities in misdiagnosis were found at all levels of the health system (emergency department, OR 2.4; 95% CI, 1.1-5.1; primary care, OR 2.5; 95% CI, 1.3-4.7; gastroenterology secondary care, OR 3.2; 95% CI, 1.2-8.4; and hospital admission, OR 4.3; 95% CI, 1.1-16.9). CONCLUSIONS There is a longer diagnostic delay in women than in men for both CD and UC due to a drawn-out evaluation of women, with a higher number of misdiagnoses at all levels of the health care system.
Collapse
Affiliation(s)
- Laura Sempere
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Purificación Bernabeu
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Cameo
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Ana Gutiérrez
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Mariana Fe García
- Gastroenterology Department, General University Hospital-Elche, Elche, Spain
| | - Mariam Aguas
- Gastroenterology Department, University and Polytechnic La Fe Hospital, Valencia, Spain
| | - Olivia Belén
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmachology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carlos van-der Hofstadt
- Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Teresa Ruiz-Cantero
- Public Health Department, University of Alicante, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| |
Collapse
|
11
|
Pablo-Fontecha V, Hernández-Illán E, Reparaz A, Asensio E, Morata J, Tonda R, Lahoz S, Parra C, Lozano JJ, García-Heredia A, Martínez-Roca A, Beltran S, Balaguer F, Jover R, Castells A, Trullàs R, Podlesniy P, Camps J. Quantification of rare somatic single nucleotide variants by droplet digital PCR using SuperSelective primers. Sci Rep 2023; 13:18997. [PMID: 37923774 PMCID: PMC10624686 DOI: 10.1038/s41598-023-39874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/01/2023] [Indexed: 11/06/2023] Open
Abstract
Somatic single-nucleotide variants (SNVs) occur every time a cell divides, appearing even in healthy tissues at low frequencies. These mutations may accumulate as neutral variants during aging, or eventually, promote the development of neoplasia. Here, we present the SP-ddPCR, a droplet digital PCR (ddPCR) based approach that utilizes customized SuperSelective primers aiming at quantifying the proportion of rare SNVs. For that purpose, we selected five potentially pathogenic variants identified by whole-exome sequencing (WES) occurring at low variant allele frequency (VAF) in at-risk colon healthy mucosa of patients diagnosed with colorectal cancer or advanced adenoma. Additionally, two APC SNVs detected in two cancer lesions were added to the study for WES-VAF validation. SuperSelective primers were designed to quantify SNVs at low VAFs both in silico and in clinical samples. In addition to the two APC SNVs in colonic lesions, SP-ddPCR confirmed the presence of three out of five selected SNVs in the normal colonic mucosa with allelic frequencies ≤ 5%. Moreover, SP-ddPCR showed the presence of two potentially pathogenic variants in the distal normal mucosa of patients with colorectal carcinoma. In summary, SP-ddPCR offers a rapid and feasible methodology to validate next-generation sequencing data and accurately quantify rare SNVs, thus providing a potential tool for diagnosis and stratification of at-risk patients based on their mutational profiling.
Collapse
Affiliation(s)
- Verónica Pablo-Fontecha
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029, Madrid, Spain
| | - Eva Hernández-Illán
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
| | - Andrea Reparaz
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029, Madrid, Spain
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
| | - Elena Asensio
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
| | - Jordi Morata
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain
| | - Raúl Tonda
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain
| | - Sara Lahoz
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Carolina Parra
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
| | - Juan José Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Anabel García-Heredia
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010, Alicante, Spain
| | - Alejandro Martínez-Roca
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010, Alicante, Spain
| | - Sergi Beltran
- CNAG-CRG, Centre for Genomic Regulation (CRG), Barcelona Institute of Science and Technology (BIST), 08028, Barcelona, Spain
| | - Francesc Balaguer
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010, Alicante, Spain
| | - Antoni Castells
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain
| | - Ramon Trullàs
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029, Madrid, Spain
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
| | - Petar Podlesniy
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28029, Madrid, Spain
- Neurobiology Unit, Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036, Barcelona, Spain
| | - Jordi Camps
- Translational Colorectal Cancer Genomics, Gastrointestinal and Pancreatic Oncology Team, Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Rosselló 149-153, 4th Floor, 08036, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28029, Madrid, Spain.
- Unitat de Biologia Cel·lular i Genètica Mèdica, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Medicina, Universitat Autònoma de Barcelona, 08193, Bellaterra, Spain.
| |
Collapse
|
12
|
Martinez-Moreno B, López-Roldán G, Martínez-Sempere J, de-Madaria E, Jover R, Aparicio JR. Long-term results after EUS gallbladder drainage in high-surgical-risk patients with acute cholecystitis: A 3-year follow-up registry. Endosc Int Open 2023; 11:E1063-E1068. [PMID: 37954111 PMCID: PMC10637859 DOI: 10.1055/a-2180-9817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/21/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has become the favorite drainage option for high surgical-risk patients with acute cholecystitis. However, data on long-term outcomes regarding efficacy and security over 1 year are scarce. Patients and methods We performed a retrospective review of a prospectively maintained database to analyze the 3-year long-term outcomes of EUS-GBD with lumen apposing metal stents (LAMS) in high-surgical-risk patients with acute cholecystitis. Results Fifty patients with acute cholecystitis who underwent EUS-GBD with LAMS and 3-year follow-up or until death were included in this study. No endoscopic revisions were scheduled unless an adverse event (AE) or suspected LAMS dysfunction occurred. AEs occurred in 18%, 20%, and 26% of patients in the first, second, and third years, respectively. Thirteen patients developed at least one AE, and six presented with a second AE during follow-up. Recurrence of cholecystitis occurred in two patients (4%). Seven stent migrations (14%) occurred but all were asymptomatic. Symptomatic LAMS-related AEs (LAMS-RAEs) (37.5%) were related to gastric location of the stent compared with duodenal location (66.7% vs. 12.5%, P = 0.03). No stent-related bleeding or stent-related mortality was observed. Conclusions EUS-GBD with LAMS without scheduled removal is an effective and safe long-term treatment in high-surgical-risk patients with acute cholecystitis. Late LAMS-RAEs tend to be more asymptomatic over time. Symptomatic LAMS-RAEs are associated with gastric location, and overall, AEs tend to recur.
Collapse
Affiliation(s)
| | | | | | - Enrique de-Madaria
- Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| | - José Ramón Aparicio
- Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
| |
Collapse
|
13
|
Aelvoet AS, Karstensen JG, Bastiaansen BA, van Leerdam ME, Balaguer F, Kaminski M, Hompes R, Bossuyt PM, Ricciardiello L, Latchford A, Jover R, Daca-Alvarez M, Pellisé M, Dekker E. Cold snare polypectomy for duodenal adenomas in familial adenomatous polyposis: a prospective international cohort study. Endosc Int Open 2023; 11:E1056-E1062. [PMID: 37954110 PMCID: PMC10637860 DOI: 10.1055/a-2165-7436] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims In patients with familial adenomatous polyposis (FAP), endoscopic resection of duodenal adenomas is commonly performed to prevent cancer and prevent or defer duodenal surgery. However, based on studies using different resection techniques, adverse events (AEs) of polypectomy in the duodenum can be significant. We hypothesized that cold snare polypectomy (CSP) is a safe technique for duodenal adenomas in FAP and evaluated its outcomes in our centers. Patients and methods We performed a prospective international cohort study including FAP patients who underwent CSP for one or more superficial non-ampullary duodenal adenomas of any size between 2020 and 2022. At that time, this technique was common practice in our centers for superficial duodenal adenomas. The primary outcome was the occurrence of intraprocedural and post-procedural AEs. Results In total, 133 CSPs were performed in 39 patients with FAP (1-18 per session). Median adenoma size was 10 mm (interquartile range 8-15 mm), ranging from 5 to 40 mm; 27 adenomas were ≥20 mm (20%). Of the 133 polypectomies, 109 (82%) were performed after submucosal injection. Sixty-one adenomas (46%) were resected en bloc and 72 (54%) piecemeal. Macroscopic radical resection was achieved for 129 polypectomies (97%). Deep mural injury type II occurred in three polyps (2%) with no delayed perforation after prophylactic clipping. There were no clinically significant bleeds, perforations or other post-procedural AEs. Histopathology showed low-grade dysplasia in all 133 adenomas. Conclusions CSP for (multiple) superficial non-ampullary duodenal adenomas in FAP seems feasible and safe. Long-term prospective research is needed to evaluate whether protocolized duodenal polypectomies prevent cancer and surgery.
Collapse
Affiliation(s)
- Arthur S. Aelvoet
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - John G. Karstensen
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Danish Polyposis Registry, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Barbara A.J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Monique E. van Leerdam
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Francesc Balaguer
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Michal Kaminski
- Department of Oncological Gastroenterology and Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Roel Hompes
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Patrick M.M. Bossuyt
- Department of Epidemiology and Data Science, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Luigi Ricciardiello
- Policlinico di Sant'Orsola, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrew Latchford
- Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Rodrigo Jover
- Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Spain
| | - Maria Daca-Alvarez
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Department of Gastroenterology, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | | |
Collapse
|
14
|
Gallardo-Gómez M, Rodríguez-Girondo M, Planell N, Moran S, Bujanda L, Etxart A, Castells A, Balaguer F, Jover R, Esteller M, Cubiella J, Gómez-Cabrero D, De Chiara L. Serum methylation of GALNT9, UPF3A, WARS, and LDB2 as noninvasive biomarkers for the early detection of colorectal cancer and advanced adenomas. Clin Epigenetics 2023; 15:157. [PMID: 37794510 PMCID: PMC10552320 DOI: 10.1186/s13148-023-01570-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Early detection has proven to be the most effective strategy to reduce the incidence and mortality of colorectal cancer (CRC). Nevertheless, most current screening programs suffer from low participation rates. A blood test may improve both the adherence to screening and the selection to colonoscopy. In this study, we conducted a serum-based discovery and validation of cfDNA methylation biomarkers for CRC screening in a multicenter cohort of 433 serum samples including healthy controls, benign pathologies, advanced adenomas (AA), and CRC. RESULTS First, we performed an epigenome-wide methylation analysis with the MethylationEPIC array using a sample pooling approach, followed by a robust prioritization of candidate biomarkers for the detection of advanced neoplasia (AN: AA and CRC). Then, candidate biomarkers were validated by pyrosequencing in independent individual cfDNA samples. We report GALNT9, UPF3A, WARS, and LDB2 as new noninvasive biomarkers for the early detection of AN. The combination of GALNT9/UPF3A by logistic regression discriminated AN with 78.8% sensitivity and 100% specificity, outperforming the commonly used fecal immunochemical test and the methylated SEPT9 blood test. CONCLUSIONS Overall, this study highlights the utility of cfDNA methylation for CRC screening. Our results suggest that the combination methylated GALNT9/UPF3A has the potential to serve as a highly specific and sensitive blood-based test for screening and early detection of CRC.
Collapse
Affiliation(s)
- María Gallardo-Gómez
- CINBIO, Universidade de Vigo, Vigo, Spain
- Department of Biochemistry, Genetics and Immunology, CINBIO, Universidade de Vigo, Campus As Lagoas-Marcosende s/n. 36310, Vigo, Spain
- Translational Oncology Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Mar Rodríguez-Girondo
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Núria Planell
- Translational Bioinformatics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Sebastian Moran
- Cancer Epigenetics and Biology Program (PEBC), Bellvitge Biomedical Research Institute (IDIBELL), Avinguda de La Granvia, 199. 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Ane Etxart
- Department of Surgery, Hospital Universitario Donostia, San Sebastián, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Alicante, Spain
- Servicio de Medicina Digestiva. ISABIAL. Universidad Miguel Hernández, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Manel Esteller
- Josep Carreras Leukaemia Research Institute (IJC), Badalona, Barcelona, Catalonia, Spain
- Centro de Investigacion Biomedica en Red Cancer (CIBERONC), Madrid, Spain
- Institucio Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Catalonia, Spain
- Physiological Sciences Department, School of Medicine and Health Sciences, University of Barcelona (UB), Barcelona, Catalonia, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Biomédica Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain
| | - David Gómez-Cabrero
- Translational Bioinformatics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
- Biological & Environmental Sciences & Engineering Division, King Abdullah University of Science & Technology, Thuwal, Kingdom of Saudi Arabia
- Mucosal & Salivary Biology Division, King's College London Dental Institute, London, SE1 9RT, UK
| | - Loretta De Chiara
- CINBIO, Universidade de Vigo, Vigo, Spain.
- Department of Biochemistry, Genetics and Immunology, CINBIO, Universidade de Vigo, Campus As Lagoas-Marcosende s/n. 36310, Vigo, Spain.
- Translational Oncology Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.
- Cancer Genomics Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.
| |
Collapse
|
15
|
Abstract
Post-polypectomy surveillance has proven to reduce colorectal cancer (CRC) incidence in patients with high-risk polyps, but it implies a major burden on colonoscopy units. Therefore, it should be targeted to individuals with a higher risk. Different societies have published guidelines on surveillance after resection of polyps, with notable discrepancies among them, and many recommendations come from low-quality evidence based on surrogate measures, such as risk of advanced adenoma, and not CRC risk. In this review, we aimed to summarize the evidence supporting post-polypectomy surveillance, compare the recently updated major guidelines, and discuss the existing discrepancies on this topic. Briefly, patients with adenomas ≥10 mm or high-grade dysplasia and patients with serrated polyps ≥10 mm or dysplasia are generally considered to have an increased risk of metachronous CRC and require surveillance, whereas the indication of surveillance is not clearly established in patients without these high-risk features.
Collapse
Affiliation(s)
- Sandra Baile-Maxía
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| |
Collapse
|
16
|
González-López N, Quintero E, Gimeno-Garcia AZ, Bujanda L, Banales J, Cubiella J, Salve-Bouzo M, Herrero-Rivas JM, Cid-Delgado E, Alvarez-Sanchez V, Ledo-Rodríguez A, de-Castro-Parga ML, Fernández-Poceiro R, Sanromán-Álvarez L, Santiago-Garcia J, Herreros-de-Tejada A, Ocaña-Bombardo T, Balaguer F, Rodríguez-Soler M, Jover R, Ponce M, Alvarez-Urturi C, Bessa X, Roncales MP, Sopeña F, Lanas A, Nicolás-Pérez D, Adrián-de-Ganzo Z, Carrillo-Palau M, González-Dávila E. Screening uptake of colonoscopy versus fecal immunochemical testing in first-degree relatives of patients with non-syndromic colorectal cancer: A multicenter, open-label, parallel-group, randomized trial (ParCoFit study). PLoS Med 2023; 20:e1004298. [PMID: 37874831 PMCID: PMC10597530 DOI: 10.1371/journal.pmed.1004298] [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: 03/13/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Colonoscopy screening is underused by first-degree relatives (FDRs) of patients with non-syndromic colorectal cancer (CRC) with screening completion rates below 50%. Studies conducted in FDR referred for screening suggest that fecal immunochemical testing (FIT) was not inferior to colonoscopy in terms of diagnostic yield and tumor staging, but screening uptake of FIT has not yet been tested in this population. In this study, we investigated whether the uptake of FIT screening is superior to the uptake of colonoscopy screening in the familial-risk population, with an equivalent effect on CRC detection. METHODS AND FINDINGS This open-label, parallel-group, randomized trial was conducted in 12 Spanish centers between February 2016 and December 2021. Eligible individuals included asymptomatic FDR of index cases <60 years, siblings or ≥2 FDR with CRC. The primary outcome was to compare screening uptake between colonoscopy and FIT. The secondary outcome was to determine the efficacy of each strategy to detect advanced colorectal neoplasia (adenoma or serrated polyps ≥10 mm, polyps with tubulovillous architecture, high-grade dysplasia, and/or CRC). Screening-naïve FDR were randomized (1:1) to one-time colonoscopy versus annual FIT during 3 consecutive years followed by a work-up colonoscopy in the case of a positive test. Randomization was performed before signing the informed consent using computer-generated allocation algorithm based on stratified block randomization. Multivariable regression analysis was performed by intention-to-screen. On December 31, 2019, when 81% of the estimated sample size was reached, the trial was terminated prematurely after an interim analysis for futility. Study outcomes were further analyzed through 2-year follow-up. The main limitation of this study was the impossibility of collecting information on eligible individuals who declined to participate. A total of 1,790 FDR of 460 index cases were evaluated for inclusion, of whom 870 were assigned to undergo one-time colonoscopy (n = 431) or FIT (n = 439). Of them, 383 (44.0%) attended the appointment and signed the informed consent: 147/431 (34.1%) FDR received colonoscopy-based screening and 158/439 (35.9%) underwent FIT-based screening (odds ratio [OR] 1.08; 95% confidence intervals [CI] [0.82, 1.44], p = 0.564). The detection rate of advanced colorectal neoplasia was significantly higher in the colonoscopy group than in the FIT group (OR 3.64, 95% CI [1.55, 8.53], p = 0.003). Study outcomes did not change throughout follow-up. CONCLUSIONS In this study, compared to colonoscopy, FIT screening did not improve screening uptake by individuals at high risk of CRC, resulting in less detection of advanced colorectal neoplasia. Further studies are needed to assess how screening uptake could be improved in this high-risk group, including by inclusion in population-based screening programs. TRIAL REGISTRATION This trial was registered with ClinicalTrials.gov (NCT02567045).
Collapse
Affiliation(s)
- Natalia González-López
- Department of Gastroenterology of Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Enrique Quintero
- Department of Gastroenterology of Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
- Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Antonio Z. Gimeno-Garcia
- Department of Gastroenterology of Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
- Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Universidad de La Laguna, La Laguna, Tenerife, Spain
| | - Luis Bujanda
- Department of Gastroenterology of Hospital Universitario Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Jesús Banales
- Department of Gastroenterology of Hospital Universitario Donostia, Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- Department of Biochemistry and Genetics, School of Sciences, University of Navarra, Pamplona, Spain
| | - Joaquin Cubiella
- Department of Gastroenterology, Hospital Universitario de Ourense, Ourense, Spain
| | - María Salve-Bouzo
- Department of Gastroenterology, Hospital Universitario de Ourense, Ourense, Spain
| | | | - Estela Cid-Delgado
- Department of Gastroenterology, Hospital Universitario de Ourense, Ourense, Spain
| | | | | | | | | | | | - Jose Santiago-Garcia
- IDIPHISA, Department of Gastroenterology of Hospital Universitario Puerta de Hierro-Majadahonda o, Madrid, Spain
| | - Alberto Herreros-de-Tejada
- IDIPHISA, Department of Gastroenterology of Hospital Universitario Puerta de Hierro-Majadahonda o, Madrid, Spain
| | - Teresa Ocaña-Bombardo
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBEREHD), IDIBAPS (Institut d’Investigacions Biomèdiques August Pi i Sunyer), University of Barcelona, Barcelona, Spain
| | - María Rodríguez-Soler
- Department of Gastroenterology, Instituto de Investigación Sanitaria ISABIAL, Hospital General Universitario Dr. Balmis, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Instituto de Investigación Sanitaria ISABIAL, Hospital General Universitario Dr. Balmis, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Marta Ponce
- Department of Gastroenterology of Hospital Universitario La Fe de Valencia, Valencia, Spain
| | - Cristina Alvarez-Urturi
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Xavier Bessa
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Maria-Pilar Roncales
- Department of Gastroenterology of Hospital Universitario Lozano Blesa de Zaragoza, IIS Aragón. CIBERehd, Zaragoza, Spain
| | - Federico Sopeña
- Department of Gastroenterology of Hospital Universitario Lozano Blesa de Zaragoza, IIS Aragón. CIBERehd, Zaragoza, Spain
| | - Angel Lanas
- Department of Gastroenterology of Hospital Universitario Lozano Blesa de Zaragoza, IIS Aragón. CIBERehd, Zaragoza, Spain
| | - David Nicolás-Pérez
- Department of Gastroenterology of Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Zaida Adrián-de-Ganzo
- Department of Gastroenterology of Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology of Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | - Enrique González-Dávila
- Departamento de Matemáticas, Estadística e Investigación Operativa, Instituto IMAULL, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | | |
Collapse
|
17
|
Mangas-Sanjuan C, de-Castro L, Cubiella J, Díez-Redondo P, Suárez A, Pellisé M, Fernández N, Zarraquiños S, Núñez-Rodríguez H, Álvarez-García V, Ortiz O, Sala-Miquel N, Zapater P, Jover R. Role of Artificial Intelligence in Colonoscopy Detection of Advanced Neoplasias : A Randomized Trial. Ann Intern Med 2023; 176:1145-1152. [PMID: 37639723 DOI: 10.7326/m22-2619] [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: 08/31/2023] Open
Abstract
BACKGROUND The role of computer-aided detection in identifying advanced colorectal neoplasia is unknown. OBJECTIVE To evaluate the contribution of computer-aided detection to colonoscopic detection of advanced colorectal neoplasias as well as adenomas, serrated polyps, and nonpolypoid and right-sided lesions. DESIGN Multicenter, parallel, randomized controlled trial. (ClinicalTrials.gov: NCT04673136). SETTING Spanish colorectal cancer screening program. PARTICIPANTS 3213 persons with a positive fecal immunochemical test. INTERVENTION Enrollees were randomly assigned to colonoscopy with or without computer-aided detection. MEASUREMENTS Advanced colorectal neoplasia was defined as advanced adenoma and/or advanced serrated polyp. RESULTS The 2 comparison groups showed no significant difference in advanced colorectal neoplasia detection rate (34.8% with intervention vs. 34.6% for controls; adjusted risk ratio [aRR], 1.01 [95% CI, 0.92 to 1.10]) or the mean number of advanced colorectal neoplasias detected per colonoscopy (0.54 [SD, 0.95] with intervention vs. 0.52 [SD, 0.95] for controls; adjusted rate ratio, 1.04 [99.9% CI, 0.88 to 1.22]). Adenoma detection rate also did not differ (64.2% with intervention vs. 62.0% for controls; aRR, 1.06 [99.9% CI, 0.91 to 1.23]). Computer-aided detection increased the mean number of nonpolypoid lesions (0.56 [SD, 1.25] vs. 0.47 [SD, 1.18] for controls; adjusted rate ratio, 1.19 [99.9% CI, 1.01 to 1.41]), proximal adenomas (0.94 [SD, 1.62] vs. 0.81 [SD, 1.52] for controls; adjusted rate ratio, 1.17 [99.9% CI, 1.03 to 1.33]), and lesions of 5 mm or smaller (polyps in general and adenomas and serrated lesions in particular) detected per colonoscopy. LIMITATIONS The high adenoma detection rate in the control group may limit the generalizability of the findings to endoscopists with low detection rates. CONCLUSION Computer-aided detection did not improve colonoscopic identification of advanced colorectal neoplasias. PRIMARY FUNDING SOURCE Medtronic.
Collapse
Affiliation(s)
- Carolina Mangas-Sanjuan
- Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Spain (C.M., N.S.)
| | - Luisa de-Castro
- Department of Gastroenterology, Hospital Álvaro Cunqueiro, Digestive Pathology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain (L. de-C., N.F.)
| | - Joaquín Cubiella
- Department of Gastroenterology, Hospital Universitario de Ourense, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain (J.C., S.Z.)
| | - Pilar Díez-Redondo
- Department of Gastroenterology, Hospital Río-Hortega, Valladolid, Spain (P.D., H.N.)
| | - Adolfo Suárez
- Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain (A.S., V.A.)
| | - María Pellisé
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain (M.P., O.O.)
| | - Nereida Fernández
- Department of Gastroenterology, Hospital Álvaro Cunqueiro, Digestive Pathology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain (L. de-C., N.F.)
| | - Sara Zarraquiños
- Department of Gastroenterology, Hospital Universitario de Ourense, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Ourense, Spain (J.C., S.Z.)
| | - Henar Núñez-Rodríguez
- Department of Gastroenterology, Hospital Río-Hortega, Valladolid, Spain (P.D., H.N.)
| | | | - Oswaldo Ortiz
- Department of Gastroenterology, Hospital Clínic Barcelona, Barcelona, Spain (M.P., O.O.)
| | - Noelia Sala-Miquel
- Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Spain (C.M., N.S.)
| | - Pedro Zapater
- Hospital General Universitario Dr. Balmis, Clinical Pharmacology Department, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Departamento de Farmacología, Universidad Miguel Hernández, Alicante, CIBERehd, Spain (P.Z.)
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario Dr. Balmis, Servicio de Medicina Digestiva, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain (R.J.)
| |
Collapse
|
18
|
Hassan C, Spadaccini M, Mori Y, Foroutan F, Facciorusso A, Gkolfakis P, Tziatzios G, Triantafyllou K, Antonelli G, Khalaf K, Rizkala T, Vandvik PO, Fugazza A, Rondonotti E, Glissen-Brown JR, Kamba S, Maida M, Correale L, Bhandari P, Jover R, Sharma P, Rex DK, Repici A. Real-Time Computer-Aided Detection of Colorectal Neoplasia During Colonoscopy : A Systematic Review and Meta-analysis. Ann Intern Med 2023; 176:1209-1220. [PMID: 37639719 DOI: 10.7326/m22-3678] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 08/31/2023] Open
Abstract
BACKGROUND Artificial intelligence computer-aided detection (CADe) of colorectal neoplasia during colonoscopy may increase adenoma detection rates (ADRs) and reduce adenoma miss rates, but it may increase overdiagnosis and overtreatment of nonneoplastic polyps. PURPOSE To quantify the benefits and harms of CADe in randomized trials. DESIGN Systematic review and meta-analysis. (PROSPERO: CRD42022293181). DATA SOURCES Medline, Embase, and Scopus databases through February 2023. STUDY SELECTION Randomized trials comparing CADe-assisted with standard colonoscopy for polyp and cancer detection. DATA EXTRACTION Adenoma detection rate (proportion of patients with ≥1 adenoma), number of adenomas detected per colonoscopy, advanced adenoma (≥10 mm with high-grade dysplasia and villous histology), number of serrated lesions per colonoscopy, and adenoma miss rate were extracted as benefit outcomes. Number of polypectomies for nonneoplastic lesions and withdrawal time were extracted as harm outcomes. For each outcome, studies were pooled using a random-effects model. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. DATA SYNTHESIS Twenty-one randomized trials on 18 232 patients were included. The ADR was higher in the CADe group than in the standard colonoscopy group (44.0% vs. 35.9%; relative risk, 1.24 [95% CI, 1.16 to 1.33]; low-certainty evidence), corresponding to a 55% (risk ratio, 0.45 [CI, 0.35 to 0.58]) relative reduction in miss rate (moderate-certainty evidence). More nonneoplastic polyps were removed in the CADe than the standard group (0.52 vs. 0.34 per colonoscopy; mean difference [MD], 0.18 polypectomy [CI, 0.11 to 0.26 polypectomy]; low-certainty evidence). Mean inspection time increased only marginally with CADe (MD, 0.47 minute [CI, 0.23 to 0.72 minute]; moderate-certainty evidence). LIMITATIONS This review focused on surrogates of patient-important outcomes. Most patients, however, may consider cancer incidence and cancer-related mortality important outcomes. The effect of CADe on such patient-important outcomes remains unclear. CONCLUSION The use of CADe for polyp detection during colonoscopy results in increased detection of adenomas but not advanced adenomas and in higher rates of unnecessary removal of nonneoplastic polyps. PRIMARY FUNDING SOURCE European Commission Horizon 2020 Marie Skłodowska-Curie Individual Fellowship.
Collapse
Affiliation(s)
- Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (C.H., M.S., A.R.)
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (C.H., M.S., A.R.)
| | - Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway, and Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan (Y.M.)
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada (F.F.)
| | - Antonio Facciorusso
- Department of Medical Sciences, Section of Gastroenterology, University of Foggia, Foggia, Italy (A.Facciorusso)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium (P.G.)
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece (G.T., K.T.)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece (G.T., K.T.)
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, and Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Rome, Italy (G.A.)
| | - Kareem Khalaf
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (K.K., T.R.)
| | - Tommy Rizkala
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy (K.K., T.R.)
| | - Per Olav Vandvik
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway (P.O.V.)
| | - Alessandro Fugazza
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (A.Fugazza, L.C.)
| | | | - Jeremy R Glissen-Brown
- Center for Advanced Endoscopy, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts (J.R.G.)
| | - Shunsuke Kamba
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan (S.K.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy (M.M.)
| | - Loredana Correale
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (A.Fugazza, L.C.)
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, United Kingdom (P.B.)
| | - Rodrigo Jover
- Departamento de Medicina Clínica, Servicio de Gastroenterología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica de Alicante ISABIAL, Universidad Miguel Hernández, Alicante, Spain (R.J.)
| | - Prateek Sharma
- Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri (P.S.)
| | - Douglas K Rex
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana (D.K.R.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, and Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy (C.H., M.S., A.R.)
| |
Collapse
|
19
|
Bonjoch L, Fernandez-Rozadilla C, Alvarez-Barona M, Lopez-Novo A, Herrera-Pariente C, Amigo J, Bujanda L, Remedios D, Dacal A, Cubiella J, Balaguer F, Fernández-Bañares F, Carracedo A, Jover R, Castellvi-Bel S, Ruiz-Ponte C. BMPR2 as a Novel Predisposition Gene for Hereditary Colorectal Polyposis. Gastroenterology 2023; 165:162-172.e5. [PMID: 36907526 DOI: 10.1053/j.gastro.2023.03.006] [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: 11/08/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND & AIMS Colorectal cancer (CRC) is one of the most prevalent tumors worldwide, with incidence quickly increasing (particularly in the context of early-onset cases), despite important prevention efforts, mainly in the form of population-wide screening programs. Although many cases present a clear familial component, the current list of hereditary CRC genes leaves a considerable proportion of the cases unexplained. METHODS In this work, we used whole-exome sequencing approaches on 19 unrelated patients with unexplained colonic polyposis to identify candidate CRC predisposition genes. The candidate genes were then validated in an additional series of 365 patients. CRISPR-Cas9 models were used to validate BMPR2 as a potential candidate for CRC risk. RESULTS We found 8 individuals carrying 6 different variants in the BMPR2 gene (approximately 2% of our cohort of patients with unexplained colonic polyposis). CRISPR-Cas9 models of 3 of these variants showed that the p.(Asn442Thrfs∗32) truncating variant completely abrogated BMP pathway function in a similar way to the BMPR2 knockout. Missense variants p.(Asn565Ser), p.(Ser967Pro) had varying effects on cell proliferation levels, with the former impairing cell control inhibition via noncanonical pathways. CONCLUSIONS Collectively, these results support loss-of-function BMPR2 variants as candidates to be involved in CRC germline predisposition.
Collapse
Affiliation(s)
- Laia Bonjoch
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ceres Fernandez-Rozadilla
- Instituto de Investigacion Sanitaria de Santiago, Grupo de Medicina Xenomica, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Miriam Alvarez-Barona
- Instituto de Investigacion Sanitaria de Santiago, Grupo de Medicina Xenomica, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Anael Lopez-Novo
- Instituto de Investigacion Sanitaria de Santiago, Grupo de Medicina Xenomica, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain
| | - Cristina Herrera-Pariente
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Jorge Amigo
- Instituto de Investigacion Sanitaria de Santiago, Grupo de Medicina Xenomica, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Luis Bujanda
- Hospital Universitario de Donostia, Instituto Biodonostia, Universidad del Pais Vasco, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, San Sebastián, Spain
| | - David Remedios
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Ourense, Spain
| | - Andrés Dacal
- Department of Gastroenterology, Hospital Lucus Augusti, Lugo, Spain; Instituto de Investigación Sanitaria de Santiago, Santiago de Compostela, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Ourense, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Bañares
- Hospital Universitari Mutua Terrassa, Barcelona, Spain; Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas, Ourense, Madrid, Spain
| | - Angel Carracedo
- Instituto de Investigacion Sanitaria de Santiago, Grupo de Medicina Xenomica, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
| | - Rodrigo Jover
- Digestive Medicine Department, Instituto de Investigación Biomédica, Hospital General Universitario de Alicante, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Sergi Castellvi-Bel
- Gastroenterology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas, Hospital Clinic, University of Barcelona, Barcelona, Spain.
| | - Clara Ruiz-Ponte
- Instituto de Investigacion Sanitaria de Santiago, Grupo de Medicina Xenomica, Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.
| |
Collapse
|
20
|
Bujanda-Miguel G, Martínez-Roca A, García-Heredia A, Guill-Berbegal D, Roche E, Jover R. Adherence to Mediterranean diet and its association with multiple colonic polyps of unknown origin: a case-control study. Front Nutr 2023; 10:1186808. [PMID: 37426188 PMCID: PMC10324649 DOI: 10.3389/fnut.2023.1186808] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Multiple colonic polyps do not have a genetic origin in most patients, and the cause of this phenotype remains elusive. Environmental factors, such as diet, could be related to this phenotype. Our aim was to investigate the relationship between the adherence to Mediterranean diet and multiple colonic polyps of unknown origin. Methods A case-control pilot study was carried out with a sample of 38 individuals, including 23 cases with more than 10 adenomatous or serrated polyps from the national multicenter project EPIPOLIP and 15 healthy controls with normal colonoscopy. A validated Spanish version of the MEDAS questionnaire was administered to cases and controls. Results Adherence to Mediterranean diet was higher in controls than in patients with multiple colonic polyps (MEDAS score: 8.6 ± 1.4 vs. 7.0 ± 1.6; p = 0.01). Optimal overall adherence to the Mediterranean diet pattern was significantly higher among the controls than among cases (MEDAS score >9: 46% vs. 13%; OR 0.17; 95% CI 0.03-0.83). Non-optimal adherence to the Mediterranean diet acts as a risk factor for developing colorectal cancer derived from colorectal polyps. Conclusion Our results suggest that environmental factors play a role in the pathogenesis of this phenotype.
Collapse
Affiliation(s)
- Gabriela Bujanda-Miguel
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Alejandro Martínez-Roca
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Anabel García-Heredia
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - David Guill-Berbegal
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Enrique Roche
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
- Department of Applied Biology-Nutrition, Institute of Bioengineering, University Miguel Hernández, Elche, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
- Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| |
Collapse
|
21
|
Baile-Maxía S, Mangas-Sanjuán C, Ladabaum U, Hassan C, Rutter MD, Bretthauer M, Medina-Prado L, Sala-Miquel N, Pomares OM, Zapater P, Jover R. Risk Factors for Metachronous Colorectal Cancer or Advanced Adenomas After Endoscopic Resection of High-risk Adenomas. Clin Gastroenterol Hepatol 2023; 21:630-643. [PMID: 36549471 DOI: 10.1016/j.cgh.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/24/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS Among the characteristics of high-risk adenomas (HRAs), some may predict a higher risk of metachronous advanced lesions. Our aim was to assess which HRA characteristics are associated with high risk of metachronous colorectal cancer (CRC) or advanced adenomas (AAs). METHODS We systematically searched Pubmed, EMBASE, and Cochrane for cohort studies and clinical trials of CRC or AA incidence at surveillance stratified by baseline lesion size, histology, and multiplicity. We calculated pooled relative risks (RRs) using a random-effects model. Heterogeneity was assessed with the I2 statistic. RESULTS Fifty-five studies were included, with 936,540 patients with mean follow-up 5.4 ± 2.9 years. CRC incidence per 1000 person-years was 2.6 (2.1-3.0) for adenomas ≥20 mm, 2.7 (2.2-3.2) for high-grade dysplasia (HGD), 2.0 (1.8-2.3) for villous component, 0.8 (0.1-1.4) for ≥5 adenomas, 1.0 (0.7-1.2) for ≥3 adenomas. Metachronous CRC risk was higher in adenomas ≥20 mm vs 10 to 19 mm (RR, 2.08; 95% confidence interval [CI], 1.20-3.61), HGD vs low-grade dysplasia (RR, 2.89; 95% CI, 1.88-4.44), villous vs tubular (RR, 1.75; 95% CI, 1.33-2.31). No significant differences in CRC risk were found in ≥3 adenomas vs 1 to 2 (RR, 1.24; 95% CI, 0.84-1.83), nor in ≥5 adenomas vs 3 to 4 (RR, 0.79; 95% CI, 0.30-2.11). Compared with normal colonoscopy, RR for CRC risk was 2.61 (95% CI, 2.06-3.32) for ≥10mm, 6.62 (95% CI, 4.60-9.52) for HGD, 3.58 (95% CI, 2.24-5.73) for villous component, and 2.03 (95% CI, 1.40-2.94) for ≥3 adenomas. Similar trends were seen for metachronous AAs. CONCLUSION Metachronous CRC risk is highest in patients with baseline adenomas with ≥20 mm or HGD. Multiplicity does not seem to be associated with substantially higher CRC risk in the near term.
Collapse
Affiliation(s)
- Sandra Baile-Maxía
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Carolina Mangas-Sanjuán
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Milan, Italy
| | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-On-Tees, Cleveland, Yorkshire, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Lucía Medina-Prado
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Noelia Sala-Miquel
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Oscar Murcia Pomares
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmacology Department, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, CIBERehd, Alicante, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| |
Collapse
|
22
|
Alustiza M, Ripoll L, Canals A, Murcia O, Martínez-Roca A, García-Heredia A, Giner-Calabuig M, Jover R, Vidal L. A novel non-invasive colorectal cancer diagnostic method: Volatile organic compounds as biomarkers. Clin Chim Acta 2023; 542:117273. [PMID: 36863694 DOI: 10.1016/j.cca.2023.117273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Population-based fecal tests for colorectal cancer (CRC) screening have shown to reduce mortality thanks to the early detection of the disease. However, currently available fecal tests are limited in their sensitivity and specificity. Our aim is to look for volatile organic compounds in fecal samples as biomarkers for CRC detection. MATERIAL AND METHODS Eighty participants were included; 24 had adenocarcinoma, 24 had adenomatous polyps and 32 presented no neoplasms. Fecal samples were collected 48 h preceding the colonoscopy from all participants, except CRC patient samples that were collected after 3-4 weeks from the colonoscopy. Magnetic headspace adsorptive extraction (Mag-HSAE) followed by thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS) was performed on stool samples to identify volatile organic compounds as biomarkers. RESULTS p-Cresol was significantly more abundant in the cancer samples (P < 0.001) with an area under the curve (AUC) of 0.85 (CI 95%; 0.737-0.953), having a sensitivity and specificity of 83% and 82%, respectively. In addition, 3(4H)-dibenzofuranone,4a,9b-dihydro-8,9b-dimethyl- (3(4H)-DBZ) was also more abundant in the cancer samples (P < 0.001) with an AUC of 0.77 (CI 95%; 0.635-0.905), sensitivity of 78% and specificity of 75%. When combined (p-cresol and 3(4H)-DBZ), the AUC was 0.86, sensitivity 87% and specificity 79%. p-Cresol also appeared to be promising as a biomarker for pre-malignant lesions with an AUC of 0.69 (CI 95%; 0.534-0.862), sensitivity 83% and specificity 63%, P = 0.045. CONCLUSIONS Volatile organic compounds emitted from feces and determined by a sensitive analytical methodology (Mag-HSAE-TD-GC-MS), employing a magnetic graphene oxide as extractant phase, could be used as a potential screening technology for CRC and pre-malignant lesions.
Collapse
Affiliation(s)
- Miren Alustiza
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Laura Ripoll
- Departamento de Química Analítica, Nutrición y Bromatología e Instituto Universitario de Materiales, Universidad de Alicante, P.O. Box 99, 03080 Alicante, Spain
| | - Antonio Canals
- Departamento de Química Analítica, Nutrición y Bromatología e Instituto Universitario de Materiales, Universidad de Alicante, P.O. Box 99, 03080 Alicante, Spain
| | - Oscar Murcia
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Alejandro Martínez-Roca
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Anabel García-Heredia
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Mar Giner-Calabuig
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Lorena Vidal
- Laboratorio de Investigación, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain; Departamento de Química Analítica, Nutrición y Bromatología e Instituto Universitario de Materiales, Universidad de Alicante, P.O. Box 99, 03080 Alicante, Spain.
| |
Collapse
|
23
|
Messmann H, Bisschops R, Antonelli G, Libânio D, Sinonquel P, Abdelrahim M, Ahmad OF, Areia M, Bergman JJGHM, Bhandari P, Boskoski I, Dekker E, Domagk D, Ebigbo A, Eelbode T, Eliakim R, Häfner M, Haidry RJ, Jover R, Kaminski MF, Kuvaev R, Mori Y, Palazzo M, Repici A, Rondonotti E, Rutter MD, Saito Y, Sharma P, Spada C, Spadaccini M, Veitch A, Gralnek IM, Hassan C, Dinis-Ribeiro M. Expected value of artificial intelligence in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2022; 54:1211-1231. [PMID: 36270318 DOI: 10.1055/a-1950-5694] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This ESGE Position Statement defines the expected value of artificial intelligence (AI) for the diagnosis and management of gastrointestinal neoplasia within the framework of the performance measures already defined by ESGE. This is based on the clinical relevance of the expected task and the preliminary evidence regarding artificial intelligence in artificial or clinical settings. MAIN RECOMMENDATIONS:: (1) For acceptance of AI in assessment of completeness of upper GI endoscopy, the adequate level of mucosal inspection with AI should be comparable to that assessed by experienced endoscopists. (2) For acceptance of AI in assessment of completeness of upper GI endoscopy, automated recognition and photodocumentation of relevant anatomical landmarks should be obtained in ≥90% of the procedures. (3) For acceptance of AI in the detection of Barrett's high grade intraepithelial neoplasia or cancer, the AI-assisted detection rate for suspicious lesions for targeted biopsies should be comparable to that of experienced endoscopists with or without advanced imaging techniques. (4) For acceptance of AI in the management of Barrett's neoplasia, AI-assisted selection of lesions amenable to endoscopic resection should be comparable to that of experienced endoscopists. (5) For acceptance of AI in the diagnosis of gastric precancerous conditions, AI-assisted diagnosis of atrophy and intestinal metaplasia should be comparable to that provided by the established biopsy protocol, including the estimation of extent, and consequent allocation to the correct endoscopic surveillance interval. (6) For acceptance of artificial intelligence for automated lesion detection in small-bowel capsule endoscopy (SBCE), the performance of AI-assisted reading should be comparable to that of experienced endoscopists for lesion detection, without increasing but possibly reducing the reading time of the operator. (7) For acceptance of AI in the detection of colorectal polyps, the AI-assisted adenoma detection rate should be comparable to that of experienced endoscopists. (8) For acceptance of AI optical diagnosis (computer-aided diagnosis [CADx]) of diminutive polyps (≤5 mm), AI-assisted characterization should match performance standards for implementing resect-and-discard and diagnose-and-leave strategies. (9) For acceptance of AI in the management of polyps ≥ 6 mm, AI-assisted characterization should be comparable to that of experienced endoscopists in selecting lesions amenable to endoscopic resection.
Collapse
Affiliation(s)
- Helmut Messmann
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, Italy
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pieter Sinonquel
- Department of Gastroenterology and Hepatology, Catholic University of Leuven (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Mohamed Abdelrahim
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Omer F Ahmad
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London Hospital, London, UK
- Division of Surgery and Interventional Sciences, University College London Hospital, London, UK
- Gastrointestinal Services, University College London Hospital, London, UK
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | | | - Pradeep Bhandari
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Ivo Boskoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Dirk Domagk
- Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany
| | - Alanna Ebigbo
- III Medizinische Klinik, Universitatsklinikum Augsburg, Augsburg, Germany
| | - Tom Eelbode
- Department of Electrical Engineering (ESAT/PSI), Medical Imaging Research Center, KU Leuven, Leuven, Belgium
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center Tel Hashomer & Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Michael Häfner
- 2nd Medical Department, Barmherzige Schwestern Krankenhaus, Vienna, Austria
| | - Rehan J Haidry
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London Hospital, London, UK
- Division of Surgery and Interventional Sciences, University College London Hospital, London, UK
| | - Rodrigo Jover
- Servicio de Gastroenterología, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica de Alicante ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Michal F Kaminski
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Oncological Gastroenterology and Department of Cancer Prevention, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation
- Department of Gastroenterology, Faculty of Additional Professional Education, N.A. Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Yuichi Mori
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Matthew D Rutter
- North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Prateek Sharma
- Gastroenterology and Hepatology Division, University of Kansas School of Medicine, Kansas, USA
- Kansas City VA Medical Center, Kansas City, USA
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Digestive Endoscopy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Marco Spadaccini
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrew Veitch
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| |
Collapse
|
24
|
Juul FE, Garborg K, Nesbakken E, Løberg M, Wieszczy P, Cubiella J, Kalager M, Kaminski MF, Erichsen R, Adami HO, Ferlitsch M, Furholm SKB, Zauber AG, Quintero E, Bugajski M, Holme Ø, Dekker E, Jover R, Bretthauer M. Rates of repeated colonoscopies to clean the colon from low-risk and high-risk adenomas: results from the EPoS trials. Gut 2022; 72:951-957. [PMID: 36307178 DOI: 10.1136/gutjnl-2022-327696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/20/2022] [Indexed: 12/08/2022]
Abstract
OBJECTIVE High-quality colonoscopy (adequate bowel preparation, whole-colon visualisation and removal of all neoplastic polyps) is a prerequisite to start polyp surveillance, and is ideally achieved in one colonoscopy. In a large multinational polyp surveillance trial, we aimed to investigate clinical practice variation in number of colonoscopies needed to enrol patients with low-risk and high-risk adenomas in polyp surveillance. DESIGN We retrieved data of all patients with low-risk adenomas (one or two tubular adenomas <10 mm with low-grade dysplasia) and high-risk adenomas (3-10 adenomas, ≥1 adenoma ≥10 mm, high-grade dysplasia or villous components) in the European Polyp Surveillance trials fulfilling certain logistic and methodologic criteria. We analysed variations in number of colonoscopies needed to achieve high-quality colonoscopy and enter polyp surveillance by endoscopy centre, and by endoscopists who enrolled ≥30 patients. RESULTS The study comprised 15 581 patients from 38 endoscopy centres in five European countries; 6794 patients had low-risk and 8787 had high-risk adenomas. 961 patients (6.2%, 95% CI 5.8% to 6.6%) underwent two or more colonoscopies before surveillance began; 101 (1.5%, 95% CI 1.2% to 1.8%) in the low-risk group and 860 (9.8%, 95% CI 9.2% to 10.4%) in the high-risk group. Main reasons were poor bowel preparation (21.3%) or incomplete colonoscopy/polypectomy (14.4%) or planned second procedure (27.8%). Need of repeat colonoscopy varied between study centres ranging from 0% to 11.8% in low-risk adenoma patients and from 0% to 63.9% in high-risk adenoma patients. On the second colonoscopy, the two most common reasons for a repeat (third) colonoscopy were piecemeal resection (26.5%) and unspecified reason (23.9%). CONCLUSION There is considerable practice variation in the number of colonoscopies performed to achieve complete polyp removal, indicating need for targeted quality improvement to reduce patient burden. TRIAL REGISTRATION NUMBER NCT02319928.
Collapse
Affiliation(s)
- Frederik Emil Juul
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Kjetil Garborg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Eugen Nesbakken
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Magnus Løberg
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Paulina Wieszczy
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Joaquín Cubiella
- Gastroenterology, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Mette Kalager
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| | - Michael F Kaminski
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway.,Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Hans-Olov Adami
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Monika Ferlitsch
- Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Siv K B Furholm
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Enrique Quintero
- Facultad de Medicina, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Marek Bugajski
- Maria Sklodowska-Curie National Research Institute of Oncology, Warszawa, Poland
| | - Øyvind Holme
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway.,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway.,Department of Gastroenterology, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Evelien Dekker
- Dept of Gastroenterology and Hepatology C2-115, Amsterdam University Medical Centres, Duivendrecht, Netherlands.,Bergman Clinics IZA, Amsterdam, The Netherlands
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Alicante, Valenciana, Spain.,Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Universidad Miguel Hernández, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway .,Clinical Effectiveness Research Group, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
25
|
Mangas‐Sanjuan C, Seoane A, Alvarez‐Gonzalez MA, Luè A, Suárez A, Álvarez‐García V, Bujanda L, Portillo I, González N, Cid‐Gomez L, Cubiella J, Rodríguez‐Camacho E, Ponce M, Díez‐Redondo P, Herráiz M, Pellisé M, Ono A, Baile‐Maxía S, Medina‐Prado L, O M, Zapater P, Jover R. Factors associated with lesion detection in colonoscopy among different indications. United European Gastroenterol J 2022; 10:1008-1019. [PMID: 36300971 PMCID: PMC9731659 DOI: 10.1002/ueg2.12325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/13/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Different factors may influence colonoscopy performance measures. We aimed to analyze procedure- and endoscopist-related factors associated with detection of colorectal lesions and whether these factors have a similar influence in the context of different colonoscopy indications: positive fecal immunochemical test (+FIT) and post-polypectomy surveillance colonoscopies. METHODS This multicenter cross-sectional study included adults aged 40-80 years. Endoscopists (N = 96) who had performed ≥50 examinations were assessed for physician-related factors. Adenoma detection rate (ADR), adenomas per colonoscopy rate (APCR), advanced ADR, serrated polyp detection (SDR), and serrated polyps per colonoscopy rate (SPPCR) were calculated. RESULTS We included 12,932 procedures, with 4810 carried out after a positive FIT and 1967 for surveillance. Of the 96 endoscopists evaluated, 43.8% were women, and the mean age was 41.9 years. The ADR, advanced ADR, and SDR were 39.7%, 17.7%, and 12.8%, respectively. Adenoma detection rate was higher in colonoscopies after a +FIT (50.3%) with a more than doubled advanced ADR compared to non-FIT procedures (27.6% vs. 13.0%) and similar results in serrated lesions (14.7% vs. 13.5%). Among all the detection indicators analyzed, withdrawal time was the only factor independently related to improvement (p < 0.001). Regarding FIT-positive and surveillance procedures, for both indications, withdrawal time was also the only factor associated with a higher detection of adenomas and serrated polyps (p < 0.001). Endoscopist-related factors (i.e., weekly hours dedicated to endoscopy, annual colonoscopy volume and lifetime number of colonoscopies performed) had also impact on lesion detection (APCR, advanced ADR and SPPCR). CONCLUSIONS Withdrawal time was the factor most commonly associated with improved detection of colonic lesions globally and in endoscopies for + FIT and post-polypectomy surveillance. Physician-related factors may help to address strategies to support training and service provision. Our results can be used for establishing future benchmarking and quality improvement in different colonoscopy indications.
Collapse
Affiliation(s)
- Carolina Mangas‐Sanjuan
- Department of GastroenterologyHospital General Universitario de AlicanteInstituto de Investigación Sanitaria y Biomédica de Alicante, ISABIALAlicanteSpain
| | - Agustin Seoane
- Department of GastroenterologyParc de Salut MarHospital del MarBarcelonaSpain
| | | | - Alberto Luè
- Department of GastroenterologyHospital Clínico Universitario Lozano BlesaAragon Health Research InstituteIIS AragonZaragozaSpain
| | - Adolfo Suárez
- Department of GastroenterologyHospital Universitario Central de AsturiasOviedoSpain
| | | | - Luis Bujanda
- Department of GastroenterologyBiodonostia Medical Research InstituteSan SebastiánSpain
| | - Isabel Portillo
- Basque Country Colorectal Cancer Screening ProgrammeOsakidetza, Basque Health ServiceBilbaoSpain
| | - Natalia González
- Department of GastroenterologyHospital Universitario de CanariasInstituto Universitario de Tecnologías Biomédicas & Centro de Investigación Biomédica de Canarias (CIBICAN)Santa Cruz de TenerifeSpain
| | - Lucía Cid‐Gomez
- Department of GastroenterologyComplexo Hospitalario Universitario de VigoInstituto de Investigación BiomédicaXerencia de Xestión Integrada de VigoVigoSpain
| | - Joaquín Cubiella
- Department of GastroenterologyComplexo Hospitalario de OurenseInstituto de Investigación Biomédica de OurensePontevedra y VigoOurenseSpain
| | | | - Marta Ponce
- Department of GastroenterologyHospital Universitario La FeValenciaSpain
| | | | - Maite Herráiz
- Department of GastroenterologyClínica Universitaria and Medical SchoolUniversity of NavarraNavarraSpain
| | - María Pellisé
- Department of GastroenterologyHospital ClínicCIBERehdIDIBAPSUniversity of BarcelonaBarcelonaSpain
| | - Akiko Ono
- Unidad de Gestión Clínica de DigestivoHospital Universitario Virgen de la ArrixacaInstituto Murciano de Investigación BiosanitariaMurciaSpain
| | - S. Baile‐Maxía
- Department of GastroenterologyHospital General Universitario de AlicanteInstituto de Investigación Sanitaria y Biomédica de Alicante, ISABIALAlicanteSpain
| | - L. Medina‐Prado
- Department of GastroenterologyHospital General Universitario de AlicanteInstituto de Investigación Sanitaria y Biomédica de Alicante, ISABIALAlicanteSpain
| | - Murcia O
- Department of GastroenterologyHospital General Universitario de AlicanteInstituto de Investigación Sanitaria y Biomédica de Alicante, ISABIALAlicanteSpain
| | - Pedro Zapater
- Unit of Clinical PharmacologyHospital General Universitario de AlicanteInstituto de Investigación Sanitaria y Biomédica de Alicante, ISABIALAlicanteSpain
| | - Rodrigo Jover
- Department of GastroenterologyHospital General Universitario de AlicanteInstituto de Investigación Sanitaria y Biomédica de Alicante, ISABIALAlicanteSpain
| | | |
Collapse
|
26
|
De Chiara L, Barcia-Castro L, Gallardo-Gómez M, Páez de la Cadena M, Martínez-Zorzano VS, Rodríguez-Berrocal FJ, Bujanda L, Etxart A, Castells A, Balaguer F, Jover R, Cubiella J, Cordero OJ. Evaluation of Blood Soluble CD26 as a Complementary Biomarker for Colorectal Cancer Screening Programs. Cancers (Basel) 2022; 14:cancers14194563. [PMID: 36230486 PMCID: PMC9559671 DOI: 10.3390/cancers14194563] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 02/07/2023] Open
Abstract
Fecal hemoglobin immunodetection (FIT) in combination with endoscopy has been implemented to reduce mortality from colorectal cancer (CRC), although there are issues that can be improved in relation to participation rates. We studied whether the blood biomarker soluble-CD26 (sCD26), related at least in part to the immune system and inflammation, and/or its dipeptidyl peptidase enzyme activity (DPP4), could help reduce false positives. In a cohort of 1703 individuals who underwent colonoscopy and had a serum sample, sCD26 and DPP4 activity showed statistically significant differences regarding sex and age. According to the colonoscopy findings, sCD26 and DPP4 activity progressively decreased in advanced adenomas and CRC, with statistically significant differences, even between both groups; 918 of them had a FIT result (n = 596 positive cases) with approximately 70% of these (n = 412) false positives. With cut-offs of 440 ng/mL for sCD26, 42 mU/mL for DPP4, and 11 ng/mU for their ratio, the combined information of the three biomarkers (at least positive for one biomarker) identified almost all advanced adenomas and CRC cases in the FIT cohort with approximately half of the false positives compared to FIT. A sequential testing strategy with FIT and our blood biomarker test is proposed.
Collapse
Affiliation(s)
- Loretta De Chiara
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, 36210 Vigo, Spain
- CINBIO, Universidade de Vigo, 36210 Vigo, Spain
- Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36213 Vigo, Spain
- Correspondence: (L.D.C.); (O.J.C.); Tel.: +34 986130051 (L.D.C.)
| | - Leticia Barcia-Castro
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, 36210 Vigo, Spain
| | - María Gallardo-Gómez
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, 36210 Vigo, Spain
| | - María Páez de la Cadena
- Department of Biochemistry, Genetics and Immunology, Universidade de Vigo, 36210 Vigo, Spain
| | | | | | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain
| | - Ane Etxart
- Department of Surgery, Hospital Universitario Donostia, 20014 San Sebastián, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, 08036 Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, 08036 Barcelona, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, 03010 Alicante, Spain
| | - Joaquín Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, CIBERehd, 32005 Ourense, Spain
| | - Oscar J. Cordero
- Department of Biochemistry and Molecular Biology, CIBUS Building, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Correspondence: (L.D.C.); (O.J.C.); Tel.: +34 986130051 (L.D.C.)
| |
Collapse
|
27
|
Ladeira L, Gamba A, Lesage R, Ertvelde JV, Jiang J, Verhoeven A, Roodzant D, Teunis M, Jover R, Vanhaecke T, Vinken M, Geris L, Staumont B. P11-09 Physiology-based framework to study chemical-induced cholestasis. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
28
|
Antonelli G, Correale L, Spadaccini M, Maselli R, Bhandari P, Bisschops R, Cereatti F, Dekker E, East JE, Iacopini F, Jover R, Kiesslich R, Pellise M, Sharma P, Rex DK, Repici A, Hassan C. Dye-based chromoendoscopy for the detection of colorectal neoplasia: meta-analysis of randomized controlled trials. Gastrointest Endosc 2022; 96:411-422. [PMID: 35588768 DOI: 10.1016/j.gie.2022.05.002] [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: 04/01/2022] [Accepted: 05/10/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Dye-based chromoendoscopy (DBC) could be effective in increasing the adenoma detection rate (ADR) in patients undergoing colonoscopy, but the technique is time-consuming and its uptake is limited. We aimed to assess the effect of DBC on ADR based on available randomized controlled trials (RCTs). METHODS Four databases were searched up to April 2022 for RCTs comparing DBC with conventional colonoscopy (CC) in terms of ADR, advanced ADR, and sessile serrated adenoma detection rate as well as the mean adenomas per patient and non-neoplastic lesions. Relative risk (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes were calculated using random-effect models. The I2 test was used for quantifying heterogeneity. Risk of bias was evaluated with the Cochrane tool. RESULTS Overall, 10 RCTs (5334 patients) were included. Indication for colonoscopy was screening or surveillance (3 studies) and mixed (7 studies). Pooled ADR was higher in the DBC group versus the CC group (95% CI, 48.1% [41.4%-54.8%] vs 39.3% [33.5%-46.4%]; RR, 1.20 [1.11-1.29]), with low heterogeneity (I2 = 29%). This effect was consistent for advanced ADR (RR, 1.21 [1.03-1.42]; I2 = .0%), sessile serrated adenomas (6.1% vs 3.5%; RR, 1.68 [1.15-2.47]; I2 = 9.8%), and mean adenomas per patient (MD, .24 [.17-.31]) overall and in the right-sided colon (MD, .28 [.14-.43]). A subgroup analysis considering only trials using high-definition white-light endoscopy reduced the heterogeneity while still showing a significant increase in adenoma detection with DBC: 51.6% (95% confidence interval [CI], 47.1%-56.1%) and 59.1% (95% CI, 54.7-63.3%), RR = 1.14 (95% CI, 1.06-1.23), P = .0004, I2 = .0%, P = .50. CONCLUSIONS Meta-analysis of RCTs showed that DBC increases key quality parameters in colonoscopy, supporting its use in everyday clinical practice.
Collapse
Affiliation(s)
- Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy; Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Loredana Correale
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Marco Spadaccini
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven, (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Fabrizio Cereatti
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Federico Iacopini
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Rodrigo Jover
- Servicio de Gastroenterología, Hospital Universitario de Canarias, Instituto Universitario de Tecnologías Biomédicas (ITB) & Centro de Investigación Biomédica de Canarias (CIBICAN), Santa Cruz de Tenerife, Spain
| | - Ralph Kiesslich
- Department of Internal Medicine II Gastroenterology, Hepatology and Endocrinology, Helios Dr Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Maria Pellise
- Gastroenterology Department, Endoscopy Unit, ICMDiM, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Catalonia, Spain
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Endoscopy Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| |
Collapse
|
29
|
Staumont B, Ladeira L, Gamba A, Lesage R, Verhoeven A, Jiang J, Ertvelde JV, Barnes D, Janssen M, Kuchovska E, Berkhout J, Roodzant D, Teunis M, Bozada T, Luechtefeld T, Jover R, Vanhaecke T, Vinken M, Masereeuw R, Fritsche E, Piersma A, Heusinkveld H, Geris L. SOC-VI-08 Physiological maps: a benchmark tool for adverse outcome pathways and a cornerstone for the development of disease ontologies. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
30
|
Jover R, Soluyanova P, Moro-Castaño E, Moreno-Torres M, Marco-Hernández A, Tomas-Vila M, Castell J. SOC-V-11 New serum miRNA biomarkers to predict liver steatosis by valproic acid in paediatric epileptic patients. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
31
|
Jung G, Hernández-Illán E, Lozano JJ, Sidorova J, Muñoz J, Okada Y, Quintero E, Hernandez G, Jover R, Carballal S, Cuatrecasas M, Moreno L, Diaz M, Ocaña T, Sánchez A, Rivero L, Ortiz O, Llach J, Castells A, Pellisé M, Goel A, Batlle E, Balaguer F. Epigenome-Wide DNA Methylation Profiling of Normal Mucosa Reveals HLA-F Hypermethylation as a Biomarker Candidate for Serrated Polyposis Syndrome. J Mol Diagn 2022; 24:674-686. [PMID: 35447336 DOI: 10.1016/j.jmoldx.2022.03.010] [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] [Received: 10/15/2021] [Revised: 01/08/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Serrated polyposis syndrome (SPS) is associated with a high risk for colorectal cancer. Intense promoter hypermethylation is a frequent molecular finding in the serrated pathway and may be present in normal mucosa, predisposing to the formation of serrated lesions. To identify novel biomarkers for SPS, fresh-frozen samples of normal mucosa from 50 patients with SPS and 19 healthy individuals were analyzed by using the 850K BeadChip Technology (Infinium). Aberrant methylation levels were correlated with gene expression using a next-generation transcriptome profiling tool. Two validation steps were performed on independent cohorts: first, on formalin-fixed, paraffin-embedded tissue of the normal mucosa; and second, on 24 serrated lesions. The most frequently hypermethylated genes were HLA-F, SLFN12, HLA-DMA, and RARRES3; and the most frequently hypomethylated genes were PIWIL1 and ANK3 (Δβ = 10%; P < 0.05). Expression levels of HLA-F, SLFN12, and HLA-DMA were significantly different between SPS patients and healthy individuals and correlated well with the methylation status of the corresponding differentially methylated region (fold change, >20%; r > 0.55; P < 0.001). Significant hypermethylation of CpGs in the gene body of HLA-F was also found in serrated lesions (Δβ = 23%; false discovery rate = 0.01). Epigenome-wide methylation profiling has revealed numerous differentially methylated CpGs in normal mucosa from SPS patients. Significant hypermethylation of HLA-F is a novel biomarker candidate for SPS.
Collapse
Affiliation(s)
- Gerhard Jung
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Juan J Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - Julia Sidorova
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Bioinformatics Platform, CIBEREHD, Barcelona, Spain
| | - Jenifer Muñoz
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Yasuyuki Okada
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute, Biomedical Research Center, Monrovia, California; Department of Gastroenterology and Oncology, Tokushima University Graduate School, Tokushima, Japan
| | - Enrique Quintero
- Department of Gastroenterology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Goretti Hernandez
- Department of Gastroenterology, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Sabela Carballal
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain; Pathology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Mireia Diaz
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Teresa Ocaña
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ariadna Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Oswaldo Ortiz
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Joan Llach
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ajay Goel
- Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute, Biomedical Research Center, Monrovia, California; City of Hope Comprehensive Cancer Center, Duarte, California
| | - Eduard Batlle
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
32
|
Giner-Calabuig M, De Leon S, Wang J, Fehlmann TD, Ukaegbu C, Gibson J, Alustiza-Fernandez M, Pico MD, Alenda C, Herraiz M, Carrillo-Palau M, Salces I, Reyes J, Ortega SP, Obrador-Hevia A, Cecchini M, Syngal S, Stoffel E, Ellis NA, Sweasy J, Jover R, Llor X, Xicola RM. Mutational signature profiling classifies subtypes of clinically different mismatch-repair-deficient tumours with a differential immunogenic response potential. Br J Cancer 2022; 126:1595-1603. [PMID: 35197584 PMCID: PMC9130322 DOI: 10.1038/s41416-022-01754-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 01/24/2022] [Accepted: 02/10/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Mismatch repair (MMR) deficiency is the hallmark of tumours from Lynch syndrome (LS), sporadic MLH1 hypermethylated and Lynch-like syndrome (LLS), but there is a lack of understanding of the variability in their mutational profiles based on clinical phenotypes. The aim of this study was to perform a molecular characterisation to identify novel features that can impact tumour behaviour and clinical management. METHODS We tested 105 MMR-deficient colorectal cancer tumours (25 LS, 35 LLS and 45 sporadic) for global exome microsatellite instability, cancer mutational signatures, mutational spectrum and neoepitope load. RESULTS Fifty-three percent of tumours showed high contribution of MMR-deficient mutational signatures, high level of global exome microsatellite instability, loss of MLH1/PMS2 protein expression and included sporadic tumours. Thirty-one percent of tumours showed weaker features of MMR deficiency, 62% lost MSH2/MSH6 expression and included 60% of LS and 44% of LLS tumours. Remarkably, 9% of all tumours lacked global exome microsatellite instability. Lastly, HLA-B07:02 could be triggering the neoantigen presentation in tumours that show the strongest contribution of MMR-deficient tumours. CONCLUSIONS Next-generation sequencing approaches allow for a granular molecular characterisation of MMR-deficient tumours, which can be essential to properly diagnose and treat patients with these tumours in the setting of personalised medicine.
Collapse
Affiliation(s)
- Mar Giner-Calabuig
- Department of Medicine and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Seila De Leon
- Department of Medicine and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Julian Wang
- Department of Medicine and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Tara D Fehlmann
- Divisions of Cancer Genetics and Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Chinedu Ukaegbu
- Divisions of Cancer Genetics and Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Joanna Gibson
- Department of Pathology and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Miren Alustiza-Fernandez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Maria-Dolores Pico
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Cristina Alenda
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Maite Herraiz
- Departamento de Digestivo, Clínica Universidad de Navarra, Navarra, Spain
| | - Marta Carrillo-Palau
- Servicio de Medicina Digestiva, Hospital Universitario de Canarias, Tenerife, Spain
| | - Inmaculada Salces
- Servicio de Medicina Digestiva, Hospital 12 de Octubre, Madrid, Spain
| | - Josep Reyes
- Servei de Digestiu, Hospital Comarcal d'Inca, Mallorca, Spain
| | - Silvia P Ortega
- Servei de Digestiu, Hospital Comarcal d'Inca, Mallorca, Spain
| | | | - Michael Cecchini
- Department of Medicine and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Sapna Syngal
- Divisions of Cancer Genetics and Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Elena Stoffel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, and Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Nathan A Ellis
- Department of Cellular and Molecular Medicine, University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Joann Sweasy
- Department of Therapeutic Radiobiology and Cancer Center, Yale University, New Haven, CT, USA
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Xavier Llor
- Department of Medicine and Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Rosa M Xicola
- Department of Medicine and Cancer Center, Yale University School of Medicine, New Haven, CT, USA.
| |
Collapse
|
33
|
Mangas-Sanjuan C, Jover R. Familial colorectal cancer. Best Pract Res Clin Gastroenterol 2022; 58-59:101798. [PMID: 35988967 DOI: 10.1016/j.bpg.2022.101798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Abstract
The introduction of average-risk colorectal cancer (CRC) screening programs means that many subjects with family history of CRC and without well-described inherited syndromes can benefit from these public health policies. Therefore, the definition of which individuals should be named under the umbrella of the term "familial CRC" should be reconsidered to include only those who are outside of the protection of population-based screening and need to be moved towards a more intensive surveillance strategy. Two subgroups have been reported as having a high enough CRC risk to be included within the term "familial risk of CRC": individuals who have ≥1 first degree relative (FDR) with CRC diagnosed at age <50 years, and those who have ≥2 FDRs with CRC. Colonoscopy-based screening starting at age 40 years is proposed as the most accepted recommendation for these individuals. Finally, the evolution of Lynch syndrome screening from clinical criteria to tumor tissue analysis and new tools for screening pathogenic gene mutations associated with cancer susceptibility in individuals with early-onset CRC might help to reduce misclassification of familial CRC.
Collapse
Affiliation(s)
- Carolina Mangas-Sanjuan
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| |
Collapse
|
34
|
Sánchez A, Roos VH, Navarro M, Pineda M, Caballol B, Moreno L, Carballal S, Rodríguez-Alonso L, Ramon Y Cajal T, Llort G, Piñol V, López-Fernández A, Salces I, Picó MD, Rivas L, Bujanda L, Garzon M, Pizarro A, Martinez de Castro E, López-Arias MJ, Poves C, Garau C, Rodriguez-Alcalde D, Herraiz M, Alvarez-Urrutia C, Dacal A, Carrillo-Palau M, Cid L, Ponce M, Barreiro-Alonso E, Saperas E, Aguirre E, Romero C, Bastiaansen B, Gonzalez-Acosta M, Morales-Romero B, Ocaña T, Rivero-Sánchez L, Jung G, Bessa X, Cubiella J, Jover R, Rodríguez-Moranta F, Balmaña J, Brunet J, Castells A, Dekker E, Capella G, Serra-Burriel M, Moreira L, Pellise M, Balaguer F. Quality of Colonoscopy Is Associated With Adenoma Detection and Postcolonoscopy Colorectal Cancer Prevention in Lynch Syndrome. Clin Gastroenterol Hepatol 2022; 20:611-621.e9. [PMID: 33157315 DOI: 10.1016/j.cgh.2020.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Colonoscopy reduces colorectal cancer (CRC) incidence and mortality in Lynch syndrome (LS) carriers. However, a high incidence of postcolonoscopy CRC (PCCRC) has been reported. Colonoscopy is highly dependent on endoscopist skill and is subject to quality variability. We aimed to evaluate the impact of key colonoscopy quality indicators on adenoma detection and prevention of PCCRC in LS. METHODS We conducted a multicenter study focused on LS carriers without previous CRC undergoing colonoscopy surveillance (n = 893). Incident colorectal neoplasia during surveillance and quality indicators of all colonoscopies were analyzed. We performed an emulated target trial comparing the results from the first and second surveillance colonoscopies to assess the effect of colonoscopy quality indicators on adenoma detection and PCCRC incidence. Risk analyses were conducted using a multivariable logistic regression model. RESULTS The 10-year cumulative incidence of adenoma and PCCRC was 60.6% (95% CI, 55.5%-65.2%) and 7.9% (95% CI, 5.2%-10.6%), respectively. Adequate bowel preparation (odds ratio [OR], 2.07; 95% CI, 1.06-4.3), complete colonoscopies (20% vs 0%; P = .01), and pan-chromoendoscopy use (OR, 2.14; 95% CI, 1.15-3.95) were associated with significant improvement in adenoma detection. PCCRC risk was significantly lower when colonoscopies were performed during a time interval of less than every 3 years (OR, 0.35; 95% CI, 0.14-0.97). We observed a consistent but not significant reduction in PCCRC risk for a previous complete examination (OR, 0.16; 95% CI, 0.03-1.28), adequate bowel preparation (OR, 0.64; 95% CI, 0.17-3.24), or previous use of high-definition colonoscopy (OR, 0.37; 95% CI, 0.02-2.33). CONCLUSIONS Complete colonoscopies with adequate bowel preparation and chromoendoscopy use are associated with improved adenoma detection, while surveillance intervals of less than 3 years are associated with a reduction of PCCRC incidence. In LS, high-quality colonoscopy surveillance is of utmost importance for CRC prevention.
Collapse
Affiliation(s)
- Ariadna Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Victorine H Roos
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Matilde Navarro
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Marta Pineda
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lorena Moreno
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Sabela Carballal
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lorena Rodríguez-Alonso
- Department of Gastroenterology, Hospital Universitari de Bellvitge, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Teresa Ramon Y Cajal
- Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Llort
- Department of Medical Oncology and Gastroenterology, Parc Tauli Hospital Universitari, Conscorci Sanitari de Terrasa, Sabadell-Terrasa, Spain
| | - Virginia Piñol
- Department of Gastroenterology, University of Girona, Hospital Dr Josep Trueta, Girona, Spain
| | - Adrià López-Fernández
- Department of Medical Oncology, Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Inmaculada Salces
- Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain
| | - Maria Dolores Picó
- Department of Gastroenterology, Hospital General Universitario de Elche, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Elche, Spain
| | - Laura Rivas
- Department of Gastroenterology, Complexo Hospitalario Universitario de Orense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Ourense, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), San Sebastián, Spain
| | - Marta Garzon
- Department of Gastroenterology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Angeles Pizarro
- Department of Gastroenterology, Hospital Virgen del Rocio, Sevilla, Spain
| | - Eva Martinez de Castro
- Department of Medical Oncology and Gastroenterology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Maria Jesus López-Arias
- Department of Medical Oncology and Gastroenterology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carmen Poves
- Department of Gastroenterology, Hospital Clínico San Carlos, Madrid, Spain
| | - Catalina Garau
- Department of Gastroenterology, Hospital Universitario Son Llatzer, Palma de Mallorca, Spain
| | | | - Maite Herraiz
- Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Cristina Alvarez-Urrutia
- Department of Gastroenterology, Institut Hospital del Mar d'Investigacions Biomèdiques (IMIM), Hospital del Mar Medical Research Institute, Barcelona Hospital del Mar, Barcelona; Spain
| | - Andres Dacal
- Department of Gastroenterology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Lucia Cid
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, Servizo Galego de Saude (SERGAS), Research Group in Digestive Diseases, Instituto de Investigacion Sanitaria Galicia Sur (IISGS), SERGAS-Universidade de Vigo (UVIGO), Vigo, Spain
| | - Marta Ponce
- Department of Gastroenterology, Hospital Universitario de la Fe de Valencia, Valencia, Spain
| | - Eva Barreiro-Alonso
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Esteban Saperas
- Department of Gastroenterology, Hospital Universitari General de Catalunya, Sant Cugat, School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elena Aguirre
- Genetic Counseling Unit, Department of Medical Oncology, Hospital Quirónsalud Zaragoza, Zaragoza, Spain
| | - Cristina Romero
- Department of Medical Oncology and Gastroenterology, Parc Tauli Hospital Universitari, Conscorci Sanitari de Terrasa, Sabadell-Terrasa, Spain
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Maribel Gonzalez-Acosta
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Blai Morales-Romero
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Teresa Ocaña
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Liseth Rivero-Sánchez
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Gerhard Jung
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Xavier Bessa
- Department of Gastroenterology, Institut Hospital del Mar d'Investigacions Biomèdiques (IMIM), Hospital del Mar Medical Research Institute, Barcelona Hospital del Mar, Barcelona; Spain
| | - Joaquin Cubiella
- Department of Gastroenterology, Complexo Hospitalario Universitario de Orense, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Ourense, Spain
| | - Rodrigo Jover
- Department of Gastroenterology, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Francisco Rodríguez-Moranta
- Department of Gastroenterology, Hospital Universitari de Bellvitge, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Judith Balmaña
- Department of Medical Oncology, Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, Institut d'Investigacio Biomèdica de Giron Dr. Josep Trueta (IDIBGI), Medical Sciences Department, School of Medicine, University of Girona, Hospital Dr Josep Trueta, Girona, Spain
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Gabriel Capella
- Hereditary Cancer Program, Oncobell Program, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Duran i Reynals
| | - Miquel Serra-Burriel
- Center for Research in Health and Economics, Universitat Pompeu Fabra, Barcelona, Spain
| | - Leticia Moreira
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Maria Pellise
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Francesc Balaguer
- Department of Gastroenterology, Hospital Clínic Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
35
|
Spada C, Koulaouzidis A, Hassan C, Amaro P, Agrawal A, Brink L, Fischbach W, Hünger M, Jover R, Kinnunen U, Ono A, Patai Á, Pecere S, Petruzziello L, Riemann JF, Staines H, Stringer AL, Toth E, Antonelli G, Fuccio L. Factors Associated with Withdrawal Time in European Colonoscopy Practice: Findings of the European Colonoscopy Quality Investigation (ECQI) Group. Diagnostics (Basel) 2022; 12:diagnostics12020503. [PMID: 35204593 PMCID: PMC8871420 DOI: 10.3390/diagnostics12020503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022] Open
Abstract
The European Colonoscopy Quality Investigation (ECQI) Group aims to raise awareness for improvement in colonoscopy standards across Europe. We analyzed data collected on a sample of procedures conducted across Europe to evaluate the achievement of the European Society of Gastrointestinal Endoscopy (ESGE) mean withdrawal time (WT) target. We also investigated factors associated with WT, in the hope of establishing areas that could lead to a quality improvement. Methods: 6445 form completions from 12 countries between 2 June 2016 and 30 April 2018 were considered for this analysis. We performed an exploratory analysis looking at WT according to the ESGE definition. Stepwise multivariable logistic regression analysis was conducted to determine the most influential associated factors after adjusting for the other pre-specified variables. Results: In 1150 qualifying colonoscopies, the mean WT was 7.8 min. Stepwise analysis, including 587 procedures where all inputs were known, found that the variables most associated with mean WT were a previous total colonoscopy in the last five years (p = 0.0011) and the time of day the colonoscopy was performed (p = 0.0192). The main factor associated with a WT < 6 min was the time of day that a colonoscopy was performed. Use of sedation was the main factor associated with a higher proportion of WT > 10 min, along with a previous colonoscopy. Conclusions: On average, the sample of European practice captured by the ECQI survey met the minimum standard set by the ESGE. However, there was variation and potential for improvement.
Collapse
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, 25124 Brescia, Italy
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Anastasios Koulaouzidis
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark (SDU), 5000 Odense, Denmark
- Surgical Research Unit, OUH, 5000 Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Cesare Hassan
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy;
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Anurag Agrawal
- Gastroenterology, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK;
| | - Lene Brink
- Gastro Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, 2730 Herlev, Denmark;
| | | | - Matthias Hünger
- Independent Researcher for Internal Medicine, 97070 Würzburg, Germany;
| | - Rodrigo Jover
- Instituto de Investigación Sanitaria ISABIAL—Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Urpo Kinnunen
- Department of Gastroenterology, Tampere University Hospital, 33521 Tampere, Finland;
| | - Akiko Ono
- Department of Gastroenterology, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, 30120 Murcia, Spain;
| | - Árpád Patai
- Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, 9700 Szombathely, Hungary;
| | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.P.); (L.P.)
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (S.P.); (L.P.)
| | - Jürgen F. Riemann
- Department of Medicine C, Klinikum Ludwigshafen, 67063 Ludwigshafen, Germany;
- LebensBlicke Foundation, 67063 Ludwigshafen, Germany
| | - Harry Staines
- Sigma Statistical Services Ltd., Saint Andrews KY16 0BD, UK;
| | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, 00185 Rome, Italy;
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, 00040 Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy;
| |
Collapse
|
36
|
Sempere L, Bernabeu P, Cameo J, Gutierrez A, Laveda R, García MF, Aguas M, Zapater P, Jover R, Ruiz-Cantero MT, Hofstadt CVD. Evolution of the emotional impact in patients with early inflammatory bowel disease during and after Covid-19 lockdown. Gastroenterología y Hepatología (English Edition) 2022. [PMCID: PMC8863151 DOI: 10.1016/j.gastre.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Methods Results Conclusions
Collapse
|
37
|
Houwen BBSL, Hassan C, Coupé VMH, Greuter MJE, Hazewinkel Y, Vleugels JLA, Antonelli G, Bustamante-Balén M, Coron E, Cortas GA, Dinis-Ribeiro M, Dobru DE, East JE, Iacucci M, Jover R, Kuvaev R, Neumann H, Pellisé M, Puig I, Rutter MD, Saunders B, Tate DJ, Mori Y, Longcroft-Wheaton G, Bisschops R, Dekker E. Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2022; 54:88-99. [PMID: 34872120 DOI: 10.1055/a-1689-5130] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND : The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 - 5 mm). METHODS : A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. RECOMMENDATION 1: In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. RECOMMENDATION 2: In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. CONCLUSION : The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.
Collapse
Affiliation(s)
- Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Veerle M H Coupé
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Marjolein J E Greuter
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud University, Nijmegen, The Netherlands
| | - Jasper L A Vleugels
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome, Rome, Italy.,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Marco Bustamante-Balén
- Gastrointestinal Endoscopy Unit, Digestive Diseases Department, La Fe Polytechnic University Hospital, Valencia, Spain.,Gastrointestinal Endoscopy Research Group, La Fe Health Research Institute, Valencia, Spain
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - George A Cortas
- Division of Gastroenterology, University of Balamand, Faculty of Medicine, St. George Hospital University Medical Center, Beirut, Lebanon
| | - Mario Dinis-Ribeiro
- Porto Comprehensive Cancer Center (Porto.CCC), Porto, Portugal.,RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Daniela E Dobru
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, Experimental Medicine Division, John Radcliffe Hospital, University of Oxford, Oxford, UK.,Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London
| | - Marietta Iacucci
- Institute of Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Roman Kuvaev
- Endoscopy Department, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russian Federation.,Department of Gastroenterology, Faculty of Additional Professional Education, N.A. Pirogov Russian National Research Medical University, Moscow, Russian Federation
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany.,GastroZentrum, Lippe, Germany
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Ignasi Puig
- Digestive Diseases Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain.,Department of Medicine, Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Manresa, Spain
| | - Matthew D Rutter
- Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK.,University Hospital of North Tees , Stockton-on-Tees, UK
| | - Brian Saunders
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, UK
| | - David J Tate
- Department of Gastroenterology and Hepatology, University of Ghent, Ghent, Belgium.,University Hospital Ghent, Ghent, Belgium
| | - Yuichi Mori
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway.,Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | | | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Catholic University of Leuven, (KUL), TARGID, University Hospital Leuven, Leuven, Belgium
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
38
|
Rutter MD, Jover R. Reply. Clin Gastroenterol Hepatol 2021; 19:2682-2683. [PMID: 33582229 DOI: 10.1016/j.cgh.2021.02.019] [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: 01/26/2021] [Accepted: 02/09/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Matthew D Rutter
- University Hospital of North Tees, Stockton on Tees, United Kingdom, Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Rodrigo Jover
- Servicio de Medina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria Isabial, Alicante, Spain
| |
Collapse
|
39
|
Bustos A, Payá A, Torrubia A, Jover R, Llor X, Bessa X, Castells A, Carracedo Á, Alenda C. xDEEP-MSI: Explainable Bias-Rejecting Microsatellite Instability Deep Learning System in Colorectal Cancer. Biomolecules 2021; 11:1786. [PMID: 34944430 PMCID: PMC8699085 DOI: 10.3390/biom11121786] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023] Open
Abstract
The prediction of microsatellite instability (MSI) using deep learning (DL) techniques could have significant benefits, including reducing cost and increasing MSI testing of colorectal cancer (CRC) patients. Nonetheless, batch effects or systematic biases are not well characterized in digital histology models and lead to overoptimistic estimates of model performance. Methods to not only palliate but to directly abrogate biases are needed. We present a multiple bias rejecting DL system based on adversarial networks for the prediction of MSI in CRC from tissue microarrays (TMAs), trained and validated in 1788 patients from EPICOLON and HGUA. The system consists of an end-to-end image preprocessing module that tile samples at multiple magnifications and a tissue classification module linked to the bias-rejecting MSI predictor. We detected three biases associated with the learned representations of a baseline model: the project of origin of samples, the patient's spot and the TMA glass where each spot was placed. The system was trained to directly avoid learning the batch effects of those variables. The learned features from the bias-ablated model achieved maximum discriminative power with respect to the task and minimal statistical mean dependence with the biases. The impact of different magnifications, types of tissues and the model performance at tile vs patient level is analyzed. The AUC at tile level, and including all three selected tissues (tumor epithelium, mucin and lymphocytic regions) and 4 magnifications, was 0.87 ± 0.03 and increased to 0.9 ± 0.03 at patient level. To the best of our knowledge, this is the first work that incorporates a multiple bias ablation technique at the DL architecture in digital pathology, and the first using TMAs for the MSI prediction task.
Collapse
Affiliation(s)
- Aurelia Bustos
- AI Cancer Research Unit, MedBravo, 03560 Alicante, Spain;
| | - Artemio Payá
- Pathology Department, Alicante University General Hospital (HGUA), 03010 Alicante, Spain; (A.P.); (R.J.)
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | | | - Rodrigo Jover
- Pathology Department, Alicante University General Hospital (HGUA), 03010 Alicante, Spain; (A.P.); (R.J.)
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| | - Xavier Llor
- Department of Medicine, Yale Cancer Center, Yale University, New Haven, CT 06511, USA;
| | - Xavier Bessa
- Gastroenterology Department, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Antoni Castells
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Gastroenterology Department, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain;
| | - Ángel Carracedo
- Fundación Pública Gallega de Medicina Genómica (GMX), 15706 Santiago de Compostela, Spain;
| | - Cristina Alenda
- Pathology Department, Alicante University General Hospital (HGUA), 03010 Alicante, Spain; (A.P.); (R.J.)
- Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain
| |
Collapse
|
40
|
Spada C, Koulaouzidis A, Hassan C, Amaro P, Agrawal A, Brink L, Fischbach W, Hünger M, Jover R, Kinnunen U, Ono A, Patai Á, Pecere S, Petruzziello L, Riemann JF, Amlani B, Staines H, Stringer AL, Toth E, Antonelli G, Fuccio L. Colonoscopy quality across Europe: a report of the European Colonoscopy Quality Investigation (ECQI) Group. Endosc Int Open 2021; 9:E1456-E1462. [PMID: 34540535 PMCID: PMC8445680 DOI: 10.1055/a-1486-6729] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
Background and study aims The European Colonoscopy Quality Investigation (ECQI) Group comprises expert colonoscopists and investigators with the aim of raising colonoscopy standards. We assessed the levels of monitoring and achievement of European Society of Gastrointestinal Endoscopy (ESGE) performance measures (PMs) across Europe using responses to the ECQI questionnaires. Methods The questionnaire comprises three forms: institution and practitioner questionnaires are completed once; a procedure questionnaire is completed on multiple occasions for individual total colonoscopies. ESGE PMs were approximated as closely as possible from the data collected via the procedure questionnaire. Procedure data could provide rate of adequate bowel preparation, cecal intubation rate (CIR), withdrawal time, polyp detection rate (PDR), and tattooing resection sites. Results We evaluated ECQI questionnaire data collected between June 2016 and April 2018, comprising 91 practitioner and 52 institution questionnaires. A total of 6445 completed procedure forms were received. Institution and practitioner responses indicate that routine recording of PMs is not widespread: adenoma detection rate (ADR) is routinely recorded in 29 % of institutions and by 34 % of practitioners; PDR by 42 % and 47 %, CIR by 62 % and 64 %, bowel preparation quality by 56 % and 76 %, respectively. Procedure data showed a rate of adequate bowel preparation of 84.2 %, CIR 73.4 %, PDR 40.5 %, mean withdrawal time 7.8 minutes and 12.2 % of procedures with possible removal of a non-pedunculated lesion ≥ 20 mm reporting tattooing. Conclusions Our findings clearly show areas in need of quality improvement and the importance of promoting quality monitoring throughout the colonoscopy procedure.
Collapse
Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy,Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anastasios Koulaouzidis
- Pomeranian Medical University in Szczecin-Department of Social Medicine and Public Health, Faculty of Health Sciences, Szczecin, Zachodniopomorskie, Poland
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - Lene Brink
- Herlev and Gentofte Hospital, Copenhagen University, Gastro Unit, Division of Endoscopy, Herlev, Denmark
| | | | | | - Rodrigo Jover
- Hospital General Universitario de Alicante – Instituto de Investigación Sanitaria ISABIAL – Servicio de Medicina Digestiva, Alicante, Spain
| | - Urpo Kinnunen
- Tampere University Hospital-Gastroenterology, Tampere, Finland
| | - Akiko Ono
- Hospital Clínico Universitario Virgen de la Arrixaca-Gastroenterology, El Palmar, Murcia, Spain
| | - Árpad Patai
- Markusovszky University Teaching Hospital-Gastroenterology, Szombathely, Hungary
| | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | | | | | - Ervin Toth
- Skåne University Hospital, Lund University, Department of Gastroenterology, Malmö, Sweden
| | - Giulio Antonelli
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy,Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, “Sapienza” University of Rome, Rome, Italy,Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, Ariccia, Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy
| |
Collapse
|
41
|
Lazaridis LD, Tziatzios G, Toth E, Beaumont H, Dray X, Eliakim R, Ellul P, Fernandez-Urien I, Keuchel M, Panter S, Rondonotti E, Rosa B, Spada C, Jover R, Bhandari P, Triantafyllou K, Koulaouzidis A. Implementation of European Society of Gastrointestinal Endoscopy (ESGE) recommendations for small-bowel capsule endoscopy into clinical practice: Results of an official ESGE survey. Endoscopy 2021; 53:970-980. [PMID: 34320664 DOI: 10.1055/a-1541-2938] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to document international practices in small-bowel capsule endoscopy (SBCE), measuring adherence to European Society of Gastrointestinal Endoscopy (ESGE) technical and clinical recommendations. METHODS Participants reached through the ESGE contact list completed a 52-item web-based survey. RESULTS 217 responded from 47 countries (176 and 41, respectively, from countries with or without a national society affiliated to ESGE). Of respondents, 45 % had undergone formal SBCE training. Among SBCE procedures, 91 % were performed with an ESGE recommended indication, obscure gastrointestinal bleeding (OGIB), iron-deficiency anemia (IDA), and suspected/established Crohn's disease being the commonest and with higher rates of positive findings (49.4 %, 38.2 % and 53.5 %, respectively). A watchful waiting strategy after a negative SBCE for OGIB or IDA was preferred by 46.7 % and 70.3 %, respectively. SBCE was a second-line exam for evaluation of extent of new Crohn's disease for 62.2 % of respondents. Endoscopists adhered to varying extents to ESGE technical recommendations regarding bowel preparation ( > 60 %), use in those with pacemaker holders (62.5 %), patency capsule use (51.2 %), and use of a validated scale for bowel preparation assessment (13.3 %). Of the respondents, 67 % read and interpreted the exams themselves and 84 % classified exams findings as relevant or irrelevant. Two thirds anticipated future increase in SBCE demand. Inability to obtain tissue (78.3 %) and high cost (68.1 %) were regarded as the main limitations, and implementation of artificial intelligence as the top development priority (56.2 %). CONCLUSIONS To some extent, endoscopists follow ESGE guidelines on using SBCE in clinical practice. However, variations in practice have been identified, whose implications require further evaluation.
Collapse
Affiliation(s)
- Lazaros-Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Hanneke Beaumont
- Department of Gastroenterology, Amsterdam University Medical Center, location VUMC, Amsterdam, The Netherlands
| | - Xavier Dray
- Sorbonne University, Center for Digestive Endoscopy, Hôpital Saint Antoine, APHP, Paris, France
| | - Rami Eliakim
- Sheba Medical Center, Department of Gastroenterology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Malta
| | | | - Martin Keuchel
- Clinic for Internal Medicine, Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany
| | - Simon Panter
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | | | - Bruno Rosa
- Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy
| | - Rodrigo Jover
- Servicio de Medicina Digestiva. Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital Portsmouth, Portsmouth, UK
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Anastasios Koulaouzidis
- Pomeranian Medical University, Department of Social Medicine and Public Health, Faculty of Health Science, Szczecin, Poland
| | | |
Collapse
|
42
|
Jover R, Clofent J, de Vera F, López-Serrano A, Gutiérrez A, Aguas M, Nos P. Recommendations of the Valencian Society of Digestive Pathology for the use of telemedicine and non-contact consultations. Gastroenterol Hepatol 2021; 45:299-303. [PMID: 34051311 PMCID: PMC8152203 DOI: 10.1016/j.gastrohep.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 10/25/2022]
Abstract
The COVID-19 pandemic has meant a qualitative change in the way patients are treated in outpatient clinics. The need to take measures of social isolation as prevention for contagion by the new coronavirus has forced the use of telematic and telephone consultations in most medical and surgical units. The specialty of digestive medicine, due to the characteristics of its patients and frequent support in complementary techniques for diagnosis, is especially suitable for the use of non-contact consultations. In this document a series of recommendations are proposed that can serve as a guide for the establishment or improvement of non-face-to-face digestive medicine consultations.
Collapse
Affiliation(s)
- Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica ISABIAL, Alicante, España.
| | | | - Félix de Vera
- Sección de Medicina Digestiva, Hospital General de Elda, Elda (Alicante)
| | | | - Ana Gutiérrez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica ISABIAL, Alicante, España; CIBERehd, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III
| | - Mariam Aguas
- Servicio de Medicina Digestiva, Hospital La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Pilar Nos
- Servicio de Medicina Digestiva, Hospital La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
| |
Collapse
|
43
|
Ruiz-Bañobre J, Roy R, Alustiza Fernández M, Murcia Ó, Jover R, Pera M, Balaguer F, López-López R, Goel A. Clinical significance of a microRNA signature for the identification and predicting prognosis in colorectal cancers with mucinous differentiation. Carcinogenesis 2021; 41:1498-1506. [PMID: 32911537 DOI: 10.1093/carcin/bgaa097] [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: 07/20/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
Accumulating evidence supports the fact that the mere presence of mucinous differentiation in colorectal cancer (CRC), rather than its proportion, is a more accurate representative of a particular CRC subtype with distinct clinical and molecular features. In addition, the prognostic significance of the mucinous carcinoma (MC) subtype remains poorly understood and biomarkers have been barely explored in this disease. Herein, we have performed a systematic and comprehensive analysis in MCs and non-MCs and identified a panel of microRNAs (miRNAs) that are differentially expressed between these two subtypes of CRC. Next, we interrogated their clinical significance and demonstrated their robust diagnostic and prognostic clinical ability in CRCs with mucinous differentiation. Finally, we established an integrative risk-assessment model by combining the miRNA-based risk scores together with TNM staging, which was a superior predictor of prognosis in mucinous CRC patients. Collectively, we report a novel miRNA biomarker panel for the identification and predicting survival in CRC patients with mucinous differentiation.
Collapse
Affiliation(s)
- Juan Ruiz-Bañobre
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
| | - Roshni Roy
- Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA
| | - Miren Alustiza Fernández
- Laboratorio de Investigación, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Óscar Murcia
- Laboratorio de Investigación, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Digestive Medicine Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Rodrigo Jover
- Laboratorio de Investigación, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.,Digestive Medicine Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Miguel Pera
- Section of Colon and Rectal Surgery, Department of Surgery, Hospital del Mar (IMIM), Barcelona, Spain
| | - Francesc Balaguer
- Gastroenterology, Hospital Clinic of Barcelona, Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Rafael López-López
- Medical Oncology Department, University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain.,Translational Medical Oncology Group (Oncomet), Health Research Institute of Santiago (IDIS), University Clinical Hospital of Santiago de Compostela, CIBERONC, Santiago de Compostela, Spain
| | - Ajay Goel
- Center for Gastrointestinal Research; Center for Translational Genomics and Oncology, Baylor Scott and White Research Institute and Charles A Sammons Cancer Center, Baylor University Medical Center, Dallas, TX, USA.,Department of Molecular Diagnostics and Experimental Therapeutics, Beckman Research Institute of City of Hope Comprehensive Cancer Center, Monrovia, CA, USA
| |
Collapse
|
44
|
Sempere L, Bernabeu P, Cameo J, Gutierrez A, Laveda R, García MF, Aguas M, Zapater P, Jover R, Ruiz-Cantero MT, Hofstadt CVD. Evolution of the emotional impact in patients with early inflammatory bowel disease during and after Covid-19 lockdown. Gastroenterol Hepatol 2021; 45:123-133. [PMID: 34023470 PMCID: PMC8807180 DOI: 10.1016/j.gastrohep.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/18/2023]
Abstract
Background Patients with inflammatory bowel disease (IBD) are vulnerable to some psychological disorders. Here we describe the psychological impact of a COVID-19 pandemic lockdown in patients with IBD. Methods This multicenter prospective cohort study included 145 patients recently diagnosed with IBD. Data on clinical and demographic characteristics, anxiety and depression scales, and IBD activity were collected in two telephone surveys, during and after the first COVID-19 lockdown in Spain. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Results During lockdown, 33.1% and 24.1% scored high on the anxiety and depression scales, respectively. Independent factors related to anxiety (all values ORs; 95% CIs) during lockdown were female sex (2; 1.2–5.4) and IBD activity (4.3; 1.8–10.4). Factors related to depression were comorbidity (3.3; 1.1–9.8), IBD activity (6; 1.9–18.1), use of biologics (2.9; 1.1–7.6), and living alone or with one person (3.1; 1.2–8.2). After lockdown, anxiety and depression symptoms showed significant improvement, with 24.8% and 15.2% having high scores for anxiety and depression, respectively. Factors related to post-lockdown anxiety were female sex (2.5; 1.01–6.3), Crohn's disease (3.3; 1.3–8.5), and active IBD (4.1; 1.2–13.7). Factors associated with depression were previous history of mood and/or anxiety disorders (6.3; 1.6–24.9), active IBD (7.5; 2.1–26.8), and steroid use (6.4; 1.4–29). Conclusions Lockdown during the COVID-19 pandemic had a significant psychological impact in patients with IBD. Disease activity was related to the presence of anxiety and depression symptoms during and after lockdown.
Collapse
Affiliation(s)
- Laura Sempere
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain; Group of working on Crohn's Disease and Ulcerative Colitis (GETECCU), Spain
| | - Purificación Bernabeu
- Health Psychology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain.
| | - José Cameo
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain; Group of working on Crohn's Disease and Ulcerative Colitis (GETECCU), Spain
| | - Ana Gutierrez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain; Group of working on Crohn's Disease and Ulcerative Colitis (GETECCU), Spain
| | - Raquel Laveda
- Servicio de Medicina Digestiva, Hospital Universitario de San Juan, Alicante, Spain; Group of working on Crohn's Disease and Ulcerative Colitis (GETECCU), Spain
| | - Mariana Fe García
- Servicio de Medicina Digestiva, Hospital General Universitario de Elche, Alicante, Spain; Group of working on Crohn's Disease and Ulcerative Colitis (GETECCU), Spain
| | - Mariam Aguas
- Servicio de Medicina Digestiva, Hospital Universitario y Politécnico la Fe, Valencia, Spain; CIBERESP (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública), Madrid, Spain; Group of working on Crohn's Disease and Ulcerative Colitis (GETECCU), Spain
| | - Pedro Zapater
- Clinical Pharmachology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - María Teresa Ruiz-Cantero
- Public Health Department University of Alicante, Alicante, Spain; CIBERESP (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública), Madrid, Spain
| | - Carlos van-der Hofstadt
- Health Psychology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| |
Collapse
|
45
|
Medina-Prado L, Hassan C, Dekker E, Bisschops R, Alfieri S, Bhandari P, Bourke MJ, Bravo R, Bustamante-Balen M, Dominitz J, Ferlitsch M, Fockens P, van Leerdam M, Lieberman D, Herráiz M, Kahi C, Kaminski M, Matsuda T, Moss A, Pellisé M, Pohl H, Rees C, Rex DK, Romero-Simó M, Rutter MD, Sharma P, Shaukat A, Thomas-Gibson S, Valori R, Jover R. When and How To Use Endoscopic Tattooing in the Colon: An International Delphi Agreement. Clin Gastroenterol Hepatol 2021; 19:1038-1050. [PMID: 33493699 DOI: 10.1016/j.cgh.2021.01.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/27/2020] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is a lack of clinical studies to establish indications and methodology for tattooing, therefore technique and practice of tattooing is very variable. We aimed to establish a consensus on the indications and appropriate techniques for colonic tattoo through a modified Delphi process. METHODS The baseline questionnaire was classified into 3 areas: where tattooing should not be used (1 domain, 6 questions), where tattooing should be used (4 domains, 20 questions), and how to perform tattooing (1 domain 20 questions). A total of 29 experts participated in the 3 rounds of the Delphi process. RESULTS A total of 15 statements were approved. The statements that achieved the highest agreement were as follows: tattooing should always be used after endoscopic resection of a lesion with suspicion of submucosal invasion (agreement score, 4.59; degree of consensus, 97%). For a colorectal lesion that is left in situ but considered suitable for endoscopic resection, tattooing may be used if the lesion is considered difficult to detect at a subsequent endoscopy (agreement score, 4.62; degree of consensus, 100%). A tattoo should never be injected directly into or underneath a lesion that might be removed endoscopically at a later point in time (agreement score, 4.79; degree of consensus, 97%). Details of the tattoo injection should be stated clearly in the endoscopy report (agreement score, 4.76; degree of consensus, 100%). CONCLUSIONS This expert consensus has developed different statements about where tattooing should not be used, when it should be used, and how that should be done.
Collapse
Affiliation(s)
- Lucía Medina-Prado
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Cesare Hassan
- Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
| | - Sergio Alfieri
- Surgery Department, Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital. Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Raquel Bravo
- Department of Gastrointestinal Surgery, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia, Spain
| | - Marco Bustamante-Balen
- Gastrointestinal Endoscopy Unit, Gastrointestinal Endoscopy Research Group, Health Research Institute (Instituto de Investigación Sanitaria La Fe. NHS: National Health Service), Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jason Dominitz
- Gastroenterology Department, VA Puget Sound Health Care System, University of Washington, Seattle, Washington
| | - Monika Ferlitsch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Wien, Austria
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Monique van Leerdam
- Department of Gastroenterology and Hepatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David Lieberman
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - Maite Herráiz
- Departamento de Digestivo, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Charles Kahi
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michal Kaminski
- Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne Medical School Western Precinct, The University of Melbourne, St. Albans, Victoria, Australia
| | - Maria Pellisé
- Gastroenterology Department, Institute of Digestive and Metabolic Diseases, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, University of Barcelona, Centro Esther Koplowitz, Cellex Biomedical Research Center, Barcelona, Catalonia Spain
| | - Heiko Pohl
- Department of Gastroenterology and Hepatology, VA Medical Center, White River Junction, Vermont; Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Colin Rees
- Department of Gastroenterology, South Tyneside NHS Foundation Trust, South Shields, United Kingdom
| | - Douglas K Rex
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Manuel Romero-Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain
| | - Matthew D Rutter
- University Hospital of North Tees, Stockton on Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, VA Medical Center, University of Kansas School of Medicine, Kansas City, Kansas
| | - Aasma Shaukat
- Section of Gastroenterology, Department of Medicine, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Siwan Thomas-Gibson
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Harrow, and Imperial College, London, United Kingdom
| | - Roland Valori
- Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, United Kingdom
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
| |
Collapse
|
46
|
Dray X, Iakovidis D, Houdeville C, Jover R, Diamantis D, Histace A, Koulaouzidis A. Artificial intelligence in small bowel capsule endoscopy - current status, challenges and future promise. J Gastroenterol Hepatol 2021; 36:12-19. [PMID: 33448511 DOI: 10.1111/jgh.15341] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
Neural network-based solutions are under development to alleviate physicians from the tedious task of small-bowel capsule endoscopy reviewing. Computer-assisted detection is a critical step, aiming to reduce reading times while maintaining accuracy. Weakly supervised solutions have shown promising results; however, video-level evaluations are scarce, and no prospective studies have been conducted yet. Automated characterization (in terms of diagnosis and pertinence) by supervised machine learning solutions is the next step. It relies on large, thoroughly labeled databases, for which preliminary "ground truth" definitions by experts are of tremendous importance. Other developments are under ways, to assist physicians in localizing anatomical landmarks and findings in the small bowel, in measuring lesions, and in rating bowel cleanliness. It is still questioned whether artificial intelligence will enter the market with proprietary, built-in or plug-in software, or with a universal cloud-based service, and how it will be accepted by physicians and patients.
Collapse
Affiliation(s)
- Xavier Dray
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France.,ETIS UMR 8051 (CY Paris Cergy University, ENSEA, CNRS), Cergy, France
| | - Dimitris Iakovidis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Charles Houdeville
- Sorbonne Université, Centre d'Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Dimitris Diamantis
- Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, Greece
| | - Aymeric Histace
- ETIS UMR 8051 (CY Paris Cergy University, ENSEA, CNRS), Cergy, France
| | | |
Collapse
|
47
|
Abstract
Polypectomy is an essential skill for all endoscopists performing lower gastrointestinal endoscopy. Different polypectomy tools and techniques have evolved and it is important that endoscopists are familiar with these so they can select the most appropriate technique for each polyp. This narrative review updates the different concepts in tailoring polypectomy technique to the characteristics of polyps. Effective polypectomy requires different components, including the following: careful evaluation of the polyp; decision making about optimal polyp management; actual polypectomy, which includes careful positioning of the endoscope and polyp; and postpolypectomy evaluation of the results (for completeness of resection and prophylaxis of complications).
Collapse
Affiliation(s)
- Matthew D Rutter
- University Hospital of North Tees, Stockton on Tees, United Kingdom; Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Rodrigo Jover
- Servicio de Medina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain.
| |
Collapse
|
48
|
Baile-Maxía S, Mangas-Sanjuan C, Medina-Prado L, Martínez-Sempere J, Murcia O, Ruíz-Gómez F, Casellas JA, Zapater P, Jover R. Diagnostic yield of early repeat colonoscopy after suboptimal bowel preparation in a fecal immunochemical test-based screening program. Endoscopy 2020; 52:1093-1100. [PMID: 32583393 DOI: 10.1055/a-1191-3011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Current guidelines regarding surveillance after screening colonoscopy assume adequate bowel preparation. However, follow-up intervals after suboptimal cleansing are highly heterogeneous. We aimed to determine the diagnostic yield of early repeat colonoscopy in patients with suboptimal bowel preparation in fecal immunochemical test (FIT)-based screening colonoscopy. METHODS An observational study including patients who underwent colonoscopy with suboptimal bowel preparation after positive FIT screening and then repeat colonoscopy within 1 year. Suboptimal preparation was defined as a Boston Bowel Preparation Scale (BBPS) score of 1 in any segment. Patients with a BBPS score of 0 in any segment or incomplete examination were excluded. The adenoma detection rate (ADR), advanced ADR (AADR), and colorectal cancer rate were calculated for the index and repeat colonoscopies. RESULTS Of the 2474 patients with FIT-positive colonoscopy at our center during this period, 314 (12.7 %) had suboptimal preparation. Of the 259 (82.5 %) patients who underwent repeat colonoscopy, suboptimal cleansing persisted in 22 (9 %). On repeat colonoscopy, the ADR was 38.7 % (95 %CI 32.6 % to 44.8 %) and the AADR was 14.9 % (95 %CI 10.5 % to 19.4 %). The per-adenoma miss rate was 27.7 % (95 %CI 24.0 % to 31.6 %), and the per-advanced adenoma miss rate was 17.6 % (95 %CI 13.3 % to 22.7 %). After repeat colonoscopy, the post-polypectomy surveillance recommendation changed from 10 to 3 years in 14.7 % of the patients with previous 10-year surveillance recommendation. CONCLUSIONS Patients with suboptimal bowel preparation on FIT-positive colonoscopy present a high rate of advanced adenomas in repeat colonoscopy, with major changes in post-polypectomy surveillance recommendations.
Collapse
Affiliation(s)
- Sandra Baile-Maxía
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Carolina Mangas-Sanjuan
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Lucía Medina-Prado
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Juan Martínez-Sempere
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Oscar Murcia
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Francisco Ruíz-Gómez
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Juan A Casellas
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| | - Pedro Zapater
- Clinical Pharmacology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, CIBERehd, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario de Alicante, Instituto de Investigación Biomédica ISABIAL, Alicante, Spain
| |
Collapse
|
49
|
Picó MD, Sánchez-Heras AB, Castillejo A, Giner-Calabuig M, Alustiza M, Sánchez A, Moreira L, Pellise M, Castells A, Llort G, Yagüe C, Ramon y Cajal T, Gisbert-Beamud A, Cubiella J, Rivas L, Herraiz M, Garau C, Salces I, Carrillo-Palau M, Bujanda L, López-Fernández A, Alvarez-Urturi C, López MJ, Alenda C, Zapater P, Lacueva FJ, Balaguer F, Soto JL, Murcia Ó, Jover R. Risk of Cancer in Family Members of Patients with Lynch-Like Syndrome. Cancers (Basel) 2020; 12:cancers12082225. [PMID: 32784934 PMCID: PMC7466118 DOI: 10.3390/cancers12082225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Abstract
Lynch syndrome (LS) is a common cause of hereditary colorectal cancer (CRC). Some CRC patients develop mismatch repair deficiency without germline pathogenic mutation, known as Lynch-like syndrome (LLS). We compared the risk of CRC in first-degree relatives (FDRs) in LLS and LS patients. LLS was diagnosed when tumors showed immunohistochemical loss of MSH2, MSH6, and PMS2; or loss of MLH1 with BRAF wild type; and/or no MLH1 methylation and absence of pathogenic mutation in these genes. CRC and other LS-related neoplasms were followed in patients diagnosed with LS and LLS and among their FDRs. Standardized incidence ratios (SIRs) were calculated for CRC and other neoplasms associated with LS among FDRs of LS and LLS patients. In total, 205 LS (1205 FDRs) and 131 LLS families (698 FDRs) had complete pedigrees. FDRs of patients with LLS had a high incidence of CRC (SIR, 2.08; 95% confidence interval (CI), 1.56–2.71), which was significantly lower than that in FDRs of patients with LS (SIR, 4.25; 95% CI, 3.67–4.90; p < 0.001). The risk of developing other neoplasms associated with LS also increased among FDR of LLS patients (SIR, 2.04; 95% CI, 1.44–2.80) but was lower than that among FDR of patients with LS (SIR, 5.01, 95% CI, 4.26–5.84; p < 0.001). FDRs with LLS have an increased risk of developing CRC as well as LS-related neoplasms, although this risk is lower than that of families with LS. Thus, their management should take into account this increased risk.
Collapse
Affiliation(s)
- María Dolores Picó
- Servicio de Medicina Digestiva, Hospital General Universitario de Elche, Elche, 03203 Alicante, Spain;
| | - Ana Beatriz Sánchez-Heras
- Servicio de Oncología Médica, Hospital General Universitario de Elche, Elche, 03203 Alicante, Spain;
| | - Adela Castillejo
- Unidad de Genética Molecular, Hospital General Universitario de Elche, 03203 Alicante, Spain; (A.C.); (J.-L.S.)
| | - Mar Giner-Calabuig
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, 03010 Alicante, Spain; (M.G.-C.); (M.A.)
| | - Miren Alustiza
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, 03010 Alicante, Spain; (M.G.-C.); (M.A.)
| | - Ariadna Sánchez
- Servicio de Medicina Digestiva, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd. University of Barcelona, 08036 Barcelona, Spain; (A.S.); (L.M.); (M.P.); (A.C.); (F.B.)
| | - Leticia Moreira
- Servicio de Medicina Digestiva, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd. University of Barcelona, 08036 Barcelona, Spain; (A.S.); (L.M.); (M.P.); (A.C.); (F.B.)
| | - María Pellise
- Servicio de Medicina Digestiva, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd. University of Barcelona, 08036 Barcelona, Spain; (A.S.); (L.M.); (M.P.); (A.C.); (F.B.)
| | - Antoni Castells
- Servicio de Medicina Digestiva, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd. University of Barcelona, 08036 Barcelona, Spain; (A.S.); (L.M.); (M.P.); (A.C.); (F.B.)
| | - Gemma Llort
- Servicio de Oncología Médica, Hospital Universitari Parc Taulí, Sabadell, Consorci Sanitari de Terrassa, Terrassa, 08208 Barcelona, Spain; (G.L.); (C.Y.)
| | - Carmen Yagüe
- Servicio de Oncología Médica, Hospital Universitari Parc Taulí, Sabadell, Consorci Sanitari de Terrassa, Terrassa, 08208 Barcelona, Spain; (G.L.); (C.Y.)
| | - Teresa Ramon y Cajal
- Servicio de Medicina Digestiva, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (T.R.yC.); (A.G.-B.)
| | - Alexandra Gisbert-Beamud
- Servicio de Medicina Digestiva, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (T.R.yC.); (A.G.-B.)
| | - Joaquin Cubiella
- Servicio de Medicina Digestiva, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, CIBERehd, 32005 Ourense, Spain; (J.C.); (L.R.)
| | - Laura Rivas
- Servicio de Medicina Digestiva, Complexo Hospitalario Universitario de Ourense, Instituto de Investigación Sanitaria Galicia Sur, CIBERehd, 32005 Ourense, Spain; (J.C.); (L.R.)
| | - Maite Herraiz
- Servicio de Medicina Digestiva, Clínica Universidad de Navarra, 31008 Navarra, Spain;
| | - Catalina Garau
- Servicio de Medicina Digestiva, Hospital de Son Llàtzer, 07198 Palma de Mallorca, Spain;
| | - Inmaculada Salces
- Servicio de Medicina Digestiva, Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Marta Carrillo-Palau
- Servicio de Medicina Digestiva, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Luis Bujanda
- Servicio de Medicina Digestiva, Hospital Donostia/Instituto Biodonostia, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad del País Vasco (UPV/EHU), 20014 San Sebastián, Spain;
| | - Adriá López-Fernández
- Unidad de Alto Riesgo y Prevención del Cáncer, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain;
| | | | - María Jesús López
- Servicio de Medicina Digestiva, Hospital Universitario Marqués de Valdecilla, 39008 Santandercity, Spain;
| | - Cristina Alenda
- Servicio de Anatomía Patológica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, 03010 Alicante, Spain;
| | - Pedro Zapater
- Servicio de Farmacología Clínica, Hospital General Universitario de Alicante, ISABIAL, CIBERehd, IDiBE, UMH, 03010 Alicante, Spain;
| | - Francisco Javier Lacueva
- Servicio de Cirugía general, Hospital General Universitario de Elche, Elche, 03203 Alicante, Spain;
| | - Francesc Balaguer
- Servicio de Medicina Digestiva, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd. University of Barcelona, 08036 Barcelona, Spain; (A.S.); (L.M.); (M.P.); (A.C.); (F.B.)
| | - Jose-Luis Soto
- Unidad de Genética Molecular, Hospital General Universitario de Elche, 03203 Alicante, Spain; (A.C.); (J.-L.S.)
| | - Óscar Murcia
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, 03010 Alicante, Spain; (M.G.-C.); (M.A.)
- Correspondence: (Ó.M.); or (R.J.); Fax: +34-965-933-468 (Ó.M. & R.J.)
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, 03010 Alicante, Spain; (M.G.-C.); (M.A.)
- Correspondence: (Ó.M.); or (R.J.); Fax: +34-965-933-468 (Ó.M. & R.J.)
| |
Collapse
|
50
|
Ventero MP, Espinosa N, Jover R, Guillen Y, Merino E, Rodríguez JC. Evolution of intestinal microbiome in a process of faecal microbiota transfer (FMT) in a patient with Clostridioides difficile infection: NGS analysis with different software programs. Enferm Infecc Microbiol Clin 2020; 39:184-187. [PMID: 32680797 DOI: 10.1016/j.eimc.2020.05.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/30/2020] [Accepted: 05/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Clostridioides difficile infection (CDI) has become a global healthcare challenge due to increases in its incidence and mortality rates. Faecal microbiota transfer (FMT) is postulated as a protocol to prevent CDI recurrence. MATERIAL AND METHODS A donor faecal sample and patient faecal samples (pre-FMT and post-FMT) were analysed. The r16S gene was amplified and sequenced by NGS, and its diversity and taxonomy composition were examined. RESULTS Microbial richness increased in post-FMT samples, and the β diversity studies grouped the samples into two clusters. One included the non-pathological samples (donor and pre-FMT samples), and the other included the pathological sample. The results obtained by Qiime2 and Bioconductor were similar. CONCLUSION The analysis showed an increase in taxonomic diversity after the FMT, which suggests its usefulness. Moreover, these results showed that standardisation of bioinformatics analysis is key.
Collapse
Affiliation(s)
- María Paz Ventero
- Servicio de Microbiología. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, Alicante, España.
| | - Noelia Espinosa
- Servicio de Microbiología. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, Alicante, España
| | - Rodrigo Jover
- Servicio Digestivo. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, Alicante, España
| | | | - Esperanza Merino
- Unidad de Enfermedades infecciosas. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, Alicante, España
| | - Juan Carlos Rodríguez
- Servicio de Microbiología. Hospital General Universitario de Alicante. Instituto de Investigación Sanitaria y Biomédica de Alicante-ISABIAL, Alicante, España; Departamento de Producción Vegetal y Microbiología. Universidad Miguel Hernández de Elche (Alicante), Elche, España
| |
Collapse
|