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Walsh M, Rahman S, Gologorsky R, Tsikitis VL. Colorectal Neoplasia in the Setting of Inflammatory Bowel Disease. Surg Clin North Am 2024; 104:673-684. [PMID: 38677829 DOI: 10.1016/j.suc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer (colorectal adenocarcinoma [CRC]) compared with the general population. IBD-related CRC is related to poorer outcomes than non-IBD-related CRC, and it accounts for 10% to 15% of death in patients with IBD. As such, screening guidelines have been made specific to this population recommending shorter intervals of endoscopic screening to detect dysplasia and CRC relative to the general population. Advances in endoscopic technology allow for improved visualization of dysplasia, which has led to widespread adoption of dye-spray chromoendoscopy with targeted biopsy.
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Affiliation(s)
- Maura Walsh
- Department of General Surgery, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road L-579, Portland, OR 97239, USA.
| | - Shahrose Rahman
- Department of Surgery, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road L-579, Portland, OR 97239, USA
| | - Rebecca Gologorsky
- Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road L-579, Portland, OR 97239, USA
| | - Vassiliki Liana Tsikitis
- Department of Surgery, Oregon Health Sciences University, 3181 Southwest Sam Jackson Park Road L-579, Portland, OR 97239, USA
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Gao Y, Ye LS, Li X, Yu B, Liao K, Xie J, Du J, Zhang QY, Hu B. Effect of vinegar supplementation on patients with esophageal lesions lightly stained with Lugol’s iodine solution: Prospective single-centre trial. World J Gastrointest Endosc 2024; 16:259-272. [DOI: 10.4253/wjge.v16.i5.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Esophageal chromoendoscopy with iodine solution is important for detecting early esophageal cancer. The effect of routine treatment for lesions lightly stained with Lugol’s iodine solution is limited, and the addition of natural substances to a regular diet is becoming increasingly common. Vinegar has antitumor effects as reported in previous studies.
AIM To evaluate whether vinegar supplementation could improve the prognosis of patients with lightly stained esophageal lesions.
METHODS This prospective single-centre trial included consecutive patients with lightly stained lesions between June 2020 and April 2022. Patients in the experimental group received increased amounts of vinegar for 6 months. The primary outcome of the study was the clinical therapeutic effect. Complications related to vinegar ingestion and adverse events were also recorded in detail.
RESULTS A total of 166 patients were included in the final analysis. There was no significant difference in the baseline data between the two groups. Intention-to-treat (ITT) analysis demonstrated that the rates at which endoscopic characteristics improved were 33.72% in the experimental group and 20.00% in the conventional group (P = 0.007); and the rates at which biopsy pathology improved were 19.77% and 8.75%, respectively (P = 0.011). Additional vinegar consumption had a statistically protective effect on the rate at which endoscopic characteristics improved [hazard ratio (HR) ITT = 2.183, 95%CI: 1.183-4.028; HRper-protocol (PP) = 2.307, 95%CI: 1.202-4.426] and biopsy pathology improved (HRITT = 2.931, 95%CI: 1.212-7.089; HRPP = 3.320, 95%CI: 1.295-8.507). No statistically significant effect of increased vinegar consumption on preventing high-grade intraepithelial neoplasia or early cancer was observed (HRITT = 0.382, 95%CI: 0.079-1.846; HRPP = 0.382, 95%CI: 0.079-1.846). The subgroup analyses indicated that the overall therapeutic improvement of endoscopic characteristics and biopsy pathology seemed more obvious in older (age > 60) male patients with small lesions (lesion size ≤ 0.5 cm). Three patients in the experimental group reported acid regurgitation and heartburn. No adverse event during gastroscopy were recorded during follow-up.
CONCLUSION A moderately increased ingestion of vinegar could not directly reduce the risk of esophageal cancer in the mucosa dysplasia population, but it improved the endoscopic characteristics and ameliorated the biopsy pathology to a certain extent. Further research is needed to verify the effect of nutritional intervention on precancerous esophageal lesions.
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Affiliation(s)
- Yuan Gao
- Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xu Li
- Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Yu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu 610065, Sichuan Province, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610044, Sichuan Province, China
| | - Ke Liao
- Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia Xie
- Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jiang Du
- Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qiong-Ying Zhang
- Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology, Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu 610041, Sichuan Province, China
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Suzuki S, Monno Y, Arai R, Miyaoka M, Toya Y, Esaki M, Wada T, Hatta W, Takasu A, Nagao S, Ishibashi F, Minato Y, Konda K, Dohmen T, Miki K, Okutomi M. Diagnostic performance of deep-learning-based virtual chromoendoscopy in gastric neoplasms. Gastric Cancer 2024; 27:539-547. [PMID: 38240891 DOI: 10.1007/s10120-024-01469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/09/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUNDS Cycle-consistent generative adversarial network (CycleGAN) is a deep neural network model that performs image-to-image translations. We generated virtual indigo carmine (IC) chromoendoscopy images of gastric neoplasms using CycleGAN and compared their diagnostic performance with that of white light endoscopy (WLE). METHODS WLE and IC images of 176 patients with gastric neoplasms who underwent endoscopic resection were obtained. We used 1,633 images (911 WLE and 722 IC) of 146 cases in the training dataset to develop virtual IC images using CycleGAN. The remaining 30 WLE images were translated into 30 virtual IC images using the trained CycleGAN and used for validation. The lesion borders were evaluated by 118 endoscopists from 22 institutions using the 60 paired virtual IC and WLE images. The lesion area concordance rate and successful whole-lesion diagnosis were compared. RESULTS The lesion area concordance rate based on the pathological diagnosis in virtual IC was lower than in WLE (44.1% vs. 48.5%, p < 0.01). The successful whole-lesion diagnosis was higher in the virtual IC than in WLE images; however, the difference was insignificant (28.2% vs. 26.4%, p = 0.11). Conversely, subgroup analyses revealed a significantly higher diagnosis in virtual IC than in WLE for depressed morphology (41.9% vs. 36.9%, p = 0.02), differentiated histology (27.6% vs. 24.8%, p = 0.02), smaller lesion size (42.3% vs. 38.3%, p = 0.01), and assessed by expert endoscopists (27.3% vs. 23.6%, p = 0.03). CONCLUSIONS The diagnostic ability of virtual IC was higher for some lesions, but not completely superior to that of WLE. Adjustments are required to improve the imaging system's performance.
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Affiliation(s)
- Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, 6-1-14, Konodai, Ichikawa-Shi, Chiba, 272-0827, Japan.
| | - Yusuke Monno
- Department of Systems and Control Engineering, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Ryo Arai
- Department of Systems and Control Engineering, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
| | - Masaki Miyaoka
- Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yosuke Toya
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukouka, Japan
- Department of Gastroenterology, Harasanshin Hospital, Fukuoka, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ayaka Takasu
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Shigeaki Nagao
- Medical Examination Center, Showa General Hospital, Tokyo, Japan
| | - Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, 6-1-14, Konodai, Ichikawa-Shi, Chiba, 272-0827, Japan
- Endoscopy Center, Koganei Tsurukame Clinic, Tokyo, Japan
| | - Yohei Minato
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Kenichi Konda
- Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takahiro Dohmen
- Department of Gastroenterology, Yuri Kumiai General Hospital, Yurihonjo, Japan
| | - Kenji Miki
- Department of Internal Medicine, Tsujinaka Hospital Kashiwanoha, Kashiwa, Japan
| | - Masatoshi Okutomi
- Department of Systems and Control Engineering, School of Engineering, Tokyo Institute of Technology, Tokyo, Japan
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Lu YB, Lu SC, Li FD, Le PH, Zhang KH, Sun ZZ, Huang YN, Weng YC, Chen WT, Fu YW, Qian JB, Hu B, Xu H, Chiu CT, Xu QW, Gong W. Artificial intelligence-aided diagnostic imaging: A state-of-the-art technique in precancerous screening. J Gastroenterol Hepatol 2024; 39:544-551. [PMID: 38059883 DOI: 10.1111/jgh.16429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND AND AIM Chromoendoscopy with the use of indigo carmine (IC) dye is a crucial endoscopic technique to identify gastrointestinal neoplasms. However, its performance is limited by the endoscopist's skill, and no standards are available for lesion identification. Thus, we developed an artificial intelligence (AI) model to replace chromoendoscopy. METHODS This pilot study assessed the feasibility of our novel AI model in the conversion of white-light images (WLI) into virtual IC-dyed images based on a generative adversarial network. The predictions of our AI model were evaluated against the assessments of five endoscopic experts who were blinded to the purpose of this study with a staining quality rating from 1 (unacceptable) to 4 (excellent). RESULTS The AI model successfully transformed the WLI of polyps with different morphologies and different types of lesions in the gastrointestinal tract into virtual IC-dyed images. The quality ratings of the real IC-dyed and AI images did not significantly differ concerning surface structure (AI vs IC: 3.08 vs 3.00), lesion border (3.04 vs 2.98), and overall contrast (3.14 vs 3.02) from 10 sets of images (10 AI images and 10 real IC-dyed images). Although the score depended significantly on the evaluator, the staining methods (AI or real IC) and evaluators had no significant interaction (P > 0.05) with each other. CONCLUSION Our results demonstrated the feasibility of employing AI model's virtual IC staining, increasing the possibility of being employed in daily practice. This novel technology may facilitate gastrointestinal lesion identification in the future.
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Affiliation(s)
- Yang-Bor Lu
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Si-Cun Lu
- Departmemt of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Shenzhen, China
| | - Fu-Dong Li
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Puo-Hsien Le
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Kai-Hua Zhang
- School of Computer, Nanjing University of Information Science and Technology, Nanjing, China
| | - Zi-Zheng Sun
- School of Computer, Nanjing University of Information Science and Technology, Nanjing, China
| | - Yung-Ning Huang
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Yu-Chieh Weng
- Department of Digestive Disease, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
- Endoscopy Center, Xiamen Chang Gung Hospital, Hua Qiao University, Xiamen, China
| | - Wei-Ting Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Yi-Wei Fu
- Department of Gastroenterology, Affiliated Taizhou People's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun-Bo Qian
- Department of Gastroenterology, The Second Hospital affiliated to Nantong University, Nantong, China
| | - Bin Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Xu
- Department of Gastroenterology and Endoscopy Center, First Hospital of Jilin University, Jilin, China
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Qin-Wei Xu
- Endoscopy Center, Department of Gastroenterology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Gong
- Departmemt of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
- The Third School of Clinical Medicine, Southern Medical University, Shenzhen, China
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Liu K, Bai J, Gao L, Zhao X, Dong X, Chen H, Dong J, Niu M, Han Y, Liu Z. The diagnostic performance of V' and U' variables as an objective index of pink-color sign for diagnosing esophageal cancerous lesions. Surg Endosc 2024; 38:148-157. [PMID: 37945708 DOI: 10.1007/s00464-023-10496-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The pink-color sign (PCS) has been widely used for diagnosing esophageal squamous cell carcinoma (ESCC) during Lugol's iodine chromoendoscopy. However, the identification of the PCS only relies on the subjective assessments made by the endoscopist, which could lead to bias and disagreement. Previous research has indicated that the V' variable can, as an objective index, define the PCS in the LU'V' color space. We aimed to validate the diagnostic performance of the PCS defined by the V' variable alone and attempt to improve the diagnostic performance by combining the V' and U' variables. METHODS We re-examined 231 subjects with Lugol's unstained lesions (LULs) from a previously reported prospective trial. The diagnostic performance of the method using V' variable alone (V' alone method), the combination method using V' and U' variables (V' + U' method), and the endoscopists were calculated and compared. RESULTS A total of 236 LULs were included, among which 46 were histologically confirmed to be cancerous lesions. The sensitivity, specificity, and accuracy of the V' alone method were 73.91% (95% CI 58.87-85.73%), 79.47% (95% CI 73.03-84.98%), and 78.39% (95% CI 72.59-83.47%) in the external validation cohort, respectively. It is inferior to endoscopists in terms of specificity and accuracy. The V' + U' method demonstrated a diagnostic performance comparable to the experienced endoscopists, with sensitivity, specificity, and accuracy of 76.74% (95% CI 61.37-88.25%), 88.64% (95% CI 83.00-92.92%), and 86.30% (95% CI 81.03-90.56%), respectively. CONCLUSION The V' alone method exhibited lower specificity and accuracy than the experienced endoscopist and the V' + U' method. However, the modified V' + U' method demonstrated a diagnostic performance comparable to experienced endoscopists. Utilizing the objective index of the PCS could provide valuable support in clinical decision-making.
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Affiliation(s)
- Kai Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jiawei Bai
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
- School of Medicine, Yan'an University, Yan'an, China
| | - Li Gao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xin Zhao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xin Dong
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Hui Chen
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Jiaqiang Dong
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Min Niu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Huang CW, Yen HH, Chen YY. Unusual Cause of Duodenal Villi Atrophy. Dig Dis Sci 2023; 68:3827-3828. [PMID: 37603203 DOI: 10.1007/s10620-023-08074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Chih-Wen Huang
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan.
- College of Medicine, National Chung Hsing University, Taichung, Taiwan.
| | - Yang-Yuan Chen
- Division of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
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Ferreira AO, Reves JB, Nascimento C, Frias-Gomes C, Costa-Santos MP, Ramos LR, Palmela C, Gloria L, Cravo M, Dinis-Ribeiro M, Canena J. Narrow Band Imaging versus White Light for the Detection of Sessile Serrated Colorectal Lesions: A Randomized Clinical Trial. GE Port J Gastroenterol 2023; 30:368-374. [PMID: 37868631 PMCID: PMC10586213 DOI: 10.1159/000526606] [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] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/14/2022] [Indexed: 10/24/2023]
Abstract
Background Colorectal cancer (CRC) is a leading cause of cancer. The detection of pre-malignant lesions by colonoscopy is associated with reduced CRC incidence and mortality. Narrow band imaging has shown promising but conflicting results for the detection of serrated lesions. Methods We performed a randomized clinical trial to compare the mean detection of serrated lesions and hyperplastic polyps ≥10 mm with NBI or high-definition white light (HD-WL) withdrawal. We also compared all sessile serrated lesions (SSLs), adenoma, and polyp prevalence and rates. Results Overall, 782 patients were randomized (WL group 392 patients; NBI group 390 patients). The average number of serrated lesions and hyperplastic polyps ≥10 mm detected per colonoscopy (primary endpoint) was similar between the HD-WL and NBI group (0.118 vs. 0.156, p = 0.44). Likewise, the adenoma detection rate (55.2% vs. 53.2%, p = 0.58) and SSL detection rate (6.8% vs. 7.5%, p = 0.502) were not different between the two study groups. Withdrawal time was higher in the NBI group (10.88 vs. 9.47 min, p = 0.004), with a statistically nonsignificant higher total procedure time (20.97 vs. 19.30 min, p = 0.052). Conclusions The routine utilization of narrow band imaging does not improve the detection of serrated class lesions or any pre-malignant lesion and increases the withdrawal time.
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Affiliation(s)
- Alexandre Oliveira Ferreira
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
- Department of Gastroenterology, Hospital da Luz Lisboa, Lisboa, Portugal
| | - Joana Branco Reves
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | | | | | - Maria Pia Costa-Santos
- Department of Gastroenterology, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - Lídia Roque Ramos
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
- Department of Gastroenterology, Hospital da Luz Lisboa, Lisboa, Portugal
| | - Carolina Palmela
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
- Department of Gastroenterology, Hospital da Luz Lisboa, Lisboa, Portugal
| | - Luísa Gloria
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Marília Cravo
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
- Department of Gastroenterology, Hospital da Luz Lisboa, Lisboa, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Instituto Português de Oncologia, Porto, Portugal
- Cintesis, Center for Health Technology and Services Research, Porto, Portugal
| | - Jorge Canena
- Cintesis, Center for Health Technology and Services Research, Porto, Portugal
- Department of Gastroenterology, Nova Medical School/Faculty of Medical Sciences, Lisboa, Portugal
- University Center of Gastroenterology, Hospital Cuf Tejo, Lisbon, Portugal
- Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal
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8
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Matsumura T, Ebigbo A, Römmele C, Ikematsu H, Ishigami H, Suzuki T, Harada H, Yada T, Takatori Y, Takeuchi M, Okimoto K, Akizue N, Maruoka D, Kitagawa Y, Minamide T, Iwaki T, Amano Y, Matsusaka K, Nagashima K, Maehata T, Yahagi N, Messmann H, Kato N. Diagnostic Value of Adding Magnifying Chromoendoscopy to Magnifying Narrow-Band Imaging Endoscopy for Colorectal Polyps. Clin Gastroenterol Hepatol 2023; 21:2551-2559.e2. [PMID: 36739935 DOI: 10.1016/j.cgh.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/28/2022] [Accepted: 01/21/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS This study examined the additional value of magnifying chromoendoscopy (MCE) on magnifying narrow-band imaging endoscopy (M-NBI) in the optical diagnosis of colorectal polyps. METHODS A multicenter prospective study was conducted at 9 facilities in Japan and Germany. Patients with colorectal polyps scheduled for resection were included. Optical diagnosis was performed by M-NBI first, followed by MCE. Both diagnoses were made in real time. MCE was performed on all type 2B lesions classified according to the Japan NBI Expert Team classification and other lesions at the discretion of endoscopists. The diagnostic accuracy and confidence of M-NBI and MCE for colorectal cancer (CRC) with deep invasion (≥T1b) were compared on the basis of histologic findings after resection. RESULTS In total, 1173 lesions were included between February 2018 and December 2020, with 654 (5 hyperplastic polyp/sessile serrated lesion, 162 low-grade dysplasia, 403 high-grade dysplasia, 97 T1 CRCs, and 32 ≥T2 CRCs) examined using MCE after M-NBI. In the diagnostic accuracy for predicting CRC with deep invasion, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for M-NBI were 63.1%, 94.2%, 61.6%, 94.5%, and 90.2%, respectively, and for MCE they were 77.4%, 93.2%, 62.5%, 96.5%, and 91.1%, respectively. The sensitivity was significantly higher in MCE (P < .001). However, these additional values were limited to lesions with low confidence in M-NBI or the ones diagnosed as ≥T1b CRC by M-NBI. CONCLUSIONS In this multicenter prospective study, we demonstrated the additional value of MCE on M-NBI. We suggest that additional MCE be recommended for lesions with low confidence or the ones diagnosed as ≥T1b CRC. Trials registry number: UMIN000031129.
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Affiliation(s)
- Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Alanna Ebigbo
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Christoph Römmele
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Hiroaki Ikematsu
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Hideaki Ishigami
- Department of Gastroenterology, Chiba Rosai Hospital, Chiba, Japan
| | - Takuto Suzuki
- Endoscopy Division, Chiba Cancer Center, Chiba, Japan
| | - Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tomoyuki Yada
- Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yusaku Takatori
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Manabu Takeuchi
- Division of Gastroenterology and Hepatology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | | | - Tatsunori Minamide
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Tomoyuki Iwaki
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yuji Amano
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | | | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Tadateru Maehata
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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9
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Ruf B, Roggia C, Schroeder C, Mattern S, Fend F, Klag T, Götz M. Chromoendoscopy in Combination with Random Biopsies for Patients with Pathogenic CDH1 Mutations Undergoing Endoscopic Surveillance. J Gastrointest Cancer 2023; 54:520-527. [PMID: 35499650 PMCID: PMC10435617 DOI: 10.1007/s12029-022-00831-1] [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] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Germline mutations in the CDH1-gene are identified as the cause of 30-40% of cases of hereditary diffuse gastric cancer, an autosomal-dominant inherited cancer predisposition syndrome. Given this high risk of developing diffuse gastric cancer, carriers of a pathogenic CDH1 germline mutation are advised to undergo prophylactic gastrectomy. For patients preferring conservative management, endoscopic surveillance is recommended. The detection of diffuse gastric cancer using white light endoscopy, however, remains challenging. METHODS Patients with pathogenic CDH1 mutation underwent (chromo)endoscopic surveillance or endoscopy prior to surgery. Biopsies were taken at suspicious sites identified by chromoendoscopy. In addition, endoscopically normal areas were assessed with mapping biopsies. Detection rates from endoscopic biopsies (mapping vs. targeted) and gastrectomy specimen were then compared. RESULT Between 11/2015 and 12/2020, ten patients from four families with a known CDH1 germline mutation had a total of n = 24 endoscopies with n = 518 total biopsies being examined. Three patients were diagnosed with GC during the study period. These patients all had suspicious chromoendoscopic lesions (= detection rate 100%). In two of three patients who had suspicious chromoendoscopic lesions, signet cell carcinoma was also detected in mapping biopsies and multiple additional cancer foci were identified in the gastrectomy specimen. CONCLUSION Chromoendoscopy facilitated detection of gastric carcinoma foci in CDH1 mutation carriers. Chromoendoscopy identified all patients with gastric cancer, but not all cancer foci present in these patients. We conclude that for patients opting against prophylactic total gastrectomy, the addition of chromoendoscopy to white light could be used to enhance diagnostic reliability of endoscopic surveillance.
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Affiliation(s)
- Benjamin Ruf
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Tübingen, Germany
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Cristiana Roggia
- Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Christopher Schroeder
- Institute of Medical Genetics and Applied Genomics, University Hospital Tübingen, Tübingen, Germany
| | - Sven Mattern
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Klag
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Tübingen, Germany
| | - Martin Götz
- Department of Internal Medicine I (Gastroenterology, Hepatology, Infectious Diseases), University Hospital Tübingen, Tübingen, Germany.
- Department of Internal Medicine IV (Gastroenterology, Oncology), Klinikum Sindelfingen-Böblingen, Bunsenstrasse 120, 71032, Böblingen, Germany.
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10
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Koh M, Lee JY, Han SH, Jeon SW, Kim SJ, Cho JY, Kim SH, Jang JY, Baik GH, Jang JS. Comparison Trial between I-SCAN-Optical Enhancement and Chromoendoscopy for Evaluating the Horizontal Margins of Gastric Epithelial Neoplasms. Gut Liver 2023; 17:234-242. [PMID: 36317515 PMCID: PMC10018302 DOI: 10.5009/gnl220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Endoscopic submucosal dissection is a widely used treatment for gastric epithelial neoplasms. Accurate delineation of the horizontal margins is necessary for the complete resection of gastric epithelial neoplasms. Recently, image-enhanced endoscopy has been used to evaluate horizontal margins of gastric epithelial neoplasms. The aim of this study was to investigate whether I-SCAN-optical enhancement (I-SCAN-OE) is superior to chromoendoscopy in evaluating the horizontal margin of gastric epithelial neoplasms. Methods This was a multicenter, prospective, and randomized trial. The participants were divided into two groups: I-SCAN-OE and chromoendoscopy. For both groups, we first evaluated the horizontal margins of early gastric cancer or high-grade dysplasia using white-light imaging, and then evaluated, the horizontal margins using I-SCAN-OE or chromoendoscopy. We devised a unique scoring method based on the pathological results obtained after endoscopic submucosal dissection to accurately evaluate the horizontal margins of gastric epithelial neoplasms. The delineation scores of both groups were compared, as were the ratios of positive/negative horizontal margins. Results In total, 124 patients were evaluated for gastric epithelial neoplasms, of whom 112 were enrolled in the study. A total of 112 patients participated in the study, and 56 were assigned to each group (1:1). There was no statistically significant difference in the delineation scores between the groups (chromoendoscopy, 7.80±1.94; I-SCAN-OE, 8.23±2.24; p=0.342). Conclusions I-SCAN-OE did not show superiority over chromoendoscopy in delineating horizontal margins of gastric epithelial neoplasms.
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Affiliation(s)
- Myeongseok Koh
- Departments of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong Yoon Lee
- Departments of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Song-Hee Han
- Departments of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Joo Young Cho
- Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Seong Hwan Kim
- Department of Internal Medicine, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jae Young Jang
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Jin Seok Jang
- Departments of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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11
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Wasielica-Berger J, Rogalski P, Pryczynicz A, Swidnicka-Siergiejko A, Dabrowski A. Methylene blue chromoendoscopy is more useful in detection of intestinal metaplasia in the stomach than mucosal pit pattern or vessel evaluation and predicts advanced Operative Link on Gastric Intestinal Metaplasia stages. Clin Endosc 2023; 56:203-213. [PMID: 36890637 PMCID: PMC10073849 DOI: 10.5946/ce.2022.087] [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: 02/26/2022] [Accepted: 05/30/2022] [Indexed: 03/10/2023] Open
Abstract
Background/Aims Intestinal metaplasia (IM) of the stomach is a precancerous condition that is often not visible during conventional endoscopy. Hence, we evaluated the utility of magnification endoscopy and methylene blue (MB) chromoendoscopy to detect IM. Methods We estimated the percentage of gastric mucosa surface staining with MB, mucosal pit pattern, and vessel visibility and correlated it with the presence of IM and the percentage of metaplastic cells in histology, similar to the Operative Link on Gastric Intestinal Metaplasia (OLGIM) stage. Results IM was found in 25 of 33 (75.8%) patients and in 61 of 135 biopsies (45.2%). IM correlated with positive MB staining (p<0.001) and other than dot pit patterns (p=0.015). MB staining indicated IM with better accuracy than the pit pattern or vessel evaluation (71.7% vs. 60.5% and 49.6%, respectively). At a cut-off point of 16.5% for the MB-stained gastric surface, the sensitivity, specificity, and accuracy of chromoendoscopy in the detection of advanced OLGIM stages were 88.9%, 91.7%, and 90.9%, respectively. The percentage of metaplastic cells detected on histology was the strongest predictor of positive MB staining. Conclusions MB chromoendoscopy can serve as a screening method for detecting advanced OLGIM stages. MB mainly stains IM areas with a high concentration of metaplastic cells.
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Affiliation(s)
| | - Pawel Rogalski
- Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
| | - Anna Pryczynicz
- Department of General Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | | | - Andrzej Dabrowski
- Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland
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12
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Zhao X, Guo M, Zhu S, Zhang L, Dong T, Luo H, Yu W, Zhu J, Fan X, Han Y, Liu Z. Pre-procedure oral administration of pronase improves efficacy of lugol chromoendoscopy in esophageal squamous cell carcinoma screening: a prospective, double-blinded, randomized, controlled trial. Surg Endosc 2023. [PMID: 36781469 DOI: 10.1007/s00464-023-09902-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/18/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND AND AIMS Chromoendoscopy with Lugol's staining is used to screen for early esophageal squamous cell carcinoma (ESCC). Its efficacy is greatly limited by unstandardized defoaming preparation. This study aimed to confirm whether pre-procedure oral administration of pronase could improve the diagnostic performance of Lugol chromoendoscopy in high-risk patients being screened for early ESCC. METHODS A total of 955 patients at-risk were prospectively recruited for screening for ESCC. Patients were randomly assigned (1:1) to groups with or without (control group) pronase administration. Endoscopic diagnosis of early ESCC was based on the presence of pink-color sign in Lugol's unstained area, and a biopsy was routinely conducted if the Lugol's unstained lesion was larger than 0.5 cm. The early cancer detection rate was used as the primary endpoint. RESULTS Pre-procedure oral administration of pronase improved mucosal visibility during Lugol chromoendoscopy (P = 0.008). There were no differences in the number of Lugol's unstained lesions between the 2 groups (23.27% [111/477] vs. 25.11% [120/478], P = 0.508). Meaningfully, the detection rate of ESCC (confirmed by histopathology) was significantly higher in the pronase group than in the control group (27.03% [30/111] vs. 17.50% [21/120], P = 0.041), as well as the detection rate of lesions with pink-color sign during chromoendoscopy (35.14% [39/111] vs. 13.33% [16/120], P < 0.001). The diagnostic performance of Lugol chromoendoscopy had improved with the use of pronase (area under the curve = 0.85 vs. 0.69, P = 0.019), accompanied by an increased sensitivity (86.67% vs. 47.62%, P = 0.004). There was no difference in the adverse events between the 2 groups (P = 0.793). CONCLUSIONS Pre-procedure oral administration of pronase significantly increased the detection rate of early ESCC and optimized the diagnostic performance of Lugol chromoendoscopy, which should be recommended during routine endoscopic screening for early ESCC in high-risk patients. TRIAL REGISTRATION Pronase improves efficacy of Lugol chromoendoscopy screening on esophageal cancerous lesions (NCT02030769).
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13
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Oh HY, Choi HH, Kim EJ, Choi JH, Choi SS, Lee HK, Kim HK, Kim SW, Park WSH, Chae HS. In vitro and in vivo phototoxicity on gastric mucosa induced by methylene blue. Saudi J Gastroenterol 2023; 29:53-58. [PMID: 36571385 PMCID: PMC10117009 DOI: 10.4103/sjg.sjg_315_22] [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] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Methylene blue (MB) is used endoscopically to demarcate tumors and as a photosensitizer in photodynamic therapy (PDT). However, there are few in vivo studies about its toxicity in healthy stomach tissue. We performed sequential in vitro and in vivo analyses of MB-induced phototoxicity. METHODS We performed in vitro experiments using the AGS human gastric cancer cell line treated with light-emitting diode (LED) irradiation (3.6 J/cm2) and MB. Cytotoxicity was evaluated using terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) assay. In vivo toxicity was evaluated in the stomach of beagles using the same dose of fiber-optic LED via gastroscopy, after spraying 0.1% and 0.5% MB solutions. Stomach tissue was also evaluated using the TUNEL assay. RESULTS In vitro, increased concentrations of MB led to higher TUNEL scores. However, cell viability was significantly lower after MB plus LED irradiation than after treatment with MB alone (P < 0.001). In vivo, the TUNEL score was highest immediately after treatment with 0.1% or 0.5% MB plus light irradiation, and the score was significantly higher in the LED illumination plus MB group than in the control group (P < 0.05). The elevated TUNEL score was maintained for 3 days in the MB plus light irradiation group but returned to normal levels on day 10. CONCLUSIONS : Endoscopic light application with MB 0.5% concentration to the stomach may be regarded as a safe procedure despite some DNA injuries in the early period.
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Affiliation(s)
- Hui Yeong Oh
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun Ho Choi
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eui Jin Kim
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Hye Choi
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Sook Choi
- College of Pharmacy, Sahmyook University, Seoul, Republic of Korea
| | - Hae Kyung Lee
- Department of Laboratory Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung-Keun Kim
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Woo Kim
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won Sang H Park
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hiun Suk Chae
- Department of Internal Medicine, Uijongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Kono Y, Higashi R, Mizushima H, Shimizu D, Katayama T, Kosaka M, Hirata I, Hirata T, Gotoda T, Miyahara K, Moritou Y, Kunihiro M, Nakagawa M, Ichimura K, Okada H. Usefulness of Acetic Acid Spray with Narrow-Band Imaging for Identifying the Margin of Sessile Serrated Lesions. Dig Dis Sci 2023; 68:2553-2560. [PMID: 36609732 DOI: 10.1007/s10620-022-07816-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Sessile serrated lesions (SSLs) are precursors of colon cancer, especially in cases of large, right colon. However, they are difficult to not only detect, but only clarify the margin of the lesion, which can lead to the poor endoscopic treatment outcomes. AIMS This study evaluated the usefulness of acetic acid spray with narrow-band imaging (A-NBI) for the better visualization of the margin of SSLs. METHODS From January 2013 to March 2022, patients with superficial elevated polyps suspected of being SSLs ≥ 10 mm with an endoscopic diagnosis that had been endoscopically resected at Hiroshima City Hiroshima Citizens Hospital were enrolled. Endoscopic images with white-light imaging (WLI), narrow-band imaging (NBI), indigo-carmine (IC), and A-NBI were recorded in each lesion and were randomly arranged and assessed by 10 endoscopists. We compared the visibility score (1 to 4) and color differences (ΔE) between inside and outside of the lesions among WLI, NBI, IC, and A-NBI. RESULTS Forty-one lesions in 33 cases were included, and a total of 164 images were evaluated. As for the visibility score, most of the lesions were scored as 1 or 2 on WLI, whereas most were scored 4 on A-NBI. The median ΔE of A-NBI was also significantly higher than that of WLI, NBI, or IC (20.5 vs. 8.3 vs. 8.2 vs. 12.3, P < 0.01). A significant correlation was observed between the color difference and visibility score (r = 0.53, P < 0.01). CONCLUSIONS A-NBI may be a useful modality for identifying the margin of SSLs.
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Affiliation(s)
- Yoshiyasu Kono
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan. .,Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Reiji Higashi
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterology, Ichinomiyanishi Hospital, 1 Kaimeihira, Ichinomiya, 494-0001, Japan
| | - Hidetaka Mizushima
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Daisuke Shimizu
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsuya Katayama
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Masanari Kosaka
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Issei Hirata
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsu Hirata
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Tatsuhiro Gotoda
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan.,Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, 710-8602, Japan
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Yuki Moritou
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-Machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Masahiro Nakagawa
- Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Koichi Ichimura
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, 7-33 Moto-machi, Naka-ku, Hiroshima, 730-8518, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Department of Internal Medicine, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, 670-8540, Japan
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15
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Young EJ, Rajandran A, Philpott HL, Sathananthan D, Hoile SF, Singh R. Mucosal imaging in colon polyps: New advances and what the future may hold. World J Gastroenterol 2022; 28:6632-6661. [PMID: 36620337 PMCID: PMC9813932 DOI: 10.3748/wjg.v28.i47.6632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/23/2022] [Accepted: 11/23/2022] [Indexed: 12/19/2022] Open
Abstract
An expanding range of advanced mucosal imaging technologies have been developed with the goal of improving the detection and characterization of lesions in the gastrointestinal tract. Many technologies have targeted colorectal neoplasia given the potential for intervention prior to the development of invasive cancer in the setting of widespread surveillance programs. Improvement in adenoma detection reduces miss rates and prevents interval cancer development. Advanced imaging technologies aim to enhance detection without significantly increasing procedural time. Accurate polyp characterisation guides resection techniques for larger polyps, as well as providing the platform for the “resect and discard” and “do not resect” strategies for small and diminutive polyps. This review aims to collate and summarise the evidence regarding these technologies to guide colonoscopic practice in both interventional and non-interventional endoscopists.
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Affiliation(s)
- Edward John Young
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Arvinf Rajandran
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
| | - Hamish Lachlan Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Dharshan Sathananthan
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Sophie Fenella Hoile
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale 5031, South Australia, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide 5000, South Australia, Australia
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16
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Dziegielewski C, Gupta S, McCurdy JD, Sy R, Saloojee N, Murthy SK. Pancolonic Dye Spray Chromoendoscopy to Detect and Resect Ill-Defined Neoplastic Lesions in Colonic Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2022; 6:37-41. [PMID: 36789142 PMCID: PMC9915055 DOI: 10.1093/jcag/gwac024] [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] [Indexed: 11/13/2022] Open
Abstract
Background Pancolonic dye spray chromoendoscopy (DCE) is used as an adjunct to white light endoscopy (WLE) to enhance the detection and delineation of ill-defined neoplastic (dysplastic) lesions in persons with colonic inflammatory bowel diseases (cIBD). We evaluated the utility of DCE as follow-up to high-definition WLE (HD-WLE) to "unmask" and/or facilitate endoscopic resection of neoplastic lesions. Methods We retrospectively studied persons with cIBD who underwent DCE as follow-up to HD-WLE between 2013 and 2020. We describe neoplastic findings and management during HD-WLE and DCE exams and report outcomes from post-DCE surveillance exams. Results Twenty-four persons were studied (mean age 56.7 ± 13.8 years, 50.0% male, 70.8% ulcerative colitis, mean disease duration 18.0 ± 11.0 years). Overall, 32 visible neoplastic lesions were unmasked during DCE, of which 24 were endoscopically resected. DCE facilitated the diagnosis of two cancers. Among 17 persons referred for evaluation of "invisible" neoplasia (detected in non-targeted biopsies) during HD-WLE, DCE identified neoplastic lesions at the same site in eight persons and a different site in four persons. Among seven persons referred for ill-defined visible neoplasia, DCE facilitated complete endoscopic resection in four individuals, whereas two individuals required colectomy for a diagnosis of cancer. Among 19 individuals with post-DCE surveillance, five developed new visible neoplastic lesions, including one high-grade neoplasia which was completely resected. Conclusions In our cohort, DCE aided in unmasking invisible neoplasia and facilitated endoscopic resection of ill-defined neoplasia, suggesting that it is a useful surveillance tool in selected persons with cIBD. Large prospective studies are needed to validate these findings.
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Affiliation(s)
| | - Sarang Gupta
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Richmond Sy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Navaaz Saloojee
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Sanjay K Murthy
- Correspondence: Sanjay K. Murthy, Department of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada, e-mail:
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17
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Vu NTH, Quach DT, Dang NLB, Le QD, Nguyen DTN, Le HM, Le NQ, Hiyama T. Performance of chromoendoscopy and narrow-band imaging in the diagnosis of gastric intestinal metaplasia. Scand J Gastroenterol 2022; 57:1005-1010. [PMID: 35275785 DOI: 10.1080/00365521.2022.2048066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Chromoendoscopy and narrow-band imaging (NBI) have been reported to aid in the diagnosis of gastric intestinal metaplasia (GIM). This study aimed to assess the diagnostic validity of chromoendoscopy combined with NBI in the diagnosis of GIM in Vietnamese. METHODS A cross-sectional study was carried out on patients with dyspeptic symptoms who underwent esophagogastroduodenoscopy (EGD) at the University Medical Center at Ho Chi Minh City. We compared the detection rates of GIM in the group of patients examined with white-light endoscopy (WLE) alone and those examined with WLE in combination with chromoendoscopy and NBI. RESULTS A total of 374 patients have been recruited. The additional GIM detection rate after chromoendoscopy combined with NBI was 8.6% (95% confidence interval [CI]: 4.3 - 12.8), p < .005. The rate of GIM within the group of patients biopsied under the guidance of chromoendoscopy combined with NBI was statistically significantly higher than in the group with WLE alone with a distinct rate of 14.4% (95% CI: 6.3 - 2.6), p = .001. CONCLUSIONS Chromoendoscopy combined with NBI helped to detect the GIM lesions missed by WLE and was a more reliable endoscopic method for the diagnosis of GIM.
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Affiliation(s)
- Nhu Thi Hanh Vu
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam.,Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Duc Trong Quach
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam.,Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Ngoc Le Bich Dang
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Quang Dinh Le
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam.,Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Doan Thi Nha Nguyen
- Department of Internal Medicine, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam.,Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Huy Minh Le
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam.,Department of Surgical Pathology, University of Medicine and Pharmacy at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Nhan Quang Le
- Department of Endoscopy, University Medical Center at Hochiminh City, Ho Chi Minh City, Vietnam
| | - Toru Hiyama
- Health Service Center, Hiroshima University, Higashihiroshima, Japan
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18
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Huguet JM, Ferrer-Barceló L, Suárez P, Sanchez E, Prieto JD, Garcia V, Sempere J. Colorectal cancer screening and surveillance in patients with inflammatory bowel disease in 2021. World J Gastroenterol 2022; 28:502-516. [PMID: 35316962 PMCID: PMC8905018 DOI: 10.3748/wjg.v28.i5.502] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/10/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
The detection of dysplasia in patients with inflammatory bowel disease (IBD) continues to be important given the increased risk of colorectal cancer in this population. Therefore, in 2017, we performed a review and update of the recommendations for the management and follow-up of patients with IBD based on the clinical practice guidelines of various scientific societies. The present manuscript focuses on new aspects of the detection, follow-up, and management of dysplasia according to the latest studies and recommendations. While chromoendoscopy with targeted biopsy continues to be the technique of choice for the screening and detection of dysplasia in IBD, the associated difficulties mean that it is now being compared with other techniques (virtual chromoendoscopy), which yield similar results with less technical difficulties. Furthermore, the emergence of new endoscopy techniques that are still being researched but seem promising (e.g., confocal laser endomicroscopy and full-spectrum endoscopy), together with the development of devices that improve endoscopic visualization (e.g., Endocuff Vision), lead us to believe that these approaches can revolutionize the screening and follow-up of dysplasia in patients with IBD. Nevertheless, further studies are warranted to define the optimal follow-up strategy in this patient population.
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Affiliation(s)
- Jose Maria Huguet
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Luis Ferrer-Barceló
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Patrícia Suárez
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Eva Sanchez
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Jose David Prieto
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Victor Garcia
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
| | - Javier Sempere
- Department of Digestive Disease, General University Hospital of Valencia, Valencia 46014, Spain
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19
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Tribonias G, Theodoropoulou A, Stylianou K, Giotis I, Mpitouli A, Moschovis D, Komeda Y, Manola ME, Paspatis G, Tzouvala M. Irrigating Acetic Acid Solution During Colonoscopy for the Detection of Sessile Serrated Neoplasia: A Randomized Controlled Trial. Dig Dis Sci 2022; 67:282-292. [PMID: 33515378 DOI: 10.1007/s10620-021-06858-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Misdiagnosed sessile serrated lesions (SSLs) are important precursors for interval colorectal cancers. AIMS We investigated the usage of acetic acid (AA) solution for improving the detection of SSLs in the right colon in a randomized controlled trial. METHODS A tandem observation of the right colon was performed in 412 consecutive patients. A first inspection was performed under white light high-definition endoscopy. In the AA group, a low concentration vinegar solution (AA: 0.005%) irrigated by a water pump in the right colon was compared with a plain solution of normal saline (NS) in the diagnostic yield of SSLs during the second inspection. Secondary outcomes in overall polyp detection were measured. RESULTS Qualitative comparisons showed significant differences in the detection rates of all polyps except adenomas, with remarkable improvement in the demonstration of advanced (> 20 mm), SSLs, and hyperplastic polyps during the second inspection of the right colon using the AA solution. Significant improvement was also noted in the AA group, as far as the mean number of polyps/patient detected, not only in SSLs (AA group: 0.14 vs. NS group: 0.01, P < 0.001), but also in all histological types and all size-categories in the right colon. Small (≤ 9 mm) polyps were detected at a higher rate in the sigmoid colon expanding the effect of the method in the rest of the colon. CONCLUSION AA-assisted colonoscopy led to a significant increase in SSLs detection rate in the right colon in a safe, quick, and effective manner.
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Affiliation(s)
- George Tribonias
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece.
| | - Angeliki Theodoropoulou
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | | | - Ioannis Giotis
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Afroditi Mpitouli
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | - Dimitrios Moschovis
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Yoriaki Komeda
- Gastroenterology Department, Kindai University Hospital, Osaka, Japan
| | - Margarita-Eleni Manola
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
| | - Gregorios Paspatis
- Gastroenterology Department, General Hospital of Heraklion "Venizeleio - Pananeio", Crete, Greece
| | - Maria Tzouvala
- Gastroenterology Department, General Hospital of Nikaia-Piraeus "Agios Panteleimon", Mantouvalou D. 3, 18454, Athens, Greece
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Abstract
Screening for colorectal cancer (CRC) in Lynch syndrome enables early detection and likely cancer prevention. CRC screening guidelines have evolved from universal to gene-specific recommendations based on lifetime neoplasia risks. Regular screening for Lynch syndrome reduces CRC-related mortality; however, high CRC incidence during regular colonoscopy screening suggests the possibility of nonpolypoid carcinogenesis. Colonoscopy is the primary modality for screening for Lynch syndrome with mixed and emerging data on quality metrics, chromoendoscopy, artificial intelligence, and nonendoscopic modalities. Screening adherence varies across studies. In this review, we present the current state of CRC screening recommendations, outcomes, and modalities in Lynch syndrome.
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Affiliation(s)
- Christine Drogan
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago, Chicago, IL, USA.
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21
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Krasaelap A, Lerner DG. Advances in Endoscopic Procedures in Pediatric Patients. Pediatr Clin North Am 2021; 68:1221-1235. [PMID: 34736586 DOI: 10.1016/j.pcl.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endoscopy has been a crucial part of the diagnostic and therapeutic modality in pediatric gastrointestinal disorders. This article outlines recent advances in pediatric gastrointestinal endoscopy, including transnasal endoscopy, functional luminal imaging probe, peroral endoscopic myotomy, mucosal impedance, endoscopic vacuum-assisted closure system, chromoendoscopy, artificial intelligence, and machine learning.
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Affiliation(s)
- Amornluck Krasaelap
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Diana G Lerner
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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22
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Murthy SK, Feuerstein JD, Nguyen GC, Velayos FS. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161:1043-1051.e4. [PMID: 34416977 DOI: 10.1053/j.gastro.2021.05.063] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/19/2021] [Accepted: 05/21/2021] [Indexed: 02/08/2023]
Abstract
Improvements in disease management, as well as endoscopic technology and quality, have dramatically changed the way in which we conceptualize and manage inflammatory bowel disease-related dysplasia over the past 20 years. Based on evolving literature, we propose a conceptual model and best practice advice statements for the prevention, detection, and management of colorectal dysplasia in people with inflammatory bowel disease. This expert review was commissioned and approved by the American Gastroenterological Association Institute Clinical Practice Updates Committee and the American Gastroenterological Association Governing Board to provide timely guidance on a topic of high clinical importance to the American Gastroenterological Association membership. It underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology.
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Affiliation(s)
- Sanjay K Murthy
- The Ottawa Hospital Inflammatory Bowel Disease Centre, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Joseph D Feuerstein
- Center for Inflammatory Bowel Disease Beth Israel Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Centre for Inflammatory Bowel Disease, University of Toronto, Toronto, Ontario, Canada
| | - Fernando S Velayos
- Division of Gastroenterology and Hepatology, The Permanente Medical Group, San Francisco, California.
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23
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Montale A, Buttitta F, Pierantoni C, Ferrari C, Cameletti M, Colussi D, Miccoli S, Bazzoli F, Turchetti D, Ricciardiello L. Chromoendoscopy Is Not Superior to White Light Endoscopy in Improving Adenoma Detection in Lynch Syndrome Cohort Undergoing Surveillance with High-Resolution Colonoscopy: A Real-World Evidence Study. Dig Dis 2021; 40:517-525. [PMID: 34515093 DOI: 10.1159/000518840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/02/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic surveillance in patients with Lynch syndrome (LS) is crucial due to a genetically based high risk of colorectal cancer (CRC). We aimed to compare the adenoma detection rate (ADR) between high-resolution white light endoscopy (WLE) alone and WLE plus dye chromoendoscopy (CE) in a cohort of LS patients. METHODS In a context of real-world data, we retrospectively enrolled 50 LS patients who had non-randomly undergone WLE versus CE surveillance examinations from 2007 to 2019. The 2 groups were compared at baseline (BL) in terms of the rate of patients with lesions and the number of lesions, and at follow-up (FU), to evaluate a possible enhanced detection rate. Longitudinal analysis of the effect of the endoscopy type on the main outcomes was performed by generalized linear mixed models. RESULTS Forty-two patients had undergone at least one diagnostic colonoscopy. At BL and at FU analysis, we found no significant differences in detection rates and clinical-pathological features between WLE and CE groups. At the longitudinal analysis, an increase in the endoscopy rank (i.e., the position of each colonoscopy for all the colonoscopies that a patient had undergone) was associated with an increase in polyp detection rate (p = 0.006) and ADR (p = 0.005), while a trend toward significance (p = 0.069) was found for endoscopy type (CE vs. WLE) in the detection of serrated lesions. CONCLUSIONS CE is not superior to high-resolution WLE in increasing the ADR. Even under standard WLE, an active and careful endoscopic surveillance of LS patients can prevent CRC.
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Affiliation(s)
- Amedeo Montale
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Buttitta
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy, .,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,
| | - Chiara Pierantoni
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Michela Cameletti
- Department of Management, Economics and Quantitative Methods, University of Bergamo, Bergamo, Italy
| | - Dora Colussi
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sara Miccoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Franco Bazzoli
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniela Turchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Ricciardiello
- Gastroenterology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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24
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Shahini E, Libânio D, Lo Secco G, Pisani A, Arezzo A. Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review. World J Gastrointest Endosc 2021; 13:275-295. [PMID: 34512876 PMCID: PMC8394186 DOI: 10.4253/wjge.v13.i8.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
In the last years, endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions. At the same time, the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged. The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery. Accordingly, this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ. We performed a literature search using electronic databases (MEDLINE/PubMed, EMBASE, and Cochrane Library). We collected all articles about endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) registering the outcomes. Moreover, we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or non-polypoid lesions of any size, preoperatively estimated as non-invasive. Seven meta-analysis studies, mainly Eastern, were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures. Of these, eighty-two were retrospective, twenty-four perspective, nine case-control, and six cohorts, while three were randomized clinical trials. A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions > 5-10 mm in size. In conclusion, it is crucial to enhance the preoperative diagnostic workup, especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy. Additionally, the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications. We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions. Nevertheless, despite the lower local recurrence rates, ESD had greater perforation rates and needed lengthier procedural times. The prevailing risk for additional surgery in ESD rather than EMR for complications or oncologic reasons is still uncertain.
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Affiliation(s)
- Endrit Shahini
- Department of Gastroenterology and Digestive Endoscopy Unit, National Institute of Research “Saverio De Bellis,” Castellana Grotte (Bari) 70013, Italy
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute, Porto 4200-072, Portugal
| | - Giacomo Lo Secco
- Department of Surgical Sciences, University of Torino, Turin 10126, Italy
| | - Antonio Pisani
- Department of Gastroenterology and Digestive Endoscopy Unit, National Institute of Research “Saverio De Bellis,” Castellana Grotte (Bari) 70013, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin 10126, Italy
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25
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Hong SM, Kim GH, Lee BE, Lee MW, Kim DM, Baek DH, Song GA. Association between mucin phenotype and lesion border detection using acetic acid-indigo carmine chromoendoscopy in early gastric cancers. Surg Endosc 2021. [PMID: 34327549 DOI: 10.1007/s00464-021-08626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND For successful treatment of early gastric cancers (EGCs), it is crucial to define the horizontal border of the lesion with high accuracy. Acetic acid-indigo carmine (AI) chromoendoscopy has been used to determine the horizontal border in EGCs, but this technique is less potent in certain situations. Mucin phenotype in gastric cancers refers to biological differences in precursor lesions and differences in histopathologic findings, and it might affect AI chromoendoscopy findings. We aimed to investigate the association between mucin phenotype and AI chromoendoscopy findings in EGCs. METHODS We prospectively evaluated 126 lesions in 126 patients with endoscopically diagnosed EGCs. Conventional endoscopy and AI chromoendoscopy findings of these lesions before treatment were prospectively analyzed. The border distinction between the lesion and surrounding mucosa was classified as distinct or indistinct on conventional endoscopy and AI chromoendoscopy, respectively. Mucin phenotypes were classified as gastric, intestinal, gastrointestinal, or null type by immunohistochemistry. RESULTS The lesion borders were distinct in 46.8% (59/126) of the lesions assessed using conventional endoscopy and in 73.0% (92/126) of those assessed with AI chromoendoscopy (p < 0.001). The border distinction rate of differentiated-type cancers on AI chromoendoscopy was significantly higher than that on conventional endoscopy (66/71 [93.0%] vs. 34/71 [47.9%], p < 0.001), but the border distinction rate of undifferentiated-type cancers on AI chromoendoscopy was not different from that on conventional endoscopy (26/55 [47.3%] vs. 25/55 [45.5%], p = 0.848). Compared with conventional endoscopy, AI chromoendoscopy identified borders in a significantly higher percentage of gastric, intestinal, and gastrointestinal mucin types; however, there was no difference in AI chromoendoscopy findings according to the mucin phenotype (p = 0.271). CONCLUSION AI chromoendoscopy was effective in horizontal border delineation in differentiated-type EGCs, but not in undifferentiated-type EGCs. Mucin phenotype had no effect on border distinction using AI chromoendoscopy.
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26
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Rubín de Célix C, Chaparro M, Moreno JA, Santander C, Gisbert JP. Colorectal cancer surveillance with chromoendoscopy in inflammatory bowel disease: results from a real-life experience. Scand J Gastroenterol 2021; 56:806-811. [PMID: 33905275 DOI: 10.1080/00365521.2021.1918758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease are at increased risk for colorectal cancer. The aim of this study was to know the prevalence of dysplasia and colorectal cancer with chromoendoscopy, to describe the characteristics and the management of the detected lesions and to identify possible risk factors of dysplasia in clinical practice. METHODS Observational, retrospective study of all chromoendoscopies performed between January 2016 and May 2019 in patients with left-sided/extensive ulcerative colitis or Crohn's disease involving more than one-third of the colon. Information about all the polyps' characteristics and the treatments received was collected. RESULTS A total of 186 chromoendoscopies on 160 patients were reviewed; 57% were men; 54% had ulcerative colitis. The dysplasia detection rate was 24% and 212 lesions were detected: rectum (36%) and left colon (30%). Flat polyps were detected in 57% patients. In total, 123 (62%) lesions were non-neoplastic and 74 (38%) were neoplastic. Among these, 69 (93%) were low grade dysplasia and five (7%) were high grade dysplasia, all of them located in rectum. Two patients (1%) required surgery. During follow-up, no patient developed colorectal cancer. Age over 60 years, flat lesions, polyp >5 mm and right colon localization were found to be risk factors for dysplasia. CONCLUSIONS This study reports a high dysplasia detection rate (24%) via targeted chromoendoscopic biopsies. In most cases, lesions were successfully removed by endoscopic resection. Our results underline the importance of colorectal cancer surveillance in inflammatory bowel disease patients.
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Affiliation(s)
- Cristina Rubín de Célix
- Gastroenterology Unit. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - María Chaparro
- Gastroenterology Unit. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - José Andrés Moreno
- Gastroenterology Unit. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Cecilio Santander
- Gastroenterology Unit. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Unit. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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27
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Sicilia B, Vicente R, Arias L, Echarri A, Zabana Y, Mañosa M, Beltrán B, Barreiro-de Acosta M; en nombre de GETECCU. Recommendations of the Spanish Working Group on Crohn's disease and Ulcerative Colitis (Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa - GETECCU) on dysplasia screening in inflammatory bowel disease patients. Gastroenterol Hepatol 2021; 44:435-47. [PMID: 33592179 DOI: 10.1016/j.gastrohep.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Colonic inflammatory bowel diseases have a higher risk of developing colorectal cancer compared to the general population, which is why they require endoscopic screening techniques with specific follow-up intervals based on the different risk factors described on the literature. This position paper analyzes the current scientific evidence for the different endoscopic techniques available today, how their implementation should be carried out in endoscopic units and describes in detail how their implementation should be carried out, in which patients and with what interval, and finally, what should be the response to finding dysplasia, proposing a specific follow-up algorithm.
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28
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Abstract
Longstanding and extensive ulcerative colitis (UC) are associated with the subsequent development of colorectal cancer (CRC). This article summarizes key strategies for colonoscopic surveillance, the most widely used and evidence-based method of CRC prevention. As currently constituted and practiced, surveillance examinations every 1 to 3 years with lesion detection and removal using high-definition endoscopic systems with or without pancolonic spray-dye chromoendoscopy is the best method for mitigating the development of CRC morbidity and mortality. For patients with primary sclerosing cholangitis with UC, surveillance should begin at the time of diagnosis and colonoscopy should be performed annually.
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Affiliation(s)
- Wendy Rabbenou
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, 33030 Rochambeau Avenue, Bronx, NY 10461, USA
| | - Thomas A Ullman
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, 33030 Rochambeau Avenue, Bronx, NY 10461, USA.
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Zhang Y, Chen HY, Zhou XL, Pan WS, Zhou XX, Pan HH. Diagnostic efficacy of the Japan Narrow-band-imaging Expert Team and Pit pattern classifications for colorectal lesions: A meta-analysis. World J Gastroenterol 2020; 26:6279-6294. [PMID: 33177800 PMCID: PMC7596636 DOI: 10.3748/wjg.v26.i40.6279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pit pattern classification using magnifying chromoendoscopy is the established method for diagnosing colorectal lesions. The Japan Narrow-band-imaging (NBI) Expert Team (JNET) classification is a novel NBI magnifying endoscopic classification that focuses on the vessel, and surface patterns.
AIM To determine the diagnostic efficacy of each category of the JNET and Pit pattern classifications for colorectal lesions.
METHODS A systematic literature search was performed using PubMed, Embase, the Cochrane Library, and Web of Science databases. The pooled sensitivity, specificity, diagnostic odds ratio, and area under the summary receiver operating characteristic curve of each category of the JNET and Pit pattern classifications were calculated.
RESULTS A total of 19227 colorectal lesions in 31 studies were included. The diagnostic performance of the JNET classification was equivalent to the Pit pattern classification in each corresponding category. The pooled sensitivity, specificity, and area under the curve (AUC) for each category of the JNET classification were as follows: 0.73 (95%CI: 0.55-0.85), 0.99 (95%CI: 0.97-1.00), and 0.97 (95%CI: 0.95-0.98), respectively, for Type 1; 0.88 (95%CI: 0.78-0.94), 0.72 (95%CI: 0.64-0.79), and 0.84 (95%CI: 0.81-0.87), respectively, for Type 2A; 0.56 (95%CI: 0.47-0.64), 0.91 (95%CI: 0.79-0.96), and 0.72 (95%CI: 0.68-0.76), respectively, for Type 2B; 0.51 (95%CI: 0.42-0.61), 1.00 (95%CI: 1.00-1.00), and 0.90 (95%CI: 0.87-0.93), respectively, for Type 3.
CONCLUSION This meta-analysis suggests that the diagnostic efficacy of the JNET classification may be equivalent to that of the Pit pattern classification. However, due to its simpler and clearer clinical application, the JNET classification should be promoted for the classification of colorectal lesions, and to guide the treatment strategy.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Hui-Yan Chen
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
| | - Xiao-Lu Zhou
- Department of Medical College, The Medical College of Qingdao University, Qingdao 266071, Shandong Province, China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xin-Xin Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Hang-Hai Pan
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
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An P, Yang D, Wang J, Wu L, Zhou J, Zeng Z, Huang X, Xiao Y, Hu S, Chen Y, Yao F, Guo M, Wu Q, Yang Y, Yu H. A deep learning method for delineating early gastric cancer resection margin under chromoendoscopy and white light endoscopy. Gastric Cancer 2020; 23:884-892. [PMID: 32356118 DOI: 10.1007/s10120-020-01071-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate delineation of cancer margins is critical for endoscopic curative resection. This study aimed to train and validate real-time fully convolutional networks for delineating the resection margin of early gastric cancer (EGC) under indigo carmine chromoendoscopy (CE) or white light endoscopy (WLE), and evaluated its performance and that of magnifying endoscopy with narrow-band imaging (ME-NBI). METHODS We collected CE and WLE images of EGC lesions to train fully convolutional networks ENDOANGEL. ENDOANGEL was tested both on stationary images and endoscopic submucosal dissection (ESD) videos. The accuracy and reliability of ENDOANGEL and NBI-dependent delineation were further evaluated by a novel endoscopy-pathology point-to-point marking. RESULTS ENDOANGEL had an accuracy of 85.7% in the CE images and 88.9% in the WLE images under an overlap ratio threshold of 0.60 in comparison with the manual markers labeled by the experts. In the ESD videos, the resection margins predicted by ENDOANGEL covered all areas of high-grade intraepithelial neoplasia and cancers. The minimum distance between the margins predicted by ENDOANGEL and the histological cancer boundary was 3.44 ± 1.45 mm which outperformed the resection margin based on ME-NBI. CONCLUSIONS ENDOANGEL has the potential to assist endoscopists in delineating the resection extent of EGC under CE or WLE during ESD.
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Affiliation(s)
- Ping An
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dongmei Yang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Wang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lianlian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jie Zhou
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhi Zeng
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xu Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yong Xiao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shan Hu
- School of Resources and Environmental Sciences of Wuhan University, Wuhan, China
| | - Yiyun Chen
- School of Resources and Environmental Sciences of Wuhan University, Wuhan, China
| | - Fang Yao
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Mingwen Guo
- Department of Gastroenterology, The first hospital of Yichang, Yichang, China
| | - Qi Wu
- Department of Endoscopy, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Yanning Yang
- Department of Ophthalmology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China.
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Zhangzhidong Road, Wuhan, 430060, Hubei Province, China. .,Key Laboratory of Hubei Province for Digestive System Disease, Renmin Hospital of Wuhan University, Wuhan, China. .,Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision, Renmin Hospital of Wuhan University, Wuhan, China.
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31
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Singh R, Chiam KH, Leiria F, Pu LZCT, Choi KC, Militz M. Chromoendoscopy: role in modern endoscopic imaging. Transl Gastroenterol Hepatol 2020; 5:39. [PMID: 32632390 DOI: 10.21037/tgh.2019.12.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
Detection of early gastrointestinal tract malignancy can be challenging on white light endoscopy especially as lesions can be subtle and inconspicuous. With the advent of electronic chromoendoscopy technologies, lesions which have already been detected can be quickly and "conveniently" characterised. This review will discuss some of the indications and modern applications of chromoendoscopy in various conditions including Barrett's oesophagus, oesophageal squamous cell carcinoma, early gastric cancer, inflammatory bowel disease and neoplastic colonic lesions. In carefully selected situations, chromoendoscopy could still be a useful adjunct to white light endoscopy in day-to-day clinical practice.
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Affiliation(s)
- Rajvinder Singh
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,Faculty of Health Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Keng Hoong Chiam
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Florencia Leiria
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Leonardo Zorron Cheng Tao Pu
- Faculty of Health Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kun Cheong Choi
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Mariana Militz
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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Abstract
PURPOSE OF THE REVIEW Atrophic gastritis is a complex syndrome with gastric atrophy as a common trait. Helicobacter pylori infection and autoimmunity are the two main contexts in which it develops. It is slightly symptomatic, affects various aspects of general health, and remains a predisposing factor for gastric cancer. This review will update current knowledge and progress on atrophic gastritis. RECENT FINDINGS Atrophic gastritis affects mostly adults with persistent dyspepsia, deficient anemia, autoimmunity disease, long-term proton pump inhibitor use, and a family history of gastric cancer. Gastric biopsies, expressed as Sydney system grade and OLGA/OLGIM classifications, represent the gold standard for diagnosis and cancer risk stage, respectively. Recently, electronic chromoendoscopy has allowed "targeted biopsies" of intestinal metaplasia. The associated hypochlorhydria affects the gastric microbiota composition suggesting that non-Helicobacter pylori microbiota may participate in the development of gastric cancer. Physicians should be aware of multifaceted clinical presentation of atrophic gastritis. It should be endoscopically monitored by targeted gastric biopsies. Autoimmune and Helicobacter pylori-induced atrophic gastritis are associated with different gastric microbial profiles playing different roles in gastric tumorigenesis.
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Affiliation(s)
- Edith Lahner
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy
| | - Laura Conti
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy
| | - Vito Domenico Corleto
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Via di Grottarossa, 1035 -, 00189, Rome, Italy.
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33
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Ji R, Liu J, Zhang MM, Li YY, Zuo XL, Wang X, Li YQ. Optical enhancement imaging versus acetic acid for detecting gastric intestinal metaplasia: A randomized, comparative trial. Dig Liver Dis 2020; 52:651-657. [PMID: 32265143 DOI: 10.1016/j.dld.2020.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The diagnosis of gastric intestinal metaplasia (GIM) is still challenging. Optical Enhancement technology (OE) may improve the detection of GIM. We compared detection of GIM with OE, acetic acid and the Sydney biopsy protocol in a surveillance population. METHODS Consecutive patients with atrophic gastritis or known GIM were prospectively included. The stomach was examined with high definition whitelight endoscopy, followed by OE or acetic acid with targeted biopsies (1:1 randomisation). Subsequently, five random biopsies were taken according to the updated Sydney system. RESULTS A total of 154 patients were randomized. Higher proportions of patients with GIM were detected by OE and acetic acid versus random biopsy (60.5% vs 35.5%, 67.1% vs 31.5%, respectively; P < 0.0001 for both comparisons). The combined use of targeted biopsies and random biopsies provides high diagnostic yields for GIM (78.9% in OE group and 83.6% in acetic acid group). In addition, the proportion of extensive GIM was significantly increased when image enhanced endoscopy was used instead of white light endoscopy (P = 0.029, P = 0.048, respectively). CONCLUSIONS OE and acetic acid showed comparable results diagnosing GIM in the study. Targeted biopsies plus random biopsies should be used complementary in high risk populations.
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Affiliation(s)
- Rui Ji
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jun Liu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Ming-Ming Zhang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yue-Yue Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Xiao Wang
- Department of Pathology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
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34
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Rey Caro EP, Rey Caro DG, Rey Caro EA. High Radiofrequency Surgery and Chromoendoscopy: A Novel Surgical Technique for the Treatment of Respiratory Papillomatosis. J Voice 2020; 35:936.e17-936.e26. [PMID: 32362579 DOI: 10.1016/j.jvoice.2020.03.021] [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: 09/12/2019] [Revised: 03/15/2020] [Accepted: 03/18/2020] [Indexed: 11/26/2022]
Abstract
Recurrent Respiratory Papillomatosis is a highly recurrent and residual disease. The use of indigo-carmine chromoendoscopy increases the early detection of nonvisible disease and reduces the possibility of leaving residual lesions. The best chances of papillomatosis being eradicated depend upon a surgical shallow epitheliolysis approach applied to patients who have never been surgically damaged before. We developed a novel surgical technique based upon the use of a time controlled High Radiofrequency (HRF) energy output. We applied a three-step bloodless HRF-surgical technique, that is, epitheliolysis, angiolysis and peeling without the aid of adjunct therapies. It acts according to differences in the water density of the tissues. We use it to remove the epithelial viral reservoir thus preserving subepithelial layers. For this purpose, we designed and manufactured a custom-made HRF electrodes set for office and O.R. use. From 2005 to 2018, 39 patients (100%) with recurrent respiratory papillomatosis participated in the present prospective work. Twenty-five (64,10%) achieved complete postsurgical remission, 6 (15,38%) were lost to follow up, and 8 (20,51%) present partial remissions. Thirty-six patients had laryngeal papillomatosis. Follow-up was possible in 30 of the 36 patients with laryngeal papillomatosis with a success remission rate of 83,33% (25 of 30). Eleven of those 36 (30,55%) entered this study without previous surgical treatment and 9 of 11 (81,81%) were cured. Indigo-carmine chromoendoscopy, a visualization solution for papillomatosis detection, together with a bloodless HRF-surgical technique proved to be effective tools to eradicate papillomatosis. Voice restoration to normal or near normal levels was achieved in all patients.
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Affiliation(s)
- Enrique P Rey Caro
- Rey Caro Voice Center, Rey Caro Ear, Nose and Throat Service, Cordoba, Argentina.
| | - Daniel G Rey Caro
- Rey Caro Voice Center, Rey Caro Ear, Nose and Throat Service, Cordoba, Argentina; Department of Otorhinolaryngology II at San Roque Hospital, National University of Córdoba, Cordoba, Argentina.
| | - Enrique A Rey Caro
- Rey Caro Voice Center, Rey Caro Ear, Nose and Throat Service, Cordoba, Argentina.
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Ogawa R, Nishikawa J, Hideura E, Goto A, Koto Y, Ito S, Unno M, Yamaoka Y, Kawasato R, Hashimoto S, Okamoto T, Ogihara H, Hamamoto Y, Sakaida I. Objective Assessment of the Utility of Chromoendoscopy with a Support Vector Machine. J Gastrointest Cancer 2020; 50:386-391. [PMID: 29504086 PMCID: PMC6675770 DOI: 10.1007/s12029-018-0083-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose The utility of chromoendoscopy for early gastric cancer (GC) was determined by machine learning using data of color differences. Methods Eighteen histopathologically confirmed early GC lesions were examined. We prepared images from white light endoscopy (WL), indigo carmine (Indigo), and acetic acid-indigo carmine chromoendoscopy (AIM). A border between cancerous and non-cancerous areas on endoscopic images was established from post-treatment pathological findings, and 2000 pixels with equivalent luminance values were randomly extracted from each image of cancerous and non-cancerous areas. Each pixel was represented as a three-dimensional vector with RGB values and defined as a sample. We evaluated the Mahalanobis distance using RGB values, indicative of color differences between cancerous and non-cancerous areas. We then conducted diagnosis test using a support vector machine (SVM) for each image. SVM was trained using the 100 training samples per class and determined which area each of 1900 test samples per class came from. Results The means of the Mahalanobis distances for WL, Indigo, and AIM were 1.52, 1.32, and 2.53, respectively and there were no significant differences in the three modalities. Diagnosability per endoscopy technique was assessed using the F1 measure. The means of F1 measures for WL, Indigo, and AIM were 0.636, 0.618, and 0.687, respectively. AIM images were better than WL and Indigo images for the diagnosis of GC. Conclusion Objective assessment by SVM found AIM to be suitable for diagnosis of early GC based on color differences.
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Affiliation(s)
- Ryo Ogawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Jun Nishikawa
- Department of Laboratory Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan.
| | - Eizaburo Hideura
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Atsushi Goto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Yurika Koto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Shunsuke Ito
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Madoka Unno
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Yuko Yamaoka
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Ryo Kawasato
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Shinichi Hashimoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Takeshi Okamoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
| | - Hiroyuki Ogihara
- Department of Biomolecular Engineering Applied Molecular Bioscience, Yamaguchi University Graduate School of Medicine, 2-16-1 Tokiwadai, Ube, Japan
| | - Yoshihiko Hamamoto
- Division of Electrical, Electronic and Information Engineering, Yamaguchi University Graduate School of Sciences and Technology for Innovation, 2-16-1 Tokiwadai, Ube, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Japan
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Har-Noy O, Yung DE, Koulaouzidis A, Eliakim R, Kopylov U, Avidan B, Katz LH. Chromoendoscopy or white light endoscopy for neoplasia detection in Lynch syndrome, a meta-analysis. Dig Liver Dis 2019; 51:1515-1521. [PMID: 31526715 DOI: 10.1016/j.dld.2019.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 12/12/2018] [Revised: 07/22/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lynch syndrome carries an increased risk of colorectal neoplasia, hence annual surveillance colonoscopy is recommended. This study aimed to compare the diagnostic yields of image enhancement modalities for colorectal neoplasia in patients with Lynch syndrome. METHODS Meta-analysis of pooled ratios of lesion detection rates (RRs) and odds ratios (ORs) with 95% confidence intervals (CIS), comparing white light endoscopy (WLE) and chromoendoscopy (ChE). RESULTS Four studies comparing WLE to ChE were analyzed. ChE fared better than WLE in overall lesion detection (RR 1.97, 95% CI 1.63-2.38) and detection of adenomas (RR 1.53, 95% CI 1.07-2.17), flat lesions (RR 3.4, 95% CI 2.47-4.67) and proximally-located lesions (RR 2.93, 95% CI 1.91-4.5). The odds of a patient having any lesion found were higher in ChE compared to WLE (OR 2.42, 95% CI 1.56-3.75). The odds of a patient having adenoma(s) found on endoscopy were not significantly higher in chromoendoscopy compared to white light endoscopy (OR 1.81, 95% CI 0.65-5.01). CONCLUSION Using standard definition technology, ChE allows detection of more lesions, especially adenomas, flat lesions and proximal lesions in Lynch syndrome patients, compared to WLE. The results show that surveillance colonoscopy of Lynch syndrome patients should be performed using ChE.
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Affiliation(s)
- Ofir Har-Noy
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, Israel; Department of Medicine A, Sheba Medical Center, Ramat-Gan, Israel.
| | - Diana E Yung
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rami Eliakim
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Uri Kopylov
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Benjamin Avidan
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Lior H Katz
- Gastroenterology Department, Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Clarke WT, Feuerstein JD. Colorectal cancer surveillance in inflammatory bowel disease: Practice guidelines and recent developments. World J Gastroenterol 2019; 25:4148-4157. [PMID: 31435169 PMCID: PMC6700690 DOI: 10.3748/wjg.v25.i30.4148] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 02/06/2023] Open
Abstract
Patients with long-standing inflammatory bowel disease (IBD) involving at least 1/3 of the colon are at increased risk for colorectal cancer (CRC). Advancements in CRC screening and surveillance and improved treatment of IBD has reduced CRC incidence in patients with ulcerative colitis and Crohn’s colitis. Most cases of CRC are thought to arise from dysplasia, and recent evidence suggests that the majority of dysplastic lesions in patients with IBD are visible, in part thanks to advancements in high definition colonoscopy and chromoendoscopy. Recent practice guidelines have supported the use of chromoendoscopy with targeted biopsies of visible lesions rather than traditional random biopsies. Endoscopists are encouraged to endoscopically resect visible dysplasia and only recommend surgery when a complete resection is not possible. New technologies such as virtual chromoendoscopy are emerging as potential tools in CRC screening. Patients with IBD at increased risk for developing CRC should undergo surveillance colonoscopy using new approaches and techniques.
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Affiliation(s)
- William T Clarke
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Joseph D Feuerstein
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
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38
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Cerrone SA, Trindade AJ. Advanced imaging in surveillance of Barrett’s esophagus: Is the juice worth the squeeze? World J Gastroenterol 2019; 25:3108-3115. [PMID: 31333304 PMCID: PMC6626724 DOI: 10.3748/wjg.v25.i25.3108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/18/2019] [Indexed: 02/06/2023] Open
Abstract
Esophageal cancer is on the rise. The known precursor lesion is Barrett’s esophagus (BE). Patients with dysplasia are at higher risk of developing esophageal cancer. Currently the gold standard for surveillance endoscopy involves taking targeted biopsies of abnormal areas as well as random biopsies every 1-2 cm of the length of the Barrett’s. Unfortunately studies have shown that this surveillance can miss dysplasia and cancer. Advanced imaging technologies have been developed that may help detect dysplasia in BE. This opinion review discusses advanced imaging in BE surveillance endoscopy and its utility in clinical practice.
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Affiliation(s)
- Sara A Cerrone
- Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY 11040, United States
| | - Arvind J Trindade
- Division of Gastroenterology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, New Hyde Park, NY 11040, United States
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Repici A, Wallace MB, East JE, Sharma P, Ramirez FC, Bruining DH, Young M, Gatof D, Irene Mimi Canto M, Marcon N, Cannizzaro R, Kiesslich R, Rutter M, Dekker E, Siersema PD, Spaander M, Kupcinskas L, Jonaitis L, Bisschops R, Radaelli F, Bhandari P, Wilson A, Early D, Gupta N, Vieth M, Lauwers GY, Rossini M, Hassan C. Efficacy of Per-oral Methylene Blue Formulation for Screening Colonoscopy. Gastroenterology 2019; 156:2198-2207.e1. [PMID: 30742834 DOI: 10.1053/j.gastro.2019.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Topically applied methylene blue dye chromoendoscopy is effective in improving detection of colorectal neoplasia. When combined with a pH- and time-dependent multimatrix structure, a per-oral methylene blue formulation (MB-MMX) can be delivered directly to the colorectal mucosa. METHODS We performed a phase 3 study of 1205 patients scheduled for colorectal cancer screening or surveillance colonoscopies (50-75 years old) at 20 sites in Europe and the United States, from December 2013 through October 2016. Patients were randomly assigned to groups given 200 mg MB-MMX, placebo, or 100 mg MB-MMX (ratio of 2:2:1). The 100-mg MB-MMX group was included for masking purposes. MB-MMX and placebo tablets were administered with a 4-L polyethylene glycol-based bowel preparation. The patients then underwent colonoscopy by an experienced endoscopist with centralized double-reading. The primary endpoint was the proportion of patients with 1 adenoma or carcinoma (adenoma detection rate [ADR]). We calculated odds ratios (ORs) and 95% confidence intervals (CIs) for differences in detection between the 200-mg MB-MMX and placebo groups. False-positive (resection rate for non-neoplastic polyps) and adverse events were assessed as secondary endpoints. RESULTS The ADR was higher for the MB-MMX group (273 of 485 patients, 56.29%) than the placebo group (229 of 479 patients, 47.81%) (OR 1.46; 95% CI 1.09-1.96). The proportion of patients with nonpolypoid lesions was higher in the MB-MMX group (213 of 485 patients, 43.92%) than the placebo group (168 of 479 patients, 35.07%) (OR 1.66; 95% CI 1.21-2.26). The proportion of patients with adenomas ≤5 mm was higher in the MB-MMX group (180 of 485 patients, 37.11%) than the placebo group (148 of 479 patients, 30.90%) (OR 1.36; 95% CI 1.01-1.83), but there was no difference between groups in detection of polypoid or larger lesions. The false-positive rate did not differ significantly between groups (83 [23.31%] of 356 patients with non-neoplastic lesions in the MB-MMX vs 97 [29.75%] of 326 patients with non-neoplastic lesions in the placebo group). Overall, 0.7% of patients had severe adverse events but there was no significant difference between groups. CONCLUSIONS In a phase 3 trial of patients undergoing screening or surveillance colonoscopies, we found MB-MMX led to an absolute 8.5% increase in ADR, compared with placebo, without increasing the removal of non-neoplastic lesions. Clinicaltrials.gov no: NCT01694966.
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Affiliation(s)
| | | | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Prateek Sharma
- Kansas City Veterans Affairs Hospital, Kansas City, Missouri
| | | | | | | | - David Gatof
- Clinical Research of the Rockies, Lafayette, Colorado
| | | | | | | | - Ralf Kiesslich
- St. Marienkrankenhaus, Frankfurt, Germany; Horst Schmidt Kliniken GmbH, Wiesbaden, Germany
| | - Matt Rutter
- University Hospital of North Tees, Stockton-on-Tees, United Kingdom
| | | | | | | | | | | | | | | | - Pradeep Bhandari
- Solent Centre for Digestive Diseases, Portsmouth, United Kingdom
| | - Ana Wilson
- St. Mark's Hospital, London, United Kingdom
| | - Dayna Early
- Washington University School of Medicine, St. Louis, Missouri
| | - Neil Gupta
- Loyola University Medical Center, Maywood, Illinois
| | - Michael Vieth
- Institut für Pathologie Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | | | - Cesare Hassan
- Ospedale Nuovo Regina, Margherita, Gastroenterology Unit, Roma, Italy
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Imperatore N, Castiglione F, Testa A, De Palma GD, Caporaso N, Cassese G, Rispo A. Augmented Endoscopy for Surveillance of Colonic Inflammatory Bowel Disease: Systematic Review With Network Meta-analysis. J Crohns Colitis 2019; 13:714-724. [PMID: 30597029 DOI: 10.1093/ecco-jcc/jjy218] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Considering the high risk of dysplasia and cancer in inflammatory bowel disease [IBD], surveillance is advocated. However, international guidelines do not reach a uniform recommendation on the way to perform surveillance. We performed a systematic review with a meta-analysis to assess the best endoscopic surveillance strategy in colonic IBD. METHODS The systematic review was performed in PubMed/MEDLINE, EMBASE, SCOPUS, and Cochrane databases to identify studies comparing white light endoscopy [WLE] and augmented endoscopy [AE] in the detection of dysplasia/neoplasia in colonic IBD. A sub-analysis between dye-spray chromoendoscopy [DCE], narrow-band imaging [NBI], I-SCAN, full-spectrum endoscopy [FUSE], and auto-fluorescence imaging [AFI] was also performed. Furthermore, a meta-regression and a network meta-analysis were also performed. RESULTS A total of 27 studies [6167 IBD patients with 2024 dysplastic lesions] met the inclusion criteria. There was no publication bias. AE showed a higher likelihood of detecting dysplasia than WLE (19.3% vs 8.5%, odds ratio [OR] = 2.036), with an incremental yield [IY] of 10.8%. DCE [OR = 2.605] and AFI [OR = 3.055] had higher likelihood of detecting dysplasia than WLE; otherwise, I-SCAN [OR = 1.096], NBI [OR = 0.650], and FUSE [OR = 1.118] were not superior to WLE. Dysplasia was found in 1256/7267 targeted biopsies [17.3%] and in 363/110 040 random biopsies [0.33%] [OR = 66.559, IY = 16.9%]. Meta-regression found no variable impacting on the efficacy of AE techniques. Network meta-analysis identified a significant superiority of DCE to WLE in detecting dysplasia [OR 2.12], but no other single technique was found to be superior to all others in dysplasia detection. CONCLUSIONS DCE was associated with higher likelihood of discovering dysplastic lesions than WLE. Chromoendoscopy is the best supported endoscopic technique for IBD surveillance.
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Affiliation(s)
- Nicola Imperatore
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Giovanni Domenico De Palma
- Surgical Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Nicola Caporaso
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Gianluca Cassese
- Surgical Endoscopy, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine 'Federico II' of Naples, Naples, Italy
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Khalid S, Abbass A, Khetpal N, Shen B, Navaneethan U. Endoscopic detection and resection of dysplasia in inflammatory bowel disease-techniques with videos. Int J Colorectal Dis 2019; 34:569-580. [PMID: 30854573 DOI: 10.1007/s00384-019-03269-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Accepted: 02/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with ulcerative colitis and Crohn's colitis have an increased risk of developing dysplasia and colorectal cancer as compared to the general population; surveillance colonoscopy is recommended in this patient population. METHODS This review of the published literature aimed to assess the published evidence. RESULTS Detection of dysplasia requires examination of mucosa with targeted biopsies of the visible lesions as well as random biopsies to detect invisible lesions. Newer endoscopic techniques, in particular chromoendoscopy, increase the yield of identifying dysplastic lesions. The surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients International Consensus (SCENIC) guidelines recommends that colonoscopy using chromoendoscopy is the optimal endoscopic surveillance strategy to detect dysplasia. Once dysplastic lesions are discovered on surveillance endoscopic examination, careful and meticulous descriptions of lesions is mandatory to aid in further decision making. Management of dysplastic lesions in inflammatory bowel disease patients depends on endoscopic (morphological) and histologic findings and patient characteristics such as age, general condition of the patient, and patient preferences. Endoscopic mucosal resection, endoscopic submucosal dissection, and surgery are different therapeutic options for colonic dysplastic lesions detected in the setting of inflammatory bowel disease. CONCLUSIONS In this review, we discuss the various techniques for endoscopic resection of dysplasia in patients with inflammatory bowel disease. Further research is required to determine the optimal approach to diagnosis and management of dysplasia in patients with inflammatory bowel disease.
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Affiliation(s)
- Sameen Khalid
- Department of Internal Medicine, Advent Health, Orlando, FL, USA
| | - Aamer Abbass
- Department of Internal Medicine, Advent Health, Orlando, FL, USA
| | - Neelam Khetpal
- Department of Internal Medicine, Advent Health, Orlando, FL, USA
| | - Bo Shen
- Department of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Udayakumar Navaneethan
- Center for Interventional Endoscopy, Advent Health, University of Central Florida College of Medicine, 601 E Rollins Street, Orlando, FL, 32803, USA.
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Wimmer G, Gadermayr M, Wolkersdörfer G, Kwitt R, Tamaki T, Tischendorf J, Häfner M, Yoshida S, Tanaka S, Merhof D, Uhl A. Quest for the best endoscopic imaging modality for computer-assisted colonic polyp staging. World J Gastroenterol 2019; 25:1197-1209. [PMID: 30886503 PMCID: PMC6421240 DOI: 10.3748/wjg.v25.i10.1197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It was shown in previous studies that high definition endoscopy, high magnification endoscopy and image enhancement technologies, such as chromoendoscopy and digital chromoendoscopy [narrow-band imaging (NBI), i-Scan] facilitate the detection and classification of colonic polyps during endoscopic sessions. However, there are no comprehensive studies so far that analyze which endoscopic imaging modalities facilitate the automated classification of colonic polyps. In this work, we investigate the impact of endoscopic imaging modalities on the results of computer-assisted diagnosis systems for colonic polyp staging. AIM To assess which endoscopic imaging modalities are best suited for the computer-assisted staging of colonic polyps. METHODS In our experiments, we apply twelve state-of-the-art feature extraction methods for the classification of colonic polyps to five endoscopic image databases of colonic lesions. For this purpose, we employ a specifically designed experimental setup to avoid biases in the outcomes caused by differing numbers of images per image database. The image databases were obtained using different imaging modalities. Two databases were obtained by high-definition endoscopy in combination with i-Scan technology (one with chromoendoscopy and one without chromoendoscopy). Three databases were obtained by high-magnification endoscopy (two databases using narrow band imaging and one using chromoendoscopy). The lesions are categorized into non-neoplastic and neoplastic according to the histological diagnosis. RESULTS Generally, it is feature-dependent which imaging modalities achieve high results and which do not. For the high-definition image databases, we achieved overall classification rates of up to 79.2% with chromoendoscopy and 88.9% without chromoendoscopy. In the case of the database obtained by high-magnification chromoendoscopy, the classification rates were up to 81.4%. For the combination of high-magnification endoscopy with NBI, results of up to 97.4% for one database and up to 84% for the other were achieved. Non-neoplastic lesions were classified more accurately in general than non-neoplastic lesions. It was shown that the image recording conditions highly affect the performance of automated diagnosis systems and partly contribute to a stronger effect on the staging results than the used imaging modality. CONCLUSION Chromoendoscopy has a negative impact on the results of the methods. NBI is better suited than chromoendoscopy. High-definition and high-magnification endoscopy are equally suited.
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Affiliation(s)
- Georg Wimmer
- Department of Computer Sciences, University of Salzburg, Salzburg 5020, Austria
| | - Michael Gadermayr
- Interdisciplinary Imaging and Vision Institute Aachen, RWTH Aachen, Aachen 52074, Germany
| | - Gernot Wolkersdörfer
- Department of Internal Medicine I, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg 5020, Austria
| | - Roland Kwitt
- Department of Computer Sciences, University of Salzburg, Salzburg 5020, Austria
| | - Toru Tamaki
- Department of Information Engineering, Graduate School of Engineering, Hiroshima University, Hiroshima 7398527, Japan
| | - Jens Tischendorf
- Internal Medicine and Gastroenterology, University Hospital Aachen, Würselen 52146, Germany
| | - Michael Häfner
- Department of Gastroenterologie and Hepatologie, Krankenhaus St. Elisabeth, Wien 1080, Austria
| | - Shigeto Yoshida
- Department of Endoscopy and Medicine, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima 7348551, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima 7348551, Japan
| | - Dorit Merhof
- Interdisciplinary Imaging and Vision Institute Aachen, RWTH Aachen, Aachen 52074, Germany
| | - Andreas Uhl
- Department of Computer Sciences, University of Salzburg, Salzburg 5020, Austria
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Manchanda S, Rizvi QUA, Singh R. Role of endoscopy in the surveillance and management of colorectal neoplasia in inflammatory bowel disease. World J Clin Cases 2019; 7:1-9. [PMID: 30637247 PMCID: PMC6327134 DOI: 10.12998/wjcc.v7.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023] Open
Abstract
Endoscopy has become increasingly fundamental in the management of patients with inflammatory bowel disease (IBD). It is required for diagnosis, assessment of therapeutic response, postoperative follow up and in the surveillance of dysplasia. With rapid advances in technology, including high definition colonoscopy and chromoendoscopy, questions have arisen regarding the most appropriate surveillance and management strategies of colorectal neoplasia in IBD. We aim to review current surveillance strategies, explore the utility of new technologies, and examine the role of endoscopic resection, with the aim of clarifying these questions.
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Affiliation(s)
- Shaad Manchanda
- Department of Gastroenterology, Lyell McEwin Hospital, South Australia 5112, Australia
- School of Medicine, University of Adelaide, South Australia 5000, Australia
| | - Qurat-ul-ain Rizvi
- Eastern Health, Department of Gastroenterology, Box Hill Hospital, Victoria 3128, Australia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, South Australia 5112, Australia
- School of Medicine, University of Adelaide, South Australia 5000, Australia
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Lewin SM, Wen KW, Velayos FS, Mahadevan U, Beck KR. How Dye May Prevent Dying from Cancer: Perceiving Imperceptible Dysplasia in Inflammatory Bowel Disease. Dig Dis Sci 2019; 64:52-5. [PMID: 30523483 DOI: 10.1007/s10620-018-5409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Huguet JM, Suárez P, Ferrer-Barceló L, Iranzo I, Sempere J. Screening for colorectal cancer in patients with inflammatory bowel disease. Should we already perform chromoendoscopy in all our patients? World J Gastrointest Endosc 2018; 10:322-325. [PMID: 30487942 PMCID: PMC6247098 DOI: 10.4253/wjge.v10.i11.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/23/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (commonly known as IBD) have a greater risk of colorectal cancer than the general population. Therefore, they are included in special programs for screening and follow-up. Chromoendoscopy, which has a high diagnostic yield in the detection of neoplasia, is generally the recommended endoscopy technique. However, this procedure does have some disadvantages (long examination time, need for optimal bowel preparation, specialist training), which increase its cost. How then can we overcome these barriers? First, it is necessary to educate hospital managers and directors of the advantages of chromoendoscopy in patients with IBD. Second, at least one endoscopist per center should be a specialist in the technique. Third, we should train nursing staff in the preparation of the dye. Finally, each examination should be given the time it needs. Even though clinical practice guidelines do not yet recommend the use of virtual imaging techniques such as narrow band imaging, a recent study reported no differences between the two approaches for the detection of tumors. Therefore, we believe that all patients should undergo chromoendoscopy. In the future, centers without access to dyes or where other barriers exist should at least perform narrow band imaging.
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Affiliation(s)
- Jose María Huguet
- Patricía Suárez, Luis Ferrer-Barceló, Isabel Iranzo, Javier Sempere, Digestive Disease Department, Hospital General Universitario de Valencia, Valencia 46014, Valencia, Spain
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Abstract
Background The treatment of flat rectal adenomas is challenging. The technical difficulty and the potential of malignancy in suspected benign lesions are the factors in question. Surgical and interventional endoscopic techniques are implemented in Europe without a clear strategy. To minimize recurrent adenoma and unclear histopathological work up en bloc excision is desirable. Methods and results We demonstrate in this article the transanal endoscopic microsurgical submucosa dissection (TEM-ESD) procedure as a feasible method for en bloc excision of rectal adenomas and early rectal cancer. The surgical technique is demonstrated in detail with the help of a video of the operation that is available online. The results of a consecutive series of 78 patients are presented. Conclusion TEM-ESD is a safe procedure for resection of rectal adenomas and low risk carcinomas. It offers the possibility of organ preservation and minimizes functional disturbances. In case of a necessary salvage operation, the preserved integrity of the rectal muscle tube grants maximal oncological safety. Electronic supplementary material The online version of this article (10.1007/s00053-018-0291-3) includes a video on the surgical technique: TEM ESD. The article and supplemental material are available at http://www.springermedizin.de/der-chirurg. The supplemental material can be found at the end of the article under “Supplementary material”.
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Affiliation(s)
- J Baral
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Karlsruhe, Moltkestr. 90, 76133 Karlsruhe, Germany
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Galanopoulos M, Tsoukali E, Gkeros F, Vraka M, Karampekos G, Matzaris GJ. Screening and surveillance methods for dysplasia in inflammatory bowel disease patients: Where do we stand? World J Gastrointest Endosc 2018; 10:250-258. [PMID: 30364842 PMCID: PMC6198309 DOI: 10.4253/wjge.v10.i10.250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/24/2018] [Accepted: 06/29/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with long-standing ulcerative colitis (UC) and extensive Crohn’s colitis (CC) are at increased risk for dysplasia and colorectal cancer (CRC). Several studies have shown that UC extending proximal to the rectum, CC involving at least 1/3 of the colon, co-existence of primary sclerosing cholangitis, undetermined or unclassified colitis, family history of CRC and young age at diagnosis appear to be independent risk factors for inflammatory bowel disease (IBD) - related CRC. Therefore, screening and surveillance for CRC in IBD patients is highly recommended by international and national guidelines, whilst colonoscopy remains the unequivocal tool in order to detect potentially resectable dysplastic lesions or CRC at an early stage. Although the importance of screening and surveillance is widely proven, there is a controversy regarding the time of the first colonoscopy and the criteria of who should undergo surveillance. In addition, there are different recommendations among scientific societies concerning which endoscopic method is more efficient to detect dysplasia early, as well as the terminology for reporting visible lesions and the management of those lesions. This article concisely presents the main endoscopic methods and techniques performed for detecting dysplasia and CRC surveillance in patients with IBD focusing on their evidence-based accuracy and efficiency, as well as their cost-effectiveness. Finally, newer methods are mentioned, highlighting their applicability in daily endoscopic practice.
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Affiliation(s)
- Michail Galanopoulos
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Emmanouela Tsoukali
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Filippos Gkeros
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Marina Vraka
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Georgios Karampekos
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
| | - Gerassimos J Matzaris
- Department of Gastroenterology, Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens 10676, Greece
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Abstract
PURPOSE OF REVIEW Esophageal adenocarcinoma bears one of the fastest rising incidence of any cancers and generally arises in the setting of gastroesophageal reflux and Barrett's esophagus. However, early detection of neoplasia can be challenging since most patients are asymptomatic until they progress to more advanced and less curable stages, and early dysplastic lesions can be small, multifocal, and difficult to detect. Clearly, new imaging tools are needed in light of sampling error associated with random biopsies, the current standard of practice. RECENT FINDINGS Advances in endoscopic imaging including virtual chromoendoscopy, confocal laser endomicroscopy, and subsurface imaging with optical coherence tomography have ushered in a new era for detecting subtle neoplastic lesions. Moreover, in light of esophagus-sparing treatments for neoplastic lesions, such tools are likely to guide ablation and follow-up management. While there is no ideal single imaging modality to facilitate improved detection, staging, ablation, and follow-up of patients with dysplastic Barrett's esophagus, new advances in available technology, the potential for multimodal imaging, and the use of computer-aided diagnosis and biomarkers all hold great promise for improving detection and treatment.
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Affiliation(s)
- Mansoureh Mkarimi
- VA Boston Healthcare, Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA, 02132, USA
| | - Hiroshi Mashimo
- VA Boston Healthcare, Harvard Medical School, 1400 VFW Parkway, West Roxbury, MA, 02132, USA.
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Klepp P, Tollisen A, Røseth A, Cvancarova Småstuen M, Andersen SN, Vatn M, Moum BA, Brackmann S. Real-life chromoendoscopy for dysplasia surveillance in ulcerative colitis. World J Gastroenterol 2018; 24:4069-4076. [PMID: 30254411 PMCID: PMC6148427 DOI: 10.3748/wjg.v24.i35.4069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the use of chromoendoscopy for surveillance of ulcerative colitis in a real-life community hospital setting.
METHODS Patients with extensive ulcerative colitis, having disease duration of more than 8 years and who presented between the years of 1999 to 2013, were offered enrolment in this single cohort prospective study. All participants underwent standard bowel preparation with sodium phosphate and chromoendoscopy. Two expert endoscopists, novice to chromoendoscopy, evaluated each segment of the colon with standard-definition colonoscopes after spray application of 0.4% indigo carmine. All observed lesions were recorded and evaluated before being removed and/or biopsied. In addition, nontargeted biopsies were taken from each segment of the colon. The dysplasia detection rate and dysplasia detection yield were ascertained.
RESULTS A total of 21 neoplastic lesions (2 carcinomas, 4 of high-grade dysplasia and 15 of low-grade dysplasia) and 27 nondysplastic lesions were detected in 16 of the total 67 patients (70% male; median disease duration: 17 years; median age at diagnosis: 25 years; 92% aminosalicylate-treated). The dysplasia detection rate was 10.5% (7/67 patients). The dysplasia detection yield was 20.8% (10/48) for targeted biopsies and 3.5% (11/318) for nontargeted biopsies. The sensitivity and specificity for the macroscopic evaluation of neoplasia using chromoendoscopy were 48% [95% confidence interval (CI): 26%-70%] and 96% (95%CI: 93%-98%), respectively. The positive predictive and negative predictive values were 42% (95%CI: 27%-59%) and 97% (95%CI: 95%-98%), respectively. A total of 19/21 dysplastic lesions were detected in mucosa with histologic inflammation.
CONCLUSION Chromoendoscopy seems to be of value for dysplasia surveillance of ulcerative colitis in a community hospital setting. The yield of non-targeted biopsies is negligible.
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Affiliation(s)
- Pasquale Klepp
- Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo 0456, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo 0317, Norway
| | - Anita Tollisen
- Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo 0456, Norway
| | - Arne Røseth
- Unger-Vetlesen Institute, Department of Internal Medicine, Lovisenberg Diaconal Hospital, Oslo 0456, Norway
| | | | - Solveig N Andersen
- Department of Pathology, Akershus University Hospital, Lørenskog 1474, Norway
| | - Morten Vatn
- Institute of Clinical Medicine, University of Oslo, Oslo 0317, Norway
| | - Bjørn A Moum
- Institute of Clinical Medicine, University of Oslo, Oslo 0317, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo 0450, Norway
| | - Stephan Brackmann
- Institute of Clinical Medicine, University of Oslo, Oslo 0317, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog 1474, Norway
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Di Stefano AFD, Radicioni MM, Vaccani A, Fransioli A, Longo L, Moro L, Repici A. Methylene blue MMX® tablets for chromoendoscopy. Bioavailability, colon staining and safety in healthy volunteers undergoing a full colonoscopy. Contemp Clin Trials 2018; 71:96-102. [PMID: 29864547 DOI: 10.1016/j.cct.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/06/2018] [Revised: 05/22/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
Methylene blue-MMX® tablets are proposed as an aid for detection and visualisation of adenomas and carcinomas in patients undergoing colonoscopy, by improving their detection rate and highlighting the presence of the intestinal dysplastic lesions. Single total doses of 100 and 200 mg were administered to healthy volunteers undergoing a bowel cleansing preparation and a full colonoscopy to investigate the colonic staining. The pharmacokinetics of methylene blue and the safety after exposure to the tablets were also investigated. With 200 mg, the best staining, assessed as the sum of acceptable and good staining, was achieved in the ascending colon and rectosigmoid (75% subjects each), the transverse and the descending colon (approximately 63% each). Absence of staining or overstaining were reported for no colonic region of interest in any subject. Similar results were observed in the 100 mg dose group. Methylene blue blood concentrations reached a peak (Cmax) in a median time (Tmax) of 12 h with 100 mg and 16 h with 200 mg. AUC0-t was 10.7 ± 6.7 μg/mLxh after 100 mg and 25.2 ± 7.4 μg/mLxh after 200 mg. Half-life ranged between 9 and 22 h after the lower dose and between 6 and 26 h after the higher dose. The cumulative urinary excretion was about 28% after 100 mg and about 39% after 200 mg up to 60 h post-dose. The overall frequency of adverse events after single dose of the test product administered along with a bowel cleansing preparation was 39%, but only one was related to the test product: abnormal transaminases. The most frequent adverse event was a transient polyuria (17%). One serious adverse event (gastrointestinal haemorrhage) led the subject to study discontinuation and hospitalisation and another subject withdrew the study due to one adverse event (haematemesis). Either event was not related to methylene blue.
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Affiliation(s)
- A F D Di Stefano
- Cross Research S.A., Via F. A. Giorgioli, 14, Arzo CH-6864, Switzerland.
| | - M M Radicioni
- Cross Research S.A., Via F. A. Giorgioli, 14, Arzo CH-6864, Switzerland
| | - A Vaccani
- Cross Research S.A., Via F. A. Giorgioli, 14, Arzo CH-6864, Switzerland
| | - A Fransioli
- Department of Gastreonterology, Regional Hospital, Bellinzona, Switzerland
| | - L Longo
- Cosmo Technologies Ltd., Riverside II, Sir John Rogerson's Quay, Dublin 2, Ireland
| | - L Moro
- Cosmo Technologies Ltd., Riverside II, Sir John Rogerson's Quay, Dublin 2, Ireland
| | - A Repici
- Department of Gastreonterology, IRCCS Istituto Clinico Humanitas, Milan, Italy
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