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Kodama K, Kudo SE, Miyachi H, Wakamura K, Maeda Y, Ichimasa K, Ogawa Y, Kouyama Y, Abe M, Ogura Y, Okumura T, Mochizuki K, Minegishi Y, Ishiyama M, Mori Y, Misawa M, Kudo T, Hayashi T, Ishida F, Watanabe D. Clinical and endoscopic characteristics of post-colonoscopy colorectal cancers detected within 10 years after a previous negative examination. Endosc Int Open 2021; 9:E1472-E1479. [PMID: 34540538 PMCID: PMC8445690 DOI: 10.1055/a-1518-6754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background and study aims We sometimes encounter colorectal cancer (CRC) that is discovered during the time interval between initial colonoscopy and the recommended follow-up examination. Although several studies reported such cases of CRC, most were based on registry data, which implied that the endoscopic quality was not consistent or guaranteed. We aimed to clarify these clinical and endoscopic characteristics at our high-volume center where a retrospective survey could be precisely performed.
Patients and methods We retrospectively analyzed patients with CRC who underwent endoscopic resection or surgery from April 2002 to December 2010, categorizing them into two groups: a “study group” of patients with a negative colonoscopy during the previous 10 years, and a “control group” of patients without a previous colonoscopy or with a previous colonoscopy more than 10 years prior.
Results A total of 2042 patients had CRC, among which 55 patients were classified into the study group and the remaining 1989 into the control group. The CRC cases in the study group showed a significant association with smaller (< 30 mm) tumor size (odds ratio [OR] 2.3; 95 % confidence interval [CI] 1.3–4.0) and proximal tumor site (OR 1.7; 95 %CI 0.9–2.9). In addition, right-sided and depressed-type T1 CRCs were significantly more common in the study group.
Conclusions Tumor size and location were associated with CRCs detected within 10 years after the negative examination. In addition, depressed-type T1 CRCs were more common. Therefore, we should pay more attention to small, right-sided, or depressed-type tumors in daily colonoscopy.
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Affiliation(s)
- Kenta Kodama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Division of Gastroenterology, Japanese Red Cross Society Fukushima Hospital, Fukushima, Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yushi Ogawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masahiro Abe
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yohei Ogura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Taishi Okumura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kenichi Mochizuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yosuke Minegishi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Misaki Ishiyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Daisuke Watanabe
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, United States
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Rubio CA. Two histologic compartments in nonpolypoid conventional colon adenomas. J Gastroenterol Hepatol 2021; 36:910-917. [PMID: 32757480 DOI: 10.1111/jgh.15210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/06/2020] [Accepted: 08/02/2020] [Indexed: 12/09/2022]
Abstract
Two intertwined compartments coexisting in nonpolypoid conventional (i.e. tubular or villous) adenomas are highlighted in this review: one built of dysplastic tissue on top and the other portraying crypts with irregular, corrupted shapes, albeit lined with normal epithelium, below. The latter compartment has remained unattended in the literature. Recently, however, the histologic characteristics of the nondysplastic compartment in nonpolypoid conventional adenomas were closely examined, and some of its biological attributes were unveiled. Studies with the proliferation marker ki67 showed that the crypts with irregular, corrupted shapes in the nondysplastic compartment displayed haphazardly distributed proliferating cell-domains. Given that the proliferating cells are generated by stem cells, the relocation of proliferating cell-domains in those crypts seems to be the result of a reorganization of the stem cells within the crypts. The abnormal distribution of proliferating cells, the finding of p53-upregulated cells, and of crypts in asymmetric fission suggest that the crypts in that compartment are histo-biologically altered, probably somatically mutated. This new information might contribute to unravel the riddle of crypto-histogenesis of nonpolypoid conventional adenomas of the colon. More research along these lines is necessary, before the biology of the crypts in the nondysplastic compartment can be fully translated into molecular terms.
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Affiliation(s)
- Carlos A Rubio
- Gastrointestinal Research Laboratory, Department of Pathology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
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Chen S, Ge X, Liu X, Ding Q, Wang N, Wang X, Chen S, Liang H, Deng Y, Xiong Q, Ni G, Bo E, Xu C, Yu H, Liu L. Understanding optical reflectance contrast for real-time characterization of epithelial precursor lesions. Bioeng Transl Med 2019; 4:e10137. [PMID: 31572795 PMCID: PMC6764805 DOI: 10.1002/btm2.10137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
Detecting early-stage epithelial cancers and their precursor lesions are challenging as lesions could be subtle and focally or heterogeneously distributed over large mucosal areas. Optical coherence tomography (OCT) that enables wide-field imaging of subsurface microstructures in vivo is a promising screening tool for epithelial diseases. However, its diagnostic capability has not been fully appreciated since the optical reflectance contrast is poorly understood. We investigated the back-scattered intensities from clustered or packed nanometer scale intracellular scatterers using finite-difference time-domain method and 1-μm resolution form of OCT, and uncovered that there existed correlations between the reflectance contrasts and the ultrastructural clustering or packing states of these scatterers, which allows us to interpret the physiological state of the cells. Specifically, both polarized goblet cells and foveolar cells exhibited asymmetric reflectance contrast, but they could be differentiated by the optical intensity of the mucin cup due to the different ultrastructural make-ups of the mucin granules; keratinocytes could demonstrate varied cytoplasmic intensity and their cytoplasmic contrast was closely correlated with the packing state of keratin filaments. Further preliminary study demonstrated that these new understandings of OCT image contrast enables the characterization of precancerous lesions, which could complement the current morphology-based criteria in realizing "virtual histology" and would have a profound impact for the screening and surveillance of epithelial cancers.
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Affiliation(s)
- Si Chen
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Xin Ge
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Xinyu Liu
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Qianshan Ding
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Nanshuo Wang
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Xianghong Wang
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Shufen Chen
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Haitao Liang
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Yunchao Deng
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Qiaozhou Xiong
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Guangming Ni
- State Key Laboratory of Electronic Thin Films and Integrated Devices, School of Optoelectronic InformationUniversity of Electronic Science and Technology of ChinaChengduChina
| | - En Bo
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Chenjie Xu
- School of Chemical and Biomedical EngineeringNanyang Technological UniversitySingaporeSingapore
| | - Honggang Yu
- Department of GastroenterologyRenmin Hospital of Wuhan UniversityWuhanChina
| | - Linbo Liu
- School of Electrical and Electronic EngineeringNanyang Technological UniversitySingaporeSingapore
- School of Chemical and Biomedical EngineeringNanyang Technological UniversitySingaporeSingapore
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Dattani M, Moran BJ. Reply to Haboubi and Salmo. Colorectal Dis 2016; 18:1187. [PMID: 27748003 DOI: 10.1111/codi.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/27/2016] [Indexed: 02/08/2023]
Affiliation(s)
- M Dattani
- Pelican Cancer Foundation, Basingstoke, UK
| | - B J Moran
- Department of Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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Rutter MD, Chattree A, Barbour JA, Thomas-Gibson S, Bhandari P, Saunders BP, Veitch AM, Anderson J, Rembacken BJ, Loughrey MB, Pullan R, Garrett WV, Lewis G, Dolwani S. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut 2015; 64:1847-73. [PMID: 26104751 PMCID: PMC4680188 DOI: 10.1136/gutjnl-2015-309576] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 02/07/2023]
Abstract
These guidelines provide an evidence-based framework for the management of patients with large non-pedunculated colorectal polyps (LNPCPs), in addition to identifying key performance indicators (KPIs) that permit the audit of quality outcomes. These are areas not previously covered by British Society of Gastroenterology (BSG) Guidelines.A National Institute of Health and Care Excellence (NICE) compliant BSG guideline development process was used throughout and the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to structure the guideline development process. A systematic review of literature was conducted for English language articles up to May 2014 concerning the assessment and management of LNPCPs. Quality of evaluated studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist System. Proposed recommendation statements were evaluated by each member of the Guideline Development Group (GDG) on a scale from 1 (strongly agree) to 5 (strongly disagree) with >80% agreement required for consensus to be reached. Where consensus was not reached a modified Delphi process was used to re-evaluate and modify proposed statements until consensus was reached or the statement discarded. A round table meeting was subsequently held to finalise recommendations and to evaluate the strength of evidence discussed. The GRADE tool was used to assess the strength of evidence and strength of recommendation for finalised statements.KPIs, a training framework and potential research questions for the management of LNPCPs were also developed. It is hoped that these guidelines will improve the assessment and management of LNPCPs.
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Affiliation(s)
- Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Amit Chattree
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Jamie A Barbour
- Department of Gastroenterology, Queen Elizabeth Hospital, Gateshead, UK
| | | | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - John Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
| | | | | | - Rupert Pullan
- Department of Colorectal Surgery, Torbay Hospital, Torquay, UK
| | - William V Garrett
- Department of Colorectal Surgery, Medway Maritime Hospital, Gillingham, UK
| | - Gethin Lewis
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - Sunil Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
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Xiang L, Zhan Q, Zhao XH, Wang YD, An SL, Xu YZ, Li AM, Gong W, Bai Y, Zhi FC, Liu SD. Risk factors associated with missed colorectal flat adenoma: A multicenter retrospective tandem colonoscopy study. World J Gastroenterol 2014; 20:10927-10937. [PMID: 25152596 PMCID: PMC4138473 DOI: 10.3748/wjg.v20.i31.10927] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/19/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the miss rate for colorectal flat adenomas during colonoscopy and the risk factors.
METHODS: Flat adenomas are frequently missed during colonoscopy. However, the risk factors that influence their miss rates are unclear. This was a multicenter, retrospective study in which patients diagnosed with colorectal adenomas at a diagnostic colonoscopy and followed within 3 mo by a second therapeutic colonoscopy were pooled out from the established database. The “per-patient” and “per-adenoma” adenoma miss rates (AMR) for overall adenomas and flat adenomas, and patient-, adenoma-, and procedure-related risk factors potentially associated with the “per-adenoma” AMR for flat adenomas were determined.
RESULTS: Chromoscopy and high-definition colonoscopy were not taken under consideration in the study. Among 2093 patients with colorectal adenomas, 691 (33.0%) were diagnosed with flat adenomas, 514 with concomitant protruding adenomas and 177 without. The “per-patient” AMR for flat adenomas was 43.3% (299/691); the rates were 54.3% and 11.3%, respectively, for those with protruding adenomas and those without (OR = 9.320, 95%CI: 5.672-15.314, χ2 = 99.084, P < 0.001). The “per-adenoma” AMR for flat adenomas was 44.3% (406/916). In multivariate analysis, older age, presence of concomitant protruding adenomas, poor bowel preparation, smaller adenoma size, location at the right colon, insufficient experience of the colonoscopist, and withdrawal time < 6 min were associated with an increased “per-adenoma” AMR for flat adenomas. The AMR for flat adenomas was moderately correlated with that for overall adenomas (r = 0.516, P < 0.0001). The AMR for flat adenomas during colonoscopy was high.
CONCLUSION: Patient’s age, concomitant protruding adenomas, bowel preparation, size and location of adenomas, proficiency of the colonoscopist, and withdrawal time are factors affecting the “per-adenoma” AMR for flat adenomas.
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le Clercq CMC, Bouwens MWE, Rondagh EJA, Bakker CM, Keulen ETP, de Ridder RJ, Winkens B, Masclee AAM, Sanduleanu S. Postcolonoscopy colorectal cancers are preventable: a population-based study. Gut 2014; 63:957-63. [PMID: 23744612 DOI: 10.1136/gutjnl-2013-304880] [Citation(s) in RCA: 263] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The quality of colonoscopy is key for ensuring protection against colorectal cancer (CRC). We therefore aimed to elucidate the aetiology of postcolonoscopy CRCs (PCCRCs), and especially to identify preventable factors. METHODS We conducted a population-based study of all patients diagnosed with CRC in South-Limburg from 2001 to 2010 using colonoscopy and histopathology records and data from the Netherlands Cancer Registry. PCCRCs were defined as cancers diagnosed within 5 years after an index colonoscopy. According to location, CRCs were categorised into proximal or distal from the splenic flexure and, according to macroscopic aspect, into flat or protruded. Aetiological factors for PCCRCs were subdivided into procedure-related (missed lesions, inadequate examination/surveillance, incomplete resection) and biology-related (new cancers). RESULTS We included a total of 5107 patients with CRC, of whom 147 (2.9% of all patients, mean age 72.8 years, 55.1% men) had PCCRCs diagnosed on average 26 months after an index colonoscopy. Logistic regression analysis, adjusted for age and gender, showed that PCCRCs were significantly more often proximally located (OR 3.92, 95% CI 2.71 to 5.69), smaller in size (OR 0.78, 95% CI 0.70 to 0.87) and more often flat (OR 1.70, 95% CI 1.18 to 2.43) than prevalent CRCs. Of the PCCRCs, 57.8% were attributed to missed lesions, 19.8% to inadequate examination/surveillance and 8.8% to incomplete resection, while 13.6% were newly developed cancers. CONCLUSIONS In our experience, 86.4% of all PCCRCs could be explained by procedural factors, especially missed lesions. Quality improvements in performance of colonoscopy, with special attention to the detection and resection of proximally located flat precursors, have the potential to prevent PCCRCs.
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Affiliation(s)
- Chantal M C le Clercq
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Maastricht University Medical Center, , Maastricht, The Netherlands
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Abstract
The purpose of most colonoscopies is to detect and treat colorectal neoplasia, preventing or providing early diagnosis of cancer. Basic to this mission is the recognition and diagnosis of neoplasms. Recent data suggest that detection of neoplasia during colonoscopy is suboptimal, resulting in a failure of screening colonoscopy as an efficient strategy for the prevention of cancer. In this article, the ramifications of these observations are examined and their relevance to the practice of colonoscopy considered.
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Abstract
OBJECTIVES Colorectal flat adenomas have been associated with a higher risk of colorectal malignancy. We describe demographic characteristics and endoscopic findings in patients with colorectal flat adenomas. METHODS In total, 1934 consecutive patients undergoing colonoscopy were prospectively included. Polyp shape was classified according to the Japanese classification. Chromoendoscopy was applied whenever a flat lesion was suspected. Indications for colonoscopy, demographic data, and characteristics of neoplastic lesions were recorded. Patients were classified as follows: group 1, no adenomas (n=1250); group 2, only protruding adenomas (n=427); group 3, protruding and flat adenomas (n=118); and group 4, only flat adenomas (n=139). RESULTS Approximately one in every 10 patients (13.2%) had flat adenomas. Among them, concomitant protruding adenomas were identified in approximately half of the cases. In multivariate analysis, age older than 50 years [odds ratio (OR)=1.62; 95% confidence interval (CI)=1.08-2.43, P=0.02], protruding adenomas (OR=2.17; 95% CI=1.65-2.87, P<0.001), follow-up colonoscopy for polyps or cancer (OR=2.22; 95% CI=1.59-3.10, P<0.001), screening colonoscopy (OR=1.60, 95% CI=1.15-2.22, P=0.005), and specifically trained endoscopist (OR=2.02, 95% CI=1.53-2.68, P<0.001) were associated independently with flat adenoma detection. CONCLUSION Flat adenomas have specific demographic factors that might help to improve detection. Particularly, age older than 50 years, colorectal neoplasia surveillance, and the presence of protruding adenomas should alert endoscopists to the possible presence of these lesions. Trained endoscopists may offer a greater chance of detecting these lesions.
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Kaltenbach T, McGill SK, Kalidindi V, Friedland S, Soetikno R. Proficiency in the diagnosis of nonpolypoid colorectal neoplasm yields high adenoma detection rates. Dig Dis Sci 2012; 57:764-70. [PMID: 21964768 DOI: 10.1007/s10620-011-1921-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 09/08/2011] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Current efforts to prevent colorectal cancer focus on the detection and removal of neoplasms. Nonpolypoid colorectal neoplasms (NP-CRN) have a subtle appearance that can be difficult to recognize during colonoscopy. Endoscopists must first be familiar with the patterns of NP-CRN in order to detect and diagnose them. We studied the adenoma detection rates of endoscopists who had trained to detect NP-CRN, versus endoscopists who had not. DESIGN Retrospective Nested Case Control Study. SETTING Outpatient Screening Colonoscopy. PARTICIPANTS Adult Veterans. INTERVENTION Proficiency in the features and diagnosis of NP-CRN. MAIN OUTCOMES MEASUREMENTS Adenoma detection. RESULTS In total, 462 patients had screening colonoscopies-267 by colonoscopists who had trained in the features and diagnosis of NP-CRN. Patient characteristics were similar between groups-the majority were men with a mean age of 62 ± 6 years. Neoplasia was more prevalent (45.7 vs. 34.9%; p = 0.02) in patients evaluated by the trained compared to the conventionally trained group. Trained colonoscopists had a higher adenoma detection rate (0.76 vs. 0.54 adenomas per patient, p < 0.001); removed a higher proportion of neoplasia (77 vs. 35%, p < 0.001); and more frequently diagnosed NP-CRN lesions (OR 2.98, 95% CI: 1.46-6.08) compared to colonoscopists without supplemental training. CONCLUSIONS Endoscopists who are proficient in the detection of NP-CRN had significantly higher adenoma detection rates-of both polypoid and flat adenomas-compared to endoscopists without training, and were more specific in resection of adenomatous over hyperplastic lesions.
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Affiliation(s)
- Tonya Kaltenbach
- Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Division of Gastroenterology, Stanford University School of Medicine, 3801 Miranda Ave, GI-111, Palo Alto, CA 94304, USA.
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Rondagh EJA, Masclee AAM, van der Valk ME, Winkens B, de Bruïne AP, Kaltenbach T, Soetikno RM, Sanduleanu S. Nonpolypoid colorectal neoplasms: gender differences in prevalence and malignant potential. Scand J Gastroenterol 2012; 47:80-8. [PMID: 22149943 DOI: 10.3109/00365521.2011.638395] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Colonoscopy may fail to prevent colorectal cancer, especially in the proximal colon and in women. Nonpolypoid colorectal neoplasms may potentially explain some of these post-colonoscopy cancers. In the present study, we aimed to examine the prevalence and malignant potential of nonpolypoid colorectal neoplasms in a large population, with special attention to gender and location. METHODS We performed a cross-sectional study of all consecutive patients undergoing elective colonoscopy at a single academic medical center. The endoscopists were familiarized on the detection and treatment of nonpolypoid lesions. Advanced histology was defined by the presence of high-grade dysplasia or early cancer. RESULTS We included 2310 patients (53.9% women, mean age 58.4 years) with 2143 colorectal polyps. Prevalences of colorectal neoplasms and nonpolypoid colorectal neoplasms were lower in women than in men (20.9% vs. 33.7%, p < 0.001 and 3.0% vs. 5.5%, p = 0.002). In women, nonpolypoid colorectal neoplasms were significantly more likely to contain advanced histology than polypoid ones (OR 2.89, 95% CI 1.24-6.74, p = 0.01), while this was not the case in men (OR 0.91, 95% CI 0.40-2.06, p = 0.83). Proximal neoplasms with advanced histology were more likely to be nonpolypoid than distal ones (OR 4.68, 95% CI 1.54-14.2, p = 0.006). CONCLUSION Nonpolypoid mechanisms may play an important role in colorectal carcinogenesis, in both women and men. Although women have fewer colorectal neoplasms than men, they have nonpolypoid colorectal neoplasms, which frequently contain advanced histology.
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Affiliation(s)
- Eveline J A Rondagh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Netherlands
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Lee JH, Hong SJ, Jang JY, Kim SE, Seol SY. Outcome after endoscopic submucosal dissection for early gastric cancer in Korea. World J Gastroenterol 2011; 17:3591-5. [PMID: 21987605 PMCID: PMC3180015 DOI: 10.3748/wjg.v17.i31.3591] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 05/21/2011] [Accepted: 05/12/2011] [Indexed: 02/06/2023] Open
Abstract
Endoscopic treatment, such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), has been established as one of the treatment options for selected cases with early gastric cancer (EGC). Most studies on this topic have been carried out by researchers in Japan. Recently, the experience in EMR/ESD for EGC outside Japan is increasingly reported. In Korea, gastric cancer is the most common malignant disease, and the second leading cause of cancer death. Currently, EMR for EGC is widely performed in many centers in Korea. Early results with a short-term follow-up period are very promising in Korea. The complete resection rate of EMR was 37.8%-94.3%, and that of ESD was 77.4%-93.1%. In this review, we will provide an overview of the outcomes of endoscopic treatments in Korea.
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Bustamante-Balén M, Bernet L, Cano R, Pertejo V, Ponce J. Prevalence of nonpolypoid colorectal neoplasms in symptomatic patients scheduled for colonoscopy: a study with total colonic chromoscopy. J Clin Gastroenterol 2010; 44:280-285. [PMID: 19713863 DOI: 10.1097/mcg.0b013e3181aed327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES (i) To determine the prevalence of nonpolypoid colorectal neoplasms (NP-CRNs) in a prospective cohort of patients of a Mediterranean area; (ii) to compare the characteristics of NP-CRNs with those of polypoid adenomas, focusing on the rate of high-grade dysplasia (HGD) and carcinoma; (iii) to evaluate the characteristics of patients harboring NP-CRNs versus patients with protruding adenomas (P-CRNs). PATIENTS AND METHODS A prospective, cross-sectional observational study was made in which consecutive unselected patients were scheduled for colonoscopy and pancolonic chromoendoscopy. The Paris Classification of Superficial Neoplastic Lesions was used to classify the detected lesions, and the revised Vienna criteria were applied to describe the grade of dysplasia. All examinations were performed by the same endoscopist, and all samples were reviewed by the same pathologist. RESULTS A total of 290 patients were included, and 613 neoplasms were detected-26% of them being NP-CRNs. The prevalence of NP-CRNs was 34.1% [95% confidence interval (CI): 28.8%-39.7%]. The proportion of HGD or carcinoma in NP-CRNs was 2.5% (95% CI: 0.8%-5.9%), versus 2.9% in P-CRNs (95% CI: 1.6%-4.7%). Size larger than 10 mm [odds ratio: 22.7 (95% CI: 5.2-99.2)] and a pedunculated morphology [odds ratio: 5.7 (95% CI: 1.3-24.3)] were related to the presence of HGD or carcinoma. A relationship between increased size and HGD or carcinoma was found for all morphologies. Patients harboring only NP-CRNs and patients harboring only P-CRNs were similar for all the variables collected. CONCLUSIONS NP-CRNs have a high prevalence in our region, but show a proportion of HGD and carcinoma similar to that seen in P-CRNs. No patient variable is predictive of the presence of a NP-CRN.
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Repici A, Pellicano R, Strangio G, Danese S, Fagoonee S, Malesci A. Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes. Dis Colon Rectum 2009; 52:1502-1515. [PMID: 19617768 DOI: 10.1007/dcr.0b013e3181a74d9b] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Open access endoscopy and screening programs enable detection and removal of an increased number of colon polyps in the early stages of neoplastic transformation. Unfortunately, polyps larger than 3 cm, involving more than one-third of circumference or two haustral folds, or with a flat/depressed morphology are more challenging to remove with standard polypectomy techniques. Endoscopic mucosal resection potentiates the removal, in a minimally invasive way, of certain colonic lesions that would otherwise require surgical or ablative treatment. Because the plane of resection during endoscopic mucosal resection is typically the middle to deep submucosal layer, compared with standard polypectomy, which normally provides resection at a mucosal level, endoscopic mucosal resection offers the advantage of providing en bloc resection specimens for histopathologic analysis. Indications to perform endoscopic mucosal resection are adenoma and small, well-differentiated carcinoma, confined to the mucosa or with minimal invasion to submucosa, and without any invasion to lymphatic channels or vessels. The most frequently reported major complications, such as perforation (0-5%) and bleeding (0.5-6%), may be controlled by endoscopic methods and rarely require surgical treatment. Follow-up postendoscopic mucosal resection is essential because of the risk of neoplastic recurrence.
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Affiliation(s)
- Alessandro Repici
- Department of Gastroenterology and Digestive Endoscopy Unit, Istituto di Recovero e Cura a Carattere Scientifico Istituto Clinico Humanitas, Milano, Italy.
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Abstract
PURPOSE Flat colorectal adenomas may not be recognized or they may be seen and dismissed as normal mucosa. As a result, the "true" incidence of flat lesions is unknown. The aim of this study was to report the incidence and character of flat adenomas in a large series of patients in the United States. METHODS Details of colorectal polyps seen during colonoscopy are entered into a prospective database that was queried for flat adenomas. No magnification or dye spray was used. The colonoscopy completion rate was 96.8 percent. The flat adenoma detection rate of the senior author is in line with that of Japanese colonoscopists. RESULTS During 2,659 colonoscopies, 5,749 colorectal lesions were seen in 2,003 patients. Of these patients, 1,125 were men and 878 were women, with a mean age of 65 years (+/- 12 years). There were 3,115 adenomas (54 percent of lesions); 315 were flat (10.1 percent), 23 (0.8 percent) were depressed, 2,575 were sessile (82.7 percent), and 200 were pedunculated (6.4 percent). Two hundred twelve patients had flat adenomas (10.6 percent of patients); 172 patients had one and 40 had multiple (2 to 8) flat adenomas. Eight patients with flat adenomas had more flat adenomas on follow-up. CONCLUSIONS Colonoscopists in the United States must be aware of the existence of flat adenomas and sensitive to their appearance.
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Kil Lee S, Il Kim T, Kwan Shin S, Ho Kim W, Kim H, Kyu Kim N. Comparison of the clinicopathologic features between flat and polypoid adenoma. Scand J Gastroenterol 2008; 43:1116-21. [PMID: 18609172 DOI: 10.1080/00365520802116414] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Several reports have suggested that flat colorectal adenomas might exhibit a higher potential for malignancy compared to polypoid adenomas. Although the clinical importance of the shape of polyps is stressed, the controversy surrounding the malignant potential of flat adenomas continues. The aim of this study was to compare the clinicopathologic characteristics, including degree of dysplasia and malignancy, between flat and polypoid adenomas 5 mm in size or larger. MATERIAL AND METHODS A total of 3263 polyps (254 flat adenomas and 3009 polypoid adenomas), >/=5 mm in size, diagnosed in 1883 patients by colonoscopy were analyzed. RESULTS Flat adenomas were found in 10% of patients, which represented 7.8% of all adenomas removed. The flat adenomas were larger in diameter than the polypoid adenomas (14.8+/-12.6 mm versus 8.6+/-5.0 mm, p <0.01), had a higher rate of villous components (18.5% versus 11.4%, p <0.01), a higher rate of high-grade dysplasia (9.4% versus 4.2%, p <0.01), and a higher rate of malignancy (10.2% versus 3.6%, p <0.01) than polypoid adenomas. However, there was no difference in the rate of high-grade dysplasia or carcinoma between flat and polypoid adenomas of equal size. It was shown by multivariate analysis that rectosigmoid location, larger size, and presence of a villous component were associated with a higher rate of malignancy, but not with flat morphology. CONCLUSIONS Flat adenomas, which were of a relatively large size in this study, were not associated with a higher risk for high-grade dysplasia and carcinoma compared with polypoid adenomas.
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Affiliation(s)
- Sang Kil Lee
- Departments of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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Adenoma detection rate and the quality of colonoscopy: the sword has two edges. Dis Colon Rectum 2008; 51:520-3. [PMID: 18322755 DOI: 10.1007/s10350-008-9239-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 11/14/2007] [Accepted: 11/14/2007] [Indexed: 02/08/2023]
Abstract
With the increasing demand for colonoscopy for colorectal cancer screening and surveillance of colorectal adenomas and carcinomas, there has been an increasing emphasis on the quality of colonoscopy. Few publications have considered the full implications of pushing the adenoma detection rate as a prime quality indicator. In this article, some of the potential problems with this course are discussed and an alternative approach is suggested. Although defining and measuring quality in colonoscopy is important, further work needs to be done to arrive at a practical, clinically meaningful way of quality assessment.
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Flat Colorectal Cancers Are Genetically Determined and Progress to Invasion without Going through a Polypoid Stage. Cancer Res 2007; 67:11594-600. [DOI: 10.1158/0008-5472.can-07-3242] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Repici A. From EMR to ESD: a new challenge from Japanese endoscopists. Dig Liver Dis 2007; 39:572-4. [PMID: 17468059 DOI: 10.1016/j.dld.2007.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 03/27/2007] [Indexed: 12/11/2022]
Affiliation(s)
- A Repici
- Digestive Endoscopy Unit, Department of Gastroenterology, Humanitas Clinic, Rozzano, Italy.
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Abstract
This article was presented at the conjoint CSSA and RACS (colorectal section) spring meeting Queensland, Australia, September 2004. The adenoma-carcinoma sequence describes a succession of events from polypoid adenoma to colorectal cancer. However, this model only accounts for up to two-thirds of colorectal cancers. There is growing evidence that flat adenomas are precursor lesions to a flat type of colorectal cancer and certain subtypes of these polyps are at greater risk of malignant transformation. If confirmed, the implications for screening, endoscopic recognition and management will become of increasing importance if we are to decrease the incidence of colorectal cancer.
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Affiliation(s)
- Doug Speake
- Colorectal Unit, Department of Surgery, Manchester Royal Infirmary, Manchester, UK
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Obrador A, Ginard D, Barranco L. Review article: colorectal cancer surveillance in ulcerative colitis - what should we be doing? Aliment Pharmacol Ther 2006; 24 Suppl 3:56-63. [PMID: 16961747 DOI: 10.1111/j.1365-2036.2006.03062.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Different societies have published guidelines for colorectal cancer (CRC) surveillance in ulcerative colitis (UC). While it would seem that most gastroenterologists and endoscopists agree with these guidelines, different studies have shown that in clinical practice, the concept of dysplasia is not fully understood, and therefore, the guidelines are not always followed. According to some studies, the reason why gastroenterologists do not follow the recommendations is inadequate education. The main advance in recent years in this subject is in endoscopic diagnosis of dysplasia. The magnification and chromoendoscopy allow targeted biopsies to be taken. Some studies indicate that nontargeted biopsies are not useful in ruling out dysplasia. It is also important to realize that most dysplasia is visible in conventional colonoscopy. In colonoscopy, it is not only significant to detect dysplasia-associated lesions or masses; the endoscopist should also be trained to detect, in the course of conventional exploration, subtle changes in colour or in mucosal surfaces that imply dysplasia. Adherence to guidelines had been extensively assessed in other disease conditions (asthma, hypertension, etc.). According to our knowledge there are no such data regarding CRC surveillance in UC. Some barriers that may affect physicians include: (i) knowledge (lack of awareness or lack of familiarity); (ii) attitudes (lack of agreement, lack of self-efficacy, lack of outcome expectancy, or the inertia of previous practice) and (iii) behaviour (external barriers). In conclusion, we need new guidelines for CRC surveillance in UC, which must take into account the advances in risk factors of dysplasia and new technologies to study colon dysplasia.
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Affiliation(s)
- A Obrador
- Gastroenterology Department, Hospital Son Dureta, IUNICS Universitat de les Illes Balears, Palma, Mallorca, Spain.
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Church J. Flat and depressed neoplasms of the colon in western populations [corrected]. Am J Gastroenterol 2006; 101:1676-7. [PMID: 16863582 DOI: 10.1111/j.1572-0241.2006.00627_7.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Konishi T, Watanabe T, Muto T, Kotake K, Nagawa H. Difference in incidence of colorectal cancer between men and women in Asia. Lancet Oncol 2006; 7:104-5. [PMID: 16455474 DOI: 10.1016/s1470-2045(06)70551-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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