|
1
|
Lin YC, Liao SC, Chang CH, Chen CC, Lin WT, Chiu FW, Ko CW. Endoscopic features and clinical course of patients with asymptomatic cecal ulcers. BMC Gastroenterol 2022; 22:309. [PMID: 35751028 PMCID: PMC9229120 DOI: 10.1186/s12876-022-02383-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background Cecal ulcers are
sometimes encountered in asymptomatic individuals. Their clinical outcomes and
management recommendations remain uncertain. Methods Asymptomatic patients who underwent a colonoscopic exam
for colon cancer screening were retrospectively reviewed from July 2009 to
November 2016. Patients with cecal ulcers were included. Patients who had
colorectal symptoms, such as abdominal pain, had nonsteroidal anti-inflammatory
drugs or were lost to follow-up were excluded. Results A total of 34,036 patients underwent colon cancer
screening. Cecal ulcers were found in 35 patients. After exclusion, 24 patients
(mean duration, 52 months) received follow-up colonoscopy. In 20 patients,
(83.3%), cecal ulcer resolved without intervention, but 4 patients (16.7%)
developed clinical significant diseases, including intestinal tuberculosis
(n = 2), Crohn’s disease (n = 1), and ulcerative colitis (n = 1). Patients who
developed clinically significant diseases had a higher percentage of ulcers
larger than 1 cm (75% vs. 15%, p = 0.035), terminal ileum involvement (100% vs.
15.4%, p = 0.006) and ulcers with irregular fold (75% vs. 5%, p = 0.008). Conclusions In patients with
asymptomatic cecal ulcers, the endoscopic features included larger ulcer size,
terminal ileum involvement and ulcers with irregular fold may predict
development of clinically significant diseases. If the above-mentioned features
are present, even asymptomatic patients should be closely monitored.
Collapse
Affiliation(s)
- Ying-Cheng Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Szu-Chia Liao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan.,School of Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chung-Hsin Chang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Chia-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Wan-Tzu Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan
| | - Fang-We Chiu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, No. 1, Rongguang Rd., Puli Township, 54552, Nantou, Taiwan.
| | - Chung-Wang Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, 1650, Section 4, Taiwan Boulevard, Xitun Dist., Taichung City, 40705, Taiwan. .,School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
|
2
|
Buchner AM, Sharma P, Wallace MB. Contrast‐Enhanced Endoscopy. SUCCESSFUL TRAINING IN GASTROINTESTINAL ENDOSCOPY 2022:177-194. [DOI: 10.1002/9781119529675.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
|
|
3
|
Mohsen W, Williams AJ, Wark G, Sechi A, Koo JH, Xuan W, Bassan M, Ng W, Connor S. Prospective single-blinded single-center randomized controlled trial of Prep Kit-C and Moviprep: Does underlying inflammatory bowel disease impact tolerability and efficacy? World J Gastroenterol 2021; 27:1090-1100. [PMID: 33776375 PMCID: PMC7985733 DOI: 10.3748/wjg.v27.i11.1090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/11/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colonoscopy remains the gold standard for detection of colonic disease. An optimal evaluation depends on adequate bowel cleansing. Patients with inflammatory bowel disease (IBD), require frequent endoscopic assessment for both activity and dysplasia assessment. Two commonly used bowel preparations in Australia are Prep Kit-C (Pc) and Moviprep (Mp). Little is known about tolerability, efficacy and safety of split protocols of Mp and Pc in both IBD and non-IBD patients.
AIM To primary aim was to compare the tolerability, efficacy and safety of split protocols of Mp and Pc in patients having a colonoscopy. The secondary aim was to compare the efficacy, tolerability and safety of either preparation in patients with or without IBD.
METHODS Patients were randomized to Pc or Mp bowel preparation. Patients completed a questionnaire to assess tolerability. Efficacy was assessed using the Ottawa Bowel Preparation Score. Serum electrolytes and renal function were collected one week prior to colonoscopy and on the day of colonoscopy.
RESULTS Of 338 patients met the inclusion criteria. Of 168 patients randomized to Mp and 170 to Pc. The efficacy of bowel preparation (mean Ottawa Bowel Preparation Score) was similar between Mp (5.4 ± 2.4) and Pc (5.1 ± 2.1) (P = 0.3). Mean tolerability scores were similar in Mp (11.84 ± 5.4) and Pc (10.99 ± 5.2; P = 0.17). 125 patients had IBD (73 had Crohn’s Disease and 52 had Ulcerative colitis). Sixty-four IBD patients were allocated to Mp and 61 to Pc. In non-IBD patients, 104 were allocated to Mp and 109 to Pc. The mean tolerability score in the IBD group was lower than the non-IBD group (mean tolerability scores: IBD: 10.3 ± 5.1 and non-IBD: 12.0 ± 5.3; P = 0.01). IBD patients described more abdominal pain with Mp when compared with Pc; (Mp: 5.7 ± 4.4 vs Pc: 3.6 ± 2.6, P = 0.046). Serum magnesium level increased with Pc compared with Mp in all patients (mean increase in mmol/L: Mp: 0.03 ± 0.117 and Pc: 0.11 ± 0.106; P < 0.0001).
CONCLUSION In this study, the efficacy, tolerability and safety of Mp and Pc were similar in all patients. However, patients with IBD reported lower tolerability with both preparations. Specifically, IBD patients had more abdominal pain with Mp. These results should be considered when recommending bowel preparation especially to IBD patients.
Collapse
Affiliation(s)
- Waled Mohsen
- Department of Digestive Diseases, Gold Coast University Hospital, Gold Coast, 4215, Queensland, Australia
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
| | - Gabrielle Wark
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Alexandra Sechi
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Jenn-Hian Koo
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Wei Xuan
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
- Ingham Institute Applied Medical Research, Sydney 2170, New South Wales, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
| | - Watson Ng
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
| | - Susan Connor
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney 2170, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney 2170, New South Wales, Australia
- Ingham Institute Applied Medical Research, Sydney 2170, New South Wales, Australia
| |
Collapse
|
|
4
|
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. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:435-447. [PMID: 33592179 DOI: 10.1016/j.gastrohep.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [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.
Collapse
|
|
5
|
Role of Chromohysteroscopy in Patients of Abnormal Uterine Bleeding. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00495-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
|
6
|
Hu AB, Burke KE, Kochar B, Ananthakrishnan AN. Yield of Random Biopsies During Colonoscopies in Inflammatory Bowel Disease Patients Undergoing Dysplasia Surveillance. Inflamm Bowel Dis 2020; 27:779-786. [PMID: 32812048 PMCID: PMC8128394 DOI: 10.1093/ibd/izaa205] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The development of chromoendoscopy (CE) and high definition endoscopy (HDE) has improved detection of subtle colonic dysplasia in patients with inflammatory bowel diseases (IBDs). The role of random biopsies for dysplasia surveillance is unclear. METHODS We reviewed patients with IBD who underwent a CE or HDE colonoscopy and had colonic dysplasia detected. Detection of dysplasia was classified as either visible or random and graded as low grade dysplasia (LGD), high grade dysplasia (HGD), or indefinite for dysplasia. Multivariable regression adjusted for relevant confounders examined the predictors of dysplasia detectable on random biopsies alone. RESULTS The study included 300 patients (203 ulcerative colitis, 97 Crohn's disease with colonic involvement) contributing 442 colonoscopies; the mean disease duration was 24.5 years; 7.2% had primary sclerosing cholangitis (PSC). Three hundred sixty-two colonoscopies (82%) had only visible dysplasia, 52 (12%) had only random dysplasia, and 28 (6%) had both visible and random dysplasia. Longer disease duration (odds ratio, 1.04; 95% CI, 1.01-1.07), active inflammation (odds ratio, 2.89; 95% CI, 1.26-6.67), and concomitant PSC (odds ratio, 3.66; 95% CI, 1.21-11.08) were associated with detecting dysplasia on random biopsies compared with visible lesions. Patients with random dysplasia (21%) or both random and visible dysplasia (21%) were more likely to undergo surgical resection compared with those with only visible dysplasia (5%; P < 0.001) and have subsequent development of colorectal cancer (15%, 7%, 1%, respectively; P < 0.0001). CONCLUSION Nearly one fifth of dysplasia detected in patients with IBD was found on random biopsies. Patients with high risk characteristics may benefit from continuing the practice of random biopsies during surveillance examinations.
Collapse
Affiliation(s)
- Anne B Hu
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Kristin E Burke
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Bharati Kochar
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Ashwin N Ananthakrishnan
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA,Address correspondence to Ashwin N. Ananthakrishnan, MD, MPH, Massachusetts General Hospital Crohn’s and Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA. E-mail:
| |
Collapse
|
|
7
|
Aladrén BS, González-Lama Y, García-Alvarado M, Sierra M, Barrio JA, Vicente VP, Hernández L, Velayos B, Garcia LA, Relea L, Suarez P, Atienza R, Vásquez M, Fernández-Salazar L, Muñoz F, on behalf of GEICYL (group of inflammatory bowel disease of Castilla y León) . Even non-experts identify non-dysplastic lesions in inflammatory bowel disease via chromoendoscopy: results of a screening program in real-life. Endosc Int Open 2019; 7:E743-E750. [PMID: 31157291 PMCID: PMC6524993 DOI: 10.1055/a-0839-4514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Chromoendoscopy with targeted biopsy is the technique of choice for colorectal cancer screening in longstanding inflammatory bowel disease. We aimed to analyze results of a chromoendoscopy screening program and to assess the possibility of identifying low-risk dysplastic lesions by their endoscopic appearance in order to avoid histological analysis. Materials and methods We retrospectively reviewed chromoendoscopies performed between February 2011 and June 2017 in seven Spanish hospitals in a standardized fashion. We analyzed the findings and the diagnostic yield of the Kudo pit pattern for predicting dysplasia. Results A total of 709 chromoendoscopies (569 patients) were reviewed. Median duration of disease was 16.7 years (SD 8.1); 80.4 % had ulcerative colitis. A total of 2025 lesions (3.56 lesions per patient) were found; two hundred and thirty-two lesions were neoplastic (11.5 %) (223 were LGD (96.1 %), eight were HGD (3.4 %), and one was colorectal cancer (0.5 %). The correlation between dysplasia and Kudo pit patterns predictors of dysplasia (≥ III) was low, with an area under the curve of 0.649. Kudo I and II lesions were correctly identified with a high negative predictive value (92 %), even by non-experts. Endoscopic activity, Paris 0-Is classification, and right colon localization were risk factors for dysplasia detection, while rectum or sigmoid localization were protective against dysplasia. Conclusions Chromoendoscopy in the real-life setting detected 11 % of dysplastic lesions with a low correlation with Kudo pit pattern. A high negative predictive value would prevent Kudo I and, probably, Kudo II biopsies in the left colon, reducing procedure time and avoiding complications.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Luis Hernández
- Hospital Santos Reyes. Aranda de Duero, Castilla y León, Spain
| | - Benito Velayos
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Lucia Relea
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Ramón Atienza
- Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
| | - Mónica Vásquez
- Hospital Santos Reyes. Aranda de Duero, Castilla y León, Spain
| | | | - Fernando Muñoz
- Hospital Universitario de Salamanca, Castilla y León, Spain
| | | |
Collapse
|
|
8
|
Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol 2018; 113:481-517. [PMID: 29610508 DOI: 10.1038/ajg.2018.27] [Citation(s) in RCA: 900] [Impact Index Per Article: 128.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 01/11/2018] [Indexed: 02/06/2023]
Abstract
Crohn's disease is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of Crohn's disease has steadily increased over the past several decades. The diagnosis and treatment of patients with Crohn's disease has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn's disease. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health-care providers should incorporate this guideline along with patient's needs, desires, and their values in order to fully and appropriately care for patients with Crohn's disease. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.
Collapse
Affiliation(s)
- Gary R Lichtenstein
- Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kim L Isaacs
- Department of Medicine, Division of Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Miguel D Regueiro
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren B Gerson
- Department of Medicine, Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
|
9
|
Moussata D, Allez M, Cazals-Hatem D, Treton X, Laharie D, Reimund JM, Bertheau P, Bourreille A, Lavergne-Slove A, Brixi H, Branche J, Gornet JM, Stefanescu C, Moreau J, Marteau P, Pelletier AL, Carbonnel F, Seksik P, Simon M, Fléjou JF, Colombel JF, Charlois AL, Roblin X, Nancey S, Bouhnik Y, Berger F, Flourié B. Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy? Gut 2018; 67:616-624. [PMID: 28115492 DOI: 10.1136/gutjnl-2016-311892] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 12/19/2016] [Accepted: 12/25/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colonoscopy with pan-chromoendoscopy (CE) is superior to standard colonoscopy in detecting neoplasia in patients with IBD. Performing random biopsies in unsuspicious mucosa after CE remains controversial. METHODS Consecutive patients with IBD who underwent surveillance colonoscopy using CE were prospectively included. The standardised procedure used CE, performed targeted biopsies or endoscopic resection on suspicious lesions and then quadrant random biopsies every 10 cm. A panel of five expert pathologists reviewed histological slides with dysplasia. Logistic regression model was used to evidence the factors associated with neoplasia in any or in random biopsies. RESULTS 1000 colonoscopes were performed in 1000 patients (495 UC, 505 Crohn's colitis). In 82 patients, neoplasia was detected from targeted biopsies or removed lesions, and among them dysplasia was detected also by random biopsies in 7 patients. Importantly, in 12 additional patients dysplasia was only detected by random biopsies. Overall, 140 neoplastic sites were found in 94 patients, 112 (80%) from targeted biopsies or removed lesions and 28 (20%) by random biopsies. The yield of neoplasia by random biopsies only was 0.2% per-biopsy (68/31 865), 1.2% per-colonoscopy (12/1000) but 12.8% per-patient with neoplasia (12/94). Dysplasia detected by random biopsies was associated with a personal history of neoplasia, a tubular appearing colon and the presence of primary sclerosing cholangitis (PSC). CONCLUSIONS Despite their low yield, random biopsies should be performed in association with CE in patients with IBD with a personal history of neoplasia, concomitant PSC or a tubular colon during colonoscopy. TRIAL REGISTRATION NUMBER IRB 001508, Paris 7 University.
Collapse
Affiliation(s)
- Driffa Moussata
- Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
| | - Matthieu Allez
- Gastroenterology Department, Saint-Louis Hospital, Paris, France
| | | | - Xavier Treton
- Gastroenterology Department, Beaujon Hospital, Clichy, France
| | - David Laharie
- Gastroenterology Department, Bordeaux Hospital, Pessac, France
| | - Jean-Marie Reimund
- Gastroenterology Department, INSERM U1113 and Hautepierre Hospital, Strasbourg, France
| | | | - Arnaud Bourreille
- Gastroenterology Department, CIC Inserm 1413, Nantes University, Nantes, France
| | | | - Hedia Brixi
- Hepato-Gastroenterology Department, Robert Debre University Hospital, Reims, France
| | - Julien Branche
- Gastroenterology Department, Claude Huriez Hospital, Lille, France
| | - Jean-Marc Gornet
- Gastroenterology Department, Saint-Louis Hospital, Paris, France
| | | | - Jacques Moreau
- Gastroenterology Department, Rangueil Hospital, Toulouse, France
| | | | | | - Franck Carbonnel
- Gastroenterology Department, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Philippe Seksik
- Gastroenterology Department, Saint-Antoine Hospital, Paris, France
| | - Marion Simon
- Hepato-Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Xavier Roblin
- Gastroenterology Department, University Hospital, Saint Etienne, France
| | - Stéphane Nancey
- Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
| | - Yoram Bouhnik
- Gastroenterology Department, Beaujon Hospital, Clichy, France
| | | | - Bernard Flourié
- Gastroenterology Department, Lyon Sud Hospital, Pierre Bénite, France
| | | |
Collapse
|
|
10
|
Carballal S, Maisterra S, López-Serrano A, Gimeno-García AZ, Vera MI, Marín-Garbriel JC, Díaz-Tasende J, Márquez L, Álvarez MA, Hernández L, De Castro L, Gordillo J, Puig I, Vega P, Bustamante-Balén M, Acevedo J, Peñas B, López-Cerón M, Ricart E, Cuatrecasas M, Jimeno M, Pellisé M. Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD. Gut 2018; 67:70-78. [PMID: 27612488 DOI: 10.1136/gutjnl-2016-312332] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Outside clinical trials, the effectiveness of chromoendoscopy (CE) for long-standing IBD surveillance is controversial. We aimed to assess the effectiveness of CE for neoplasia detection and characterisation, in real-life. DESIGN From June 2012 to 2014, patients with IBD were prospectively included in a multicentre cohort study. Each colonic segment was evaluated with white light followed by 0.4% indigo carmine CE. Specific lesions' features were recorded. Optical diagnosis was assessed. Dysplasia detection rate between expert and non-expert endoscopists and learning curve were ascertained. RESULTS Ninety-four (15.7%) dysplastic (1 cancer, 5 high-grade dysplasia, 88 low-grade dysplasia) and 503 (84.3%) non-dysplastic lesions were detected in 350 patients (47% female; mean disease duration: 17 years). Colonoscopies were performed with standard definition (41.5%) or high definition (58.5%). Dysplasia miss rate with white light was 40/94 (57.4% incremental yield for CE). CE-incremental detection yield for dysplasia was comparable between standard definition and high definition (51.5% vs 52.3%, p=0.30). Dysplasia detection rate was comparable between expert and non-expert (18.5% vs 13.1%, p=0.20). No significant learning curve was observed (8.2% vs 14.2%, p=0.46). Sensitivity, specificity, and positive and negative predictive values for dysplasia optical diagnosis were 70%, 90%, 58% and 94%, respectively. Endoscopic characteristics predictive of dysplasia were: proximal location, loss of innominate lines, polypoid morphology and Kudo pit pattern III-V. CONCLUSIONS CE presents a high diagnostic yield for neoplasia detection, irrespectively of the technology and experience available in any centre. In vivo, CE optical diagnosis is highly accurate for ruling out dysplasia, especially in expert hands. Lesion characteristics can aid the endoscopist for in situ therapeutic decisions. TRIAL REGISTRATION NUMBER NCT02543762.
Collapse
Affiliation(s)
- Sabela Carballal
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Sandra Maisterra
- Gastroenterology Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - María Isabel Vera
- Gastroenterology Department, Hospital Puerta del Hierro, Madrid, Spain
| | | | - José Díaz-Tasende
- Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | | | - Luis Hernández
- Digestive Disease Section, Hospital Universitario de Móstoles, Madrid, Spain
| | - Luisa De Castro
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica. Estructura Organizativa de Xestión Integrada de Vigo, Vigo, Spain
| | - Jordi Gordillo
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ignasi Puig
- Gastroenterology Department, Althaia, Xarxa Assistencial Universitària de Manresa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pablo Vega
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Juan Acevedo
- Gastroenterology Department, Hospital Comarcal de Calella, Barcelona, Spain
| | - Beatriz Peñas
- Gastroenterology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - María López-Cerón
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Miriam Cuatrecasas
- Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
| | - Mireya Jimeno
- Pathology Department, Centre de Diagnostic Biomèdic (CDB), Hospital Clínic, University of Barcelona and Banc de Tumors-Biobanc Clinic-IDIBAPS-XBTC, Barcelona, Catalonia, Spain
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
|
11
|
Buchner AM. The Role of Chromoendoscopy in Evaluating Colorectal Dysplasia. Gastroenterol Hepatol (N Y) 2017; 13:336-347. [PMID: 28690450 PMCID: PMC5495038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Chromoendoscopy pertains to image-enhanced endoscopic techniques such as dye-based chromoendoscopy and electronic chromoendoscopy using narrow-band imaging, flexible spectral imaging color enhancement, and i-scan. Dye-based chromoendoscopy has been demonstrated to improve colorectal dysplasia detection in high-risk patients with long-term inflammatory bowel disease, and electronic chromoendoscopy techniques have been shown to improve characterization of diminutive colorectal lesions, allowing for optical diagnosis during a colonoscopy examination. This article reviews endoscopic imaging using chromoendoscopy techniques for colorectal dysplasia evaluation.
Collapse
Affiliation(s)
- Anna M Buchner
- Dr Buchner is an assistant professor of medicine in the Division of Gastroenterology at the University of Pennsylvania in Philadelphia, Pennsylvania
| |
Collapse
|
|
12
|
Beintaris I, Rutter M. Advanced imaging in colonoscopy: contemporary approach to dysplasia surveillance in inflammatory bowel disease. Frontline Gastroenterol 2016; 7:308-315. [PMID: 28839872 PMCID: PMC5369495 DOI: 10.1136/flgastro-2016-100735] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/19/2016] [Indexed: 02/04/2023] Open
Abstract
Inflammatory bowel disease (IBD) (ulcerative colitis (UC) and Crohn's disease (CD)) is a chronic relapsing/remitting condition characterised by intestinal inflammation. One of the main concerns in patients with longstanding ulcerative and Crohn's colitis is development of colonic dysplasia and colorectal cancer (CRC), a risk higher than that of the general population. Colonoscopy surveillance programmes have been developed by major societies worldwide to improve early dysplasia detection and treatment, thus preventing progression to colorectal cancer. Colonoscopy is an imperfect tool as lesions can be missed, an issue even more relevant to colitic patients, where mucosal inspection and lesion recognition may prove challenging. Extensive research has been undertaken on performance improvement in this area while technical advances in optical imaging, such as high-definition, have made their way into modern endoscopy units. Techniques and technologies available to enhance optical diagnosis of dysplasia in inflammatory bowel disease are reviewed in this paper, focusing on those that are realistic, widely available and feasible for everyday practice.
Collapse
Affiliation(s)
| | - Matt Rutter
- University Hospital of North Tees, Cleveland, UK
| |
Collapse
|
|
13
|
Shergill AK, Farraye FA. Endoscopic evaluation for colon cancer and dysplasia in patients with inflammatory bowel disease. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2016. [DOI: 10.1016/j.tgie.2016.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
|
14
|
Abstract
Ulcerative colitis (UC) is a chronic inflammatory bowel disease whose pathogenesis is multifactorial and includes influences from genes, the environment, and the gut microbiome. Recent advances in diagnosis and treatment have led to significant improvement in managing the disease. Disease monitoring with the use of therapeutic drug monitoring, stool markers, and assessment of mucosal healing have garnered much attention. The recent approval of vedolizumab for treatment of moderate to severe UC has been a welcome addition. Newer biologics, including those targeting the Janus tyrosine kinase (JAK) pathway, are on the horizon to add to the current armamentarium of anti-TNF alpha and anti-integrin therapies. The recent publication of the SCENIC consensus statement on surveillance and management of dysplasia in UC patients supports the use of chromoendoscopy over random biopsies in detecting dysplasia. This review highlights these recent advances along with others that have been made with ulcerative colitis.
Collapse
|
|
15
|
Cleveland NK, Colman RJ, Rodriquez D, Hirsch A, Cohen RD, Hanauer SB, Hart J, Rubin DT. Surveillance of IBD Using High Definition Colonoscopes Does Not Miss Adenocarcinoma in Patients with Low-grade Dysplasia. Inflamm Bowel Dis 2016; 22:631-7. [PMID: 26658214 PMCID: PMC5058785 DOI: 10.1097/mib.0000000000000634] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Historically, limits to the ability to detect dysplasia in chronic inflammatory bowel disease (IBD)-associated colitis resulted in the recommendation that neoplasia of any grade be treated by proctocolectomy. We hypothesized that with improved optical technologies, most neoplasia in colitis is now detectable and reassessed the prevalence of colitis-associated neoplasia. METHODS We retrospectively reviewed all our patients with IBD who had pathologist-confirmed neoplasia on surveillance colonoscopy and underwent a subsequent colectomy. We included patients whose index lesions were found between 2005 and 2014 (the dates of our high definition equipment) and recorded the location and grade of these lesions. These findings were compared to the surgical specimens, and in patients with partial colectomies, included follow-up. RESULTS Thirty-six patients with IBD (19 [53%] ulcerative colitis and 17 [47%] Crohn's disease) were found to have neoplastic lesions on surveillance colonoscopy and underwent a subsequent partial colectomy or total proctocolectomy. Forty-four index lesions were identified by colonoscopy (29 white light and 7 methylene blue chromoscopy): 30 low-grade dysplasia, 6 high-grade dysplasia, and 8 adenocarcinoma. None of the low-grade dysplasia or adenocarcinoma index lesions were associated with synchronous carcinoma at colectomy. One of the patients with high-grade dysplasia had adenocarcinoma of the appendix. CONCLUSIONS In this experience with high definition colonoscopes in chronic colitis, no synchronous adenocarcinomas were found when colectomy was performed for low-grade dysplasia or index adenocarcinoma, and only 1 adenocarcinoma in the appendix was found in the setting of high-grade dysplasia. These findings suggest that active surveillance or subtotal colectomy may be safe options for patients with IBD and some grades of neoplasia.
Collapse
Affiliation(s)
| | | | | | - Ayal Hirsch
- University of Chicago Inflammatory Bowel Disease Center
| | | | | | - John Hart
- University of Chicago Inflammatory Bowel Disease Center,University of Chicago Department of Pathology
| | | |
Collapse
|
|
16
|
Development of Advanced Imaging Criteria for the Endoscopic Identification of Inflammatory Polyps. Clin Transl Gastroenterol 2015; 6:e128. [PMID: 26583503 PMCID: PMC4816089 DOI: 10.1038/ctg.2015.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/18/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Inflammatory polyps (IPs) are frequently encountered at colonoscopy in inflammatory bowel disease (IBD) patients and are associated with an increased risk of colon cancer. The aim of this prospective endoscopic image review and analysis was to describe endoscopic features of IPs in IBD patients at surveillance colonoscopy and determine the ability to endoscopically discern IPs from other colon polyps using high-definition white light (WL), narrow band imaging with magnification (NBI), and chromoendoscopy (CE). METHODS Digital images of IPs using WL, NBI, and CE were reviewed by four attending gastroenterologists using a two-round modified Delphi method. The ability to endoscopically discern IPs from other colon polyps was determined among groups of gastroenterology fellows and attendings. IPs were classified by gross appearance, contour, surface pattern, pit pattern, and appearance of surrounding mucosa in IPs, as well as accuracy of diagnosis. RESULTS Features characteristic of IPs included a fibrinous cap, surface friability and ulceration, an appendage-like appearance, the halo sign with CE, and a clustering of a multiplicity of IPs. The overall diagnostic accuracy for IP identification was 63% for WL, 42% for NBI, and 64% for CE. High degrees of histologic inflammation significantly improved the accuracy of diagnosis of IP with WL and CE, whereas the use of NBI significantly impaired IP accuracy. CONCLUSIONS The overall diagnostic accuracy when applying these criteria to clinical images was modest, with incremental benefit with addition of CE to WL. CE showed promise predicting IP histology in actively inflamed tissue. Institutional Review Board approval was obtained. ClinicalTrials.gov Identifier: NCT01557387.
Collapse
|
|
17
|
Chromoendoscopy for Surveillance in Inflammatory Bowel Disease Does Not Increase Neoplasia Detection Compared With Conventional Colonoscopy With Random Biopsies: Results From a Large Retrospective Study. Am J Gastroenterol 2015; 110:1014-21. [PMID: 25823770 DOI: 10.1038/ajg.2015.63] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/03/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Randomized trials demonstrated that chromoendoscopy is superior to white light endoscopy with random biopsy sampling (WLE) for the detection of dysplasia in patients with inflammatory bowel disease (IBD). Whether implementing chromoendoscopy can increase the detection of dysplasia in clinical practice is unknown. METHODS Patients with ulcerative colitis (UC) and Crohn's disease (CD) undergoing colonoscopic surveillance between January 2000 and November 2013 in three referral centers were identified using the patients' medical records. In recent years, the use of high-definition chromoendoscopy was adopted in all three centers using segmental pancolonic spraying of 0.1% methylene blue or 0.3% indigo carmine (chromoendoscopy group). Previously, surveillance was performed employing WLE with random biopsies every 10 cm (WLE group). The percentage of colonoscopies with dysplasia was compared between both groups. RESULTS A total of 440 colonoscopies in 401 patients were performed using chromoendoscopy and 1,802 colonoscopies in 772 patients using WLE. Except for a higher number of CD patients with extensive disease and more patients with a first-degree relative with colorectal cancer (CRC) in the chromoendoscopy group, the known risk factors for IBD-associated CRC were comparable between both groups. Dysplasia was detected during 48 surveillance procedures (11%) in the chromoendoscopy group as compared with 189 procedures (10%) in the WLE group (P=0.80). Targeted biopsies yielded 59 dysplastic lesions in the chromoendoscopy group, comparable to the 211 dysplastic lesions detected in the WLE group (P=0.30). CONCLUSIONS Despite compelling evidence from randomized trials, implementation of chromoendoscopy for IBD surveillance did not increase dysplasia detection compared with WLE with targeted and random biopsies.
Collapse
|
|
18
|
Abstract
Chromoendoscopy techniques improve the visualization of mucosal structures. This article reviews and summarizes key studies addressing the impact of chromoendoscopy on colonic neoplasia detection and differentiation of neoplastic from non-neoplastic polyps in average and high-risk populations, including patients with colonic inflammatory bowel disease (IBD). In this context, there are convincing data that chromoendoscopy differentiates neoplastic from non-neoplastic polyps in average-risk populations with high accuracy. Moreover, dye-based chromoendoscopy improves neoplasia detection in colonic IBD surveillance.
Collapse
Affiliation(s)
- Michael J Bartel
- Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael F Picco
- Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Michael B Wallace
- Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| |
Collapse
|
|
19
|
Charanya T, York T, Bloch S, Sudlow G, Liang K, Garcia M, Akers WJ, Rubin D, Gruev V, Achilefu S. Trimodal color-fluorescence-polarization endoscopy aided by a tumor selective molecular probe accurately detects flat lesions in colitis-associated cancer. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:126002. [PMID: 25473883 PMCID: PMC4255434 DOI: 10.1117/1.jbo.19.12.126002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/24/2014] [Indexed: 05/10/2023]
Abstract
Colitis-associated cancer (CAC) arises from premalignant flat lesions of the colon, which are difficult to detect with current endoscopic screening approaches. We have developed a complementary fluorescence and polarization reporting strategy that combines the unique biochemical and physical properties of dysplasia and cancer for real-time detection of these lesions. Using azoxymethane-dextran sodium sulfate (AOM-DSS) treated mice, which recapitulates human CAC and dysplasia, we show that an octapeptide labeled with a near-infrared (NIR) fluorescent dye selectively identified all precancerous and cancerous lesions. A new thermoresponsive sol-gel formulation allowed topical application of the molecular probe during endoscopy. This method yielded high contrast-to-noise ratios (CNR) between adenomatous tumors (20.6 ± 1.65) and flat lesions (12.1 ± 1.03) and surrounding uninvolved colon tissue versus CNR of inflamed tissues (1.62±0.42) Incorporation of nanowire-filtered polarization imaging into NIR fluorescence endoscopy shows a high depolarization contrast in both adenomatous tumors and flat lesions in CAC, reflecting compromised structural integrity of these tissues. Together, the real-time polarization imaging provides real-time validation of suspicious colon tissue highlighted by molecular fluorescence endoscopy.
Collapse
Affiliation(s)
- Tauseef Charanya
- Washington University in St. Louis, Department of Radiology, 4525 Scott Avenue, East Building, St. Louis, Missouri 63110, United States
- Washington University in St. Louis, Department of Biomedical Engineering, 1 Brookings Drive, St. Louis, Missouri 63110, United States
| | - Timothy York
- Washington University in St. Louis, Department of Computer Science and Engineering, 1 Brookings Drive, St. Louis, Missouri 63110, United States
| | - Sharon Bloch
- Washington University in St. Louis, Department of Radiology, 4525 Scott Avenue, East Building, St. Louis, Missouri 63110, United States
| | - Gail Sudlow
- Washington University in St. Louis, Department of Radiology, 4525 Scott Avenue, East Building, St. Louis, Missouri 63110, United States
| | - Kexian Liang
- Washington University in St. Louis, Department of Radiology, 4525 Scott Avenue, East Building, St. Louis, Missouri 63110, United States
| | - Missael Garcia
- Washington University in St. Louis, Department of Computer Science and Engineering, 1 Brookings Drive, St. Louis, Missouri 63110, United States
| | - Walter J. Akers
- Washington University in St. Louis, Department of Radiology, 4525 Scott Avenue, East Building, St. Louis, Missouri 63110, United States
| | - Deborah Rubin
- Washington University in St. Louis, Department of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110, United States
| | - Viktor Gruev
- Washington University in St. Louis, Department of Computer Science and Engineering, 1 Brookings Drive, St. Louis, Missouri 63110, United States
| | - Samuel Achilefu
- Washington University in St. Louis, Department of Radiology, 4525 Scott Avenue, East Building, St. Louis, Missouri 63110, United States
- Washington University in St. Louis, Department of Biomedical Engineering, 1 Brookings Drive, St. Louis, Missouri 63110, United States
- Washington University in St. Louis, Department of Biochemistry and Molecular Biophysics, 660 South Euclid Avenue, St. Louis, Missouri 63110, United States
- Address all correspondence to: Samuel Achilefu, E-mail:
| |
Collapse
|
|
20
|
Shah SA, Rubin DT, Farraye FA. Chromoendoscopy for colorectal cancer surveillance in patients with inflammatory bowel disease. Curr Gastroenterol Rep 2014; 16:407. [PMID: 25113042 DOI: 10.1007/s11894-014-0407-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Chromoendoscopy utilizes colorimetric techniques to increase detection of lesions that are difficult to see or cannot be seen with conventional white light endoscopy. Multiple studies have demonstrated that chromoendoscopy with dye spraying significantly increases the detection of dysplastic lesions in patients with chronic inflammatory bowel disease (IBD) of the colon undergoing colonoscopy. Furthermore, chromoendoscopy may obviate the need for random biopsies and pending additional studies and may allow increased intervals between surveillance exams, reducing costs while increasing the sensitivity for detection of dysplasia per exam. Despite convincing data supporting the use of chromoendoscopy for IBD colonic surveillance, it is seldom utilized outside of academic centers. Here, we review the current approach to colorectal cancer surveillance in IBD focusing on the data supporting the use of chromoendoscopy including its use in a community setting and offer practical recommendations for incorporating chromoendoscopy as a routine part of surveillance in IBD regardless of practice setting.
Collapse
Affiliation(s)
- Samir A Shah
- Gastroenterology Associates, Inc., 44 West River Street, Providence, RI, 02904, USA,
| | | | | |
Collapse
|
|
21
|
Teubner D, Kiesslich R, Matsumoto T, Rey JW, Hoffman A. Beyond standard image-enhanced endoscopy confocal endomicroscopy. Gastrointest Endosc Clin N Am 2014; 24:427-34. [PMID: 24975533 DOI: 10.1016/j.giec.2014.03.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endomicroscopy is a new imaging tool for gastrointestinal endoscopy. In vivo histology becomes possible at subcellular resolution during ongoing colonoscopy. Panchromoendoscopy with targeted biopsies has become the method of choice for surveillance of patients with inflammatory bowel disease. Endomicroscopy can be added after chromoendoscopy to clarify whether standard biopsies are needed. This smart biopsy concept can increase the diagnostic yield of intraepithelial neoplasia and substantially reduce the need for biopsies. Clinical acceptance is increasing because of a multitude of positive studies about the diagnostic value of endomicroscopy. Smart biopsies, functional imaging, and molecular imaging may represent the future for endomicroscopy.
Collapse
Affiliation(s)
- Daniel Teubner
- Department for Internal Medicine, Gastroenterology and Oncology, St Marienkrankenhaus, Richard-Wagner-Street, 14, Frankfurt 60318, Germany
| | - Ralf Kiesslich
- Department for Internal Medicine, Gastroenterology and Oncology, St Marienkrankenhaus, Richard-Wagner-Street, 14, Frankfurt 60318, Germany.
| | - Takayuki Matsumoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Johannes W Rey
- Department for Internal Medicine, Gastroenterology and Oncology, St Marienkrankenhaus, Richard-Wagner-Street, 14, Frankfurt 60318, Germany
| | - Arthur Hoffman
- Department for Internal Medicine, Gastroenterology and Oncology, St Marienkrankenhaus, Richard-Wagner-Street, 14, Frankfurt 60318, Germany
| |
Collapse
|
|
22
|
Nett A, Velayos F, McQuaid K. Quality bowel preparation for surveillance colonoscopy in patients with inflammatory bowel disease is a must. Gastrointest Endosc Clin N Am 2014; 24:379-92. [PMID: 24975529 DOI: 10.1016/j.giec.2014.03.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Colonoscopy is routinely performed in patients with inflammatory bowel disease (IBD) for surveillance of dysplasia. Thorough bowel preparation is necessary to facilitate lesion detection. Patients with IBD do not have poorer bowel preparation outcomes but may have decreased preparation tolerance affecting adherence to surveillance protocols. A low-fiber prepreparation diet may improve preparation tolerance without affecting preparation quality. The standard preparation regimen should consist of split-dose administration of a polyethylene glycol-based purgative. Low-volume, hyperosmolar purgatives may be considered in patients with previous preparation intolerance, heightened anxiety, stenotic disease, or dysmotility. Appropriate patient education is critical to enhance preparation quality.
Collapse
Affiliation(s)
- Andrew Nett
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143, USA
| | - Fernando Velayos
- Department of Medicine, University of California, San Francisco, 513 Parnassus Avenue, Room S-357, San Francisco, CA 94143, USA
| | - Kenneth McQuaid
- Department of Medicine, San Francisco VA Medical Center, University of California, San Francisco, 4150 Clement Street, Room 111-B, San Francisco, CA 94121, USA.
| |
Collapse
|
|
23
|
Hoffman A, Rey JW, Mueller L, Hansen T, Goetz M, Tresch A, Galle PR, Kiesslich R. Analysis of interobserver variability for endomicroscopy of the gastrointestinal tract. Dig Liver Dis 2014; 46:140-5. [PMID: 24210992 DOI: 10.1016/j.dld.2013.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 08/26/2013] [Accepted: 09/07/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endomicroscopy allows in vivo microscopic investigation of enteral mucosa during endoscopic examinations. The aim of this study was to determine interobserver variability in the evaluation of endomicroscopic pictures of several organs by groups of investigators composed of confocal experts, pathologists and students. METHODS Twenty-five selected representative endomicroscopic pictures of the colon, stomach and oesophagus (total number, 75) were evaluated based on tissue, inflammatory and neoplastic changes (secondary endpoints). The endomicroscopic presence of neoplastic features was the primary endpoint and correlated with the final histological diagnosis. RESULTS The kappa values for experts examining colon, stomach, and oesophagus pictures were 0.80, 0.91, and 0.488, respectively; for students 0.74, 0.684, and 0.527 and for pathologists 0.749, 0.633, and 0.346, respectively. Neoplasia was accurately diagnosed in 67-97% of patients with no significant differences between the 3 groups. Tissue differentiation was determined best by pathologists, whereas the degree of inflammation was better diagnosed by experts and students. In all 3 groups the diagnosis of oesophageal diseases was the most difficult. CONCLUSIONS Endomicroscopic images can be interpreted with high concordance. In our study, the diagnostic reliability was not different between students, endomicroscopic experts, and pathologists. Thus, endomicroscopy could be an additional and reliable imaging modality for diagnosing mucosal neoplasia of the gut.
Collapse
Affiliation(s)
- Arthur Hoffman
- St. Mary's Hospital, Department of Medicine, Frankfurt, Germany; Medical Department, Johannes Gutenberg University of Mainz, Germany.
| | - Johannes Wilhelm Rey
- St. Mary's Hospital, Department of Medicine, Frankfurt, Germany; Medical Department, Johannes Gutenberg University of Mainz, Germany
| | - Lena Mueller
- Medical Department, Johannes Gutenberg University of Mainz, Germany
| | - Torsten Hansen
- Institute of Pathology, Johannes Gutenberg University Mainz, Germany
| | - Martin Goetz
- Medical Department, Johannes Gutenberg University of Mainz, Germany; Medical Department, University of Tübingen, Germany
| | | | | | - Ralf Kiesslich
- St. Mary's Hospital, Department of Medicine, Frankfurt, Germany; Medical Department, Johannes Gutenberg University of Mainz, Germany
| |
Collapse
|
|
24
|
Rees CJ, Rajasekhar PT, Rutter MD, Dekker E. Quality in colonoscopy: European perspectives and practice. Expert Rev Gastroenterol Hepatol 2014; 8:29-47. [PMID: 24410471 DOI: 10.1586/17474124.2014.858599] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Colonoscopy is the 'gold standard' investigation of the colon. High quality colonoscopy is essential to diagnose early cancer and reduce its incidence through the detection and removal of pre-malignant adenomas. In this review, we discuss the key components of a high quality colonoscopy, review methods for improving quality, emerging technologies that have the potential to improve quality and highlight areas for future work.
Collapse
Affiliation(s)
- Colin J Rees
- South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear, NE34 0PL, UK
| | | | | | | |
Collapse
|
|
25
|
Colorectal cancer and Crohn's colitis: clinical implications from 313 surgical patients. World J Surg 2013; 37:902-10. [PMID: 23381673 DOI: 10.1007/s00268-013-1922-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The relation between Crohn's colitis (CC) and colorectal cancer is still controversial. Several case reports and retrospective studies have shown that patients with Crohn's disease (CD) have a 6- to 20-fold higher risk to develop CRC than does the normal population. The extent of disease (extensive colitis), presence of anal fistula, age > 40 years, strictures, and length of disease >10 years may be important determinants for increasing risk. Despite this evidence, other population-based studies have shown no increased risk of colon or rectal cancer. The aim of this study was to investigate retrospectively factors that may predict the development of cancer. METHODS We searched the histopathologic database of the Digestive Surgery Unit at Careggi University Hospital for CC patients (January 1987 to September 2011) and identified 313 patients with CC who underwent surgery. RESULTS There are 11 (3.5 %) of adenocarcinomas. Multivariate analysis showed disease duration (p = 0.001), age at CD diagnosis (p = 0.002), distal localization (p = 0.045), and penetrating disease (p = 0.041) to be risk factors. Multivariate analysis showed that 40 patients who had undergone previous immunosuppressive therapy had a significant risk of developing CRC (p = 0.026). CONCLUSIONS Crohn's colitis patients who require surgery are at higher risk for developing CRC, particularly those whose disease duration is >10 years, have distal localization, age at diagnosis was <40 years, and have penetrating disease. Previous immunosuppressive therapy should be better investigated. We recommend surgery for any patient presenting with colonic strictures.
Collapse
|
|
26
|
East JE. Colonoscopic Cancer Surveillance in Inflammatory Bowel Disease: What's New Beyond Random Biopsy? Clin Endosc 2012; 45:274-7. [PMID: 22977816 PMCID: PMC3429750 DOI: 10.5946/ce.2012.45.3.274] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 07/26/2012] [Accepted: 07/27/2012] [Indexed: 12/18/2022] Open
Abstract
Colonoscopy based colitis surveillance is widely accepted to try to prevent development of and ensure early detection of colitis-associated colorectal cancer. Traditionally this has been performed with quadrantic random biopsies throughout the colon. Chromoendoscopy "dye-spray" with targeted biopsies only has been shown to increase dysplasia detection 4 to 5 fold on a per lesion basis. It has therefore been suggested that random biopsies should be abandoned as they do not increase dysplasia detection nor change patient clinical course. Recent British guidelines for colitis surveillance have strongly endorsed chromoendoscopy. This short review summarizes current international guidelines and looks at how to optimize white light colonoscopy in colitis considering: bowel preparation, withdrawal time, high definition, and structure enhancement. Data for advanced imaging techniques are reviewed including positive evidence in favor of chromoendoscopy, and limited data suggesting autofluoresence imaging may be promising. Narrow band imaging does not increase dysplasia detection in colitis. Confocal endomicroscopy might potentially reduce biopsies beyond that of chromoendoscopy but does not offer a clear detection advantage. Pan-colonic chromoendoscopy with targeted biopsies increases dysplasia detection and is the standard of care in the United Kingdom. It is likely that the use of chromoendoscopy for colitis surveillance will become widely accepted internationally.
Collapse
Affiliation(s)
- James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
|
27
|
Neumann H, Vieth M, Langner C, Neurath MF, Mudter J. Cancer risk in IBD: How to diagnose and how to manage DALM and ALM. World J Gastroenterol 2011; 17:3184-91. [PMID: 21912466 PMCID: PMC3158393 DOI: 10.3748/wjg.v17.i27.3184] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 03/01/2011] [Accepted: 03/08/2011] [Indexed: 02/06/2023] Open
Abstract
The risk of developing neoplasia leading to colorectal cancer is significantly increased in ulcerative colitis (UC) and most likely in Crohn’s disease. Several endoscopic surveillance strategies have been implemented to identify these lesions. The main issue is that colitis-associated neoplasms often occurs in flat mucosa, often being detected on taking random biopsies rather than by identification of these lesions via endoscopic imaging. The standard diagnostic procedure in long lasting UC is to take four biopsies every 10 cm. Image enhancement methods, such as chromoendoscopy and virtual histology using endomicroscopy, have greatly improved neoplasia detection rates and may contribute to reduced random biopsies by taking targeted “smart” biopsies. Chromoendoscopy may effectively be performed by experienced endoscopists for routine screening of UC patients. By contrast, endomicroscopy is often only available in selected specialized endoscopic centers. Importantly, advanced endoscopic imaging has the potential to increase the detection rate of neoplasia whereas the interplay between endoscopic experience and interpretation of histological biopsy evaluation allows the physician to make a proper diagnosis and to find the appropriate therapeutic approach. Colitis-associated intraepithelial neoplasms may occur in flat mucosa of endoscopically normal appearance or may arise as dysplasia-associated lesion or mass (DALM), which may be indistinguishable from sporadic adenomas in healthy or non-colitis mucosa [adenoma-like mass (ALM)]. The aim of this review was to summarize endoscopic and histological characteristics of DALM and ALM in the context of therapeutic procedures.
Collapse
|
|
28
|
Goetz M, Neurath MF. Imaging techniques in inflammatory bowel disease: recent trends, questions and answers. ACTA ACUST UNITED AC 2010; 33 Suppl 3:S174-82. [PMID: 20117340 DOI: 10.1016/s0399-8320(09)73152-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Imaging techniques have undergone substantial progress in recent years and contribute significantly in the diagnosis of inflammatory bowel diseases in conjunction with patient history, clinical and laboratory examination. Modern cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging allow an evaluation not only of the complete bowel wall of the small intestine, but also of extraluminal structures. They constitute a major diagnostic component in the initial workup, in stricturing or fistulizing disease and in suspected abscess. Transabdominal ultrasonography has been re-appreciated in these settings as an easy- and ready-to-use tool yielding real-time information. Positron emission tomography was found useful to add functional diagnosis of inflammation. Colonoscopy techniques still represent the gold standard for evaluation of inflammatory activity and for cancer surveillance. Here, chromoendoscopy has proven efficacy for enhanced detection of flat intraepithelial neoplasias in ulcerative colitis and has been incorporated into recent surveillance guidelines. Narrow band imaging may provide virtual chromoendoscopy in the future, but confirmatory studies are still on the way. Confocal endomicroscopy allows in vivo microscopy at high resolution and with excellent accuracy in first trials to predict histology of inflammatory and neoplastic lesions. The current data from endoscopic studies should result in an integrated approach to both identify and characterize a suspicious lesion during ongoing endoscopy for reliable, accurate diagnosis and targeted, immediate therapy.
Collapse
Affiliation(s)
- M Goetz
- I. Med. Clinic, Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany
| | | |
Collapse
|
|
29
|
Hurley JJ, Turner J, Berrill J, Swift G, Dolwani S, Green J. Surveillance for colorectal cancer in patients with inflammatory bowel disease. Br J Hosp Med (Lond) 2010; 71:562-7. [DOI: 10.12968/hmed.2010.71.10.78939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Joanna J Hurley
- Department of Gastroenterology, University Hospital Llandough, Cardiff CF64 2XX
| | - Jeff Turner
- Department of Gastroenterology, University Hospital Llandough, Cardiff CF64 2XX
| | - James Berrill
- Department of Gastroenterology, University Hospital Llandough, Cardiff CF64 2XX
| | - Gillian Swift
- Department of Gastroenterology, University Hospital Llandough, Cardiff CF64 2XX
| | - Sunil Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff CF64 2XX
| | - John Green
- Department of Gastroenterology, University Hospital Llandough, Cardiff CF64 2XX
| |
Collapse
|
|
30
|
|
|
31
|
Abstract
Endomicroscopy is a newly developed imaging modality, which provides in vivo histology during ongoing endoscopy. This review characterizes the currently available endomicroscopic systems and reflects the clinical value of endomicroscopy for different diseases. Endomicroscopy can be used to discover histology of the mucosal layer at cellular and subcellular resolution. Furthermore, endomicroscopy can be used to observe physiologic and pathophysiologic changes, which offer a newly available insight into the pathogenesis of different diseases. The diagnostic possibilities of endomicroscopy are extensive and highly valuable for every day practice. However, the era of endomicroscopy has just started and it can be anticipated that its role will significantly increase in the future.
Collapse
|
|
32
|
Velayos F. Colon cancer surveillance in inflammatory bowel disease patients: current and emerging practices. Expert Rev Gastroenterol Hepatol 2008; 2:817-25. [PMID: 19090741 DOI: 10.1586/17474124.2.6.817] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Colorectal cancer (CRC) is a feared complication of inflammatory bowel disease (IBD). The cumulative probability of developing this malignancy is significantly higher than in the general population, making IBD the third highest risk condition for CRC. Since CRC is such a concerning complication, it should be no surprise that patients and physicians want to know what the most important risk factors are for its development, as well as potential strategies for reducing these risks. This article reviews the current practice and emerging technologies for detecting and preventing colon cancer in patients with IBD.
Collapse
Affiliation(s)
- Fernando Velayos
- University of California, San Francisco, Center for Crohn's and Colitis, 2330 Post Street, Suite 610, San Francisco, CA 94116, USA.
| |
Collapse
|
|
33
|
Abstract
Confocal laser endomicroscopy enables in vivo microscopy of the mucosal layer of the GI-tract with subcellular resolution during ongoing endoscopy. Endomicroscopy opens a new door for immediate tissue and vessel analysis. Different types of diseases can be diagnosed with optical surface and subsurface analysis. Analysis of the in vivo microarchitecture can be used for targeting biopsies to relevant areas. Furthermore, subsurface imaging can unmask microscopic diseases - (microscopic colitis) or bacterial infection (Helicobacter pylori), for example. Molecular imaging is becoming feasible, and this will shortly open the door to new indications in gastrointestinal endoscopy. This chapter reviews the currently rapidly expanding clinical data about endomicroscopy and gives a look into future research.
Collapse
Affiliation(s)
- Ralf Kiesslich
- I. Med. Department, Johannes Gutenberg University of Mainz, Germany.
| | | | | |
Collapse
|
|
34
|
Abstract
Confocal laser endomicroscopy enables in vivo microscopy of the mucosal layer of the gastrointestinal tract with subcellular resolution during ongoing endoscopy. Endomicroscopy opens the door to immediate tissue and vessel analysis. Different types of diseases can be diagnosed with optical surface and subsurface analysis. Analysis of the in vivo microarchitecture can be used for targeting biopsies to relevant areas, and subsurface imaging can unmask microscopic diseases or bacterial infection. Molecular imaging is becoming feasible, which will enable new indications in gastrointestinal endoscopy. This article reviews the current and rapidly expanding clinical data on endomicroscopy and gives a look into future research.
Collapse
|
|
35
|
Biancone L, Michetti P, Travis S, Escher JC, Moser G, Forbes A, Hoffmann JC, Dignass A, Gionchetti P, Jantschek G, Kiesslich R, Kolacek S, Mitchell R, Panes J, Soderholm J, Vucelic B, Stange E. European evidence-based Consensus on the management of ulcerative colitis: Special situations. J Crohns Colitis 2008; 2:63-92. [PMID: 21172196 DOI: 10.1016/j.crohns.2007.12.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 12/30/2007] [Indexed: 02/08/2023]
|
|
36
|
East JE, Saunders BP, Jass JR. Sporadic and syndromic hyperplastic polyps and serrated adenomas of the colon: classification, molecular genetics, natural history, and clinical management. Gastroenterol Clin North Am 2008; 37:25-46, v. [PMID: 18313538 DOI: 10.1016/j.gtc.2007.12.014] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is now strong evidence for an alternative pathway of colorectal carcinogenesis implicating hyperplastic polyps and serrated adenomas. This article briefly reviews the evidence for this serrated pathway, provides diagnostic criteria for clinically significant hyperplastic polyps and allied serrated polyps, and suggests how this information may be translated into safe, effective guidelines for colonoscopy-based colon cancer prevention. Consideration also is given to the definition and management of hyperplastic polyposis syndrome. The currently proposed management plan for serrated polyps is tentative because of incomplete knowledge of the nature and behavior of these polyps. This article highlights key areas warranting further research.
Collapse
Affiliation(s)
- James E East
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
| | | | | |
Collapse
|
|
37
|
East JE, Saunders BP. Narrow band imaging at colonoscopy: seeing through a glass darkly or the light of a new dawn? Expert Rev Gastroenterol Hepatol 2008; 2:1-4. [PMID: 19072363 DOI: 10.1586/17474124.2.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
|
38
|
Zanoni ECA, Cutait R, Averbach M, de Oliveira LAR, Teixeira CR, Corrêa PAFP, Paccos JL, Rossini GF, Câmara Lopes LH. Magnifying colonoscopy: interobserver agreement in the assessment of colonic pit patterns and its correlation with histopathological findings. Int J Colorectal Dis 2007; 22:1383-8. [PMID: 17579873 DOI: 10.1007/s00384-007-0336-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Magnifying colonoscopy (MC) is recognized as an aid to the differential diagnosis between neoplastic and nonneoplastic lesions. This study evaluated interobserver agreement of experienced endoscopists in the assessment of colonic pit patterns through the Kudo's classification and correlated morphological aspects with histopathological findings. MATERIALS AND METHODS A total of 213 magnification chromoendoscopic pictures of colonic lesions were collected from 161 consecutive patients and presented to three independent observers who expressed opinion about predominant pit pattern. All lesions were excised and sent for histopathological study. RESULTS Kappa statistics showed that the general agreement index with respect to the aspects of the pits was good among the three observers (0.561). Regarding prediction of histopathology according to the pit pattern diagnosis, overall accuracy was 84%, sensitivity was 91.4%, specificity was 67.2%, positive predictive value was 86.6%, and negative predictive value was 79.3%. CONCLUSION Although the interobserver reproducibility of the colonic pit pattern is good for experienced endoscopists, MC must not be used to replace the histopathological analysis, since it does not differentiate with the necessary safety neoplastic from nonneoplastic lesions.
Collapse
|
|
39
|
Ullman TA. Chromoendoscopy should be the standard method and more widely used for cancer surveillance colonoscopy in ulcerative colitis--con. Inflamm Bowel Dis 2007; 13:1273-4; discussion 1275-6. [PMID: 17567865 DOI: 10.1002/ibd.20194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Thomas A Ullman
- Dr. Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, New York, New York 10029, USA.
| |
Collapse
|
|
40
|
Kiesslich R, Goetz M, Vieth M, Galle PR, Neurath MF. Technology insight: confocal laser endoscopy for in vivo diagnosis of colorectal cancer. ACTA ACUST UNITED AC 2007; 4:480-90. [PMID: 17657253 DOI: 10.1038/ncponc0881] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 04/16/2007] [Indexed: 01/07/2023]
Abstract
Recent studies on a novel technology, denoted confocal laser endomicroscopy (CLE), have altered thinking about the possibilities of endoscopy in the diagnosis and treatment of colorectal cancer. CLE is a new endoscopic tool that allows in vivo histology at subcellular resolution during ongoing endoscopy, and permits subsurface imaging of normal and neoplastic human mucosa. This new technique has unequivocal major implications for the diagnosis and clinical management of patients scheduled for screening or surveillance colonoscopy for colorectal cancer. For instance, CLE allows immediate diagnosis of colonic neoplasias, and the detection of neoplastic cells helps to target endoscopic intervention to relevant areas. Furthermore, the combination of chromoendoscopy with CLE significantly decreases the number of biopsies required for cancer surveillance in patients with ulcerative colitis, but provides a fourfold higher diagnostic yield compared with white-light endoscopy used with random biopsies. Taken together, CLE has led colorectal cancer endoscopy into a new era. CLE can no longer be regarded as just another endoscopic technique, but emerges as a crucial novel imaging technique for in vivo diagnosis of colorectal cancer.
Collapse
Affiliation(s)
- Ralf Kiesslich
- I Med. Klinik und Poliklinik, Johannes Gutenberg Universität Mainz, Mainz, Germany.
| | | | | | | | | |
Collapse
|
|
41
|
Thorlacius H, Toth E. Role of chromoendoscopy in colon cancer surveillance in inflammatory bowel disease. Inflamm Bowel Dis 2007; 13:911-917. [PMID: 17309075 DOI: 10.1002/ibd.20118] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Inflammation in the intestine is a well-known risk factor for neoplastic changes in the mucosa. In fact, it has been shown that long-standing ulcerative colitis and colonic Crohn's disease have a significantly increased risk for developing colorectal cancer, although the estimates vary widely between studies. Conventional colonoscopy is effective in detecting polypoid changes in the mucosa. However, it is now generally accepted that neoplastic changes in colitis are frequently flat and depressed, which are easily missed by use of routine colonoscopy. The introduction of chromoendoscopy, especially in combination with magnifying endoscopy, has greatly advanced our means to detect and differentiate neoplastic lesions in the colorectum. Accumulating evidence-based data indicate that implementation of chromoendoscopy into colon cancer surveillance protocols for patients with inflammatory bowel disease is effective. However, the introduction of chromoendoscopy into surveillance programs requires meticulous training and further studies to compare the value of chromoendoscopy to newer endoscopic devices and techniques, such as narrow band imaging.
Collapse
Affiliation(s)
- Henrik Thorlacius
- Department of Surgery, Malmö University Hospital, Lund University, Malmö, Sweden
| | | |
Collapse
|
|
42
|
Rubin DT, Rothe JA, Hetzel JT, Cohen RD, Hanauer SB. Are dysplasia and colorectal cancer endoscopically visible in patients with ulcerative colitis? Gastrointest Endosc 2007; 65:998-1004. [PMID: 17451704 DOI: 10.1016/j.gie.2006.09.025] [Citation(s) in RCA: 193] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 09/20/2006] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dysplasia and colorectal cancer (CRC) in ulcerative colitis (UC) develop via pathways distinct from sporadic CRC and may occur in flat mucosa indistinct from surrounding tissue. Surveillance guidelines, therefore, have emphasized the ;roach of periodic endoscopic examinations and systematic random biopsies of involved mucosa. Given the imperfect nature of this random approach, recent work has focused on improved surveillance techniques and suggests that neoplasia is endoscopically visible in many patients. OBJECTIVE To assess the endoscopic visibility of dysplasia and CRC in UC. DESIGN This was a retrospective review that used the University of Chicago Inflammatory Bowel Disease Registry and the clinical administrative database. All cases of dysplasia or CRC in UC between November 1994 and October 2004 were identified. The approach to surveillance in these patients included both random biopsies at approximately 10-cm intervals throughout the involved colon and directed biopsies of polypoid lesions, masses, strictures, or irregular mucosa distinct from surrounding inflamed tissue. Findings on endoscopy were compared with pathologic findings from biopsy or surgical specimens. Visible dysplasia was defined as a lesion reported by the endoscopist that led to directed biopsy and that was confirmed by pathology. Invisible dysplasia was defined as dysplasia diagnosed on pathology but not described on endoscopy. Per-lesion and per-patient sensitivities were determined. SETTING Tertiary referral center. PATIENTS Database of patients with inflammatory bowel disease seen at the University of Chicago. MAIN OUTCOME MEASUREMENTS Endoscopically visible neoplasia. RESULTS In this database, there were 1339 surveillance examinations in 622 patients with UC. Forty-six patients were found to have dysplasia or CRC at a median age of 48 years and with median duration of disease of 20 years. Of these patients, 77% had pancolitis, 21% had left-sided colitis, and 2% had proctitis. These patients had 128 surveillance examinations (median 3 per patient; range, 1-9 per patient), and, in 51 examinations, 75 separate dysplastic or cancerous lesions were identified (mean, 1.6 lesions per patient; standard deviation, 1.3). Thirty-eight of 65 dysplastic lesions (58.5%) and 8 of 10 cancers (80.0%) were visible to the endoscopist as 23 polyps and masses, 1 stricture, and 22 irregular mucosa. The per-patient sensitivities for dysplasia and for cancer were 71.8% and 100%, respectively. The overall per-lesion and per-patient sensitivities were 61.3% and 76.1%, respectively. LIMITATIONS Retrospective review of clinical databases and medical records. CONCLUSIONS Dysplasia and cancer in UC are endoscopically visible in most patients and may be reliably identified during scheduled examinations. Future surveillance guidelines should incorporate this information.
Collapse
Affiliation(s)
- David T Rubin
- The Reva and David Logan Gastrointestinal Clinical Research Center at the University of Chicago, Chicago, Illinois 60637, USA
| | | | | | | | | |
Collapse
|
|
43
|
Geboes K. Review article: what are the important endoscopic lesions for detection of dysplasia in inflammatory bowel disease? Aliment Pharmacol Ther 2006; 24 Suppl 3:50-5. [PMID: 16961746 DOI: 10.1111/j.1365-2036.2006.03061.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It is recognized that inflammatory bowel diseases predispose to colorectal adenocarcinoma. Early detection of precursor lesions and subsequent treatment may prevent cancer development and this is possible with colonoscopy and biopsy. Inflammatory bowel disease-associated precursor lesions (dysplasia = intraepithelial neoplasia) must be distinguished from sporadic adenomas, occurring in non-colitic mucosa. Macroscopic lesions suspected of harbouring precursor lesions include irregular 'polypoid or elevated' lesions, which are usually broad-based and 'flat' lesions. Flat lesions are more common than elevated lesions and they are usually smaller. Chromoendoscopy increases the detection rate substantially as it allows targeted biopsies from suspicious lesions that increase the diagnostic yield of dysplasia. Ultimately, the combination of chromoendoscopy, or more advanced endoscopic techniques, and targeted biopsies may become the standard approach, rather than random biopsy sampling.
Collapse
Affiliation(s)
- K Geboes
- Department of Pathology, University Hospital KU, Leuven, Belgium.
| |
Collapse
|
|
44
|
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: 14] [Impact Index Per Article: 0.7] [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.
Collapse
Affiliation(s)
- A Obrador
- Gastroenterology Department, Hospital Son Dureta, IUNICS Universitat de les Illes Balears, Palma, Mallorca, Spain.
| | | | | |
Collapse
|
|
45
|
Maykel JA, Hagerman G, Mellgren AF, Li SY, Alavi K, Baxter NN, Madoff RD. Crohn's colitis: the incidence of dysplasia and adenocarcinoma in surgical patients. Dis Colon Rectum 2006; 49:950-7. [PMID: 16729218 DOI: 10.1007/s10350-006-0555-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Data supporting an increased risk of colorectal cancer in patients with Crohn's colitis are inconsistent. Despite this, clinical recommendations regarding colonoscopic screening and surveillance for patients with Crohn's colitis are extrapolated from chronic ulcerative colitis protocols. The primary aim of our study was to determine the incidence of dysplasia and carcinoma in pathology specimens of patients undergoing segmental or total colectomy for Crohn's disease of the large bowel. In addition, we sought to identify risk factors associated with the development of dysplasia and carcinoma. METHODS We performed a retrospective review of all patients operated on at our institution for Crohn's colitis between January 1992 and May 2004. Data were retrieved from patient charts, operative notes, and pathology reports. Logistic regression was used to model the probability of having dysplasia or adenocarcinoma. RESULTS Two hundred twenty-two patients (138 females) who underwent surgical resection for the treatment of Crohn's colitis were included in the study. Mean age at surgery was 41 (range, 15-82) years and the mean duration of disease was 10 (range, 0-53) years. There were five cases of dysplasia (2.3 percent) and six cases of adenocarcinoma (2.7 percent). Three patients with dysplasia and one with adenocarcinoma were diagnosed on preoperative colonoscopy; while the other cases were discovered incidentally on pathologic examination of resected specimens. Factors associated with the presence of dysplasia or adenocarcinoma included older age at diagnosis (38.2 vs. 30.3 years, P = 0.02), longer disease duration (16.0 vs. 10.1 years, P = 0.05), and disease extent (90 percent extensive vs. 59 percent limited, P = 0.05). CONCLUSIONS Patients with severe Crohn's colitis requiring surgery are at significant risk for developing dysplasia and adenocarcinoma, particularly when diagnosed at an older age, after longer disease duration, and with more extensive colon involvement.
Collapse
Affiliation(s)
- Justin A Maykel
- Department of Surgery, Section of Colon and Rectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | | | | | | | | | | | | |
Collapse
|
|
46
|
Kiesslich R, Neurath MF. Magnifying chromoendoscopy for the detection of premalignant gastrointestinal lesions. Best Pract Res Clin Gastroenterol 2006; 20:59-78. [PMID: 16473801 DOI: 10.1016/j.bpg.2005.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The prognosis for patients with malignancies of the gastrointestinal tract is strictly dependent on the early detection of premalignant and malignant lesions. At present, endoscopy can be performed with new, powerful high-resolution or magnifying endoscopes. Comparable to the rapid development in chip technology, the optic features of the newly designed endoscopes offer resolutions that allow new mucosal surface details to be seen. In conjunction with chromoendoscopy, the newly discovered tool of video endoscopy is much easier to use and more impressive than previously used fibreoptic endoscopy. This review summarises the value of magnifying endoscopy in the upper and lower gastrointestinal tract and focuses on gastroesophageal reflux disease and early gastric and colorectal cancer.
Collapse
Affiliation(s)
- R Kiesslich
- I. Med. Klinik und Poliklinik, Johannes Gutenberg Universität Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
| | | |
Collapse
|
|
47
|
Abstract
Endomicroscopy becomes possible due to the integration of a miniaturized confocal microscope in the distal tip of a conventional endoscope. Endomicroscopy enables subsurface analysis of the gut mucosa and in vivo histology during ongoing endoscopy in full resolution by point scanning laser fluorescence analysis. Cellular, vascular and connective structures can be seen in detail. Graduation of cellular changes with endomicroscopy allows an immediate in-vivo diagnosis of different gastrointestinal diseases. The diagnostic spectrum of confocal endomicroscopy is currently expanding from screening and surveillance for colorectal cancer towards Barrett's esophagus, Helicobacter pylori associated gastritis and early gastric cancer. The new detailed images seen with confocal laser endomicroscopy are unequivocally the beginning of a new era where this optical development will allow a unique look on cellular structures and functions at and below the surface of the gut.
Collapse
Affiliation(s)
- R Kiesslich
- I. Medizinische Klinik, Johannes-Gutenberg-Universität, Langenbeckstrasse 1, 55131 Mainz.
| | | | | | | |
Collapse
|
|
48
|
Abstract
Early colorectal cancer can be treated with curative resection if the depth of invasion is limited to the submucosa (pathologic T category pT1 in the TNM classification). Macroscopically early colorectal cancer and its precursor lesions present as elevated polyps or non-polypoid flat lesions. Microscopically, precursor lesions are characterized by intraepithelial neoplasia and present as classic adenomas or serrated adenomas. Precursor lesions may already contain foci of early colorectal cancer. Early colorectal cancer can be treated by endoscopic resection. Careful handling of the specimen is required in order to optimally identify the factors that may predict an adverse outcome. Whenever a favourable tumour grade is found, without vascular invasion and tumour budding, there seems to be a low risk for adverse outcome and laparotomy may thus be avoided.
Collapse
Affiliation(s)
- Karel Geboes
- Department of Pathology, University Hospital, KULeuven, Minderbroedersstraat 12, 3000 Leuven, Belgium.
| | | | | |
Collapse
|
|
49
|
Abstract
The prognosis for patients with malignancies of the lower gastrointestinal tract is strictly dependent on early detection of premalignant and malignant lesions. What should an ideal screening and surveillance colonoscopy be able to accomplish? The technique should allow detection of large but also discrete mucosal alterations. Ideally, endoscopic discrimination between neoplastic and non-neoplastic lesions would be possible during the ongoing procedure. At present, endoscopy can be performed with powerful new endoscopes. Comparable to the rapid development in chip technology, the optical features of the newly designed endoscopes offer resolutions, which allow new surface details to be seen. In conjunction with chromoendoscopy, the newly discovered tool video colonoscopy is much easier and more impressive today than with the previously used fibre-optic endoscopes. Recently, new endoscopic technologies such as narrow band imaging, endocytoscopy, or confocal laser endoscopy have allowed the discovery of a whole new world of image details which will surely improve the diagnostic yield in the field of early malignancies. This review summarises newly available technologies and clinical data about the diagnosis of early lower gastrointestinal cancers.
Collapse
Affiliation(s)
- R Kiesslich
- I. Med. Klinik und Poliklinik, Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, Germany.
| | | |
Collapse
|
|
50
|
Kiesslich R, Goetz M, Vieth M, Galle PR, Neurath MF. Confocal laser endomicroscopy. Gastrointest Endosc Clin N Am 2005; 15:715-31. [PMID: 16278135 DOI: 10.1016/j.giec.2005.08.010] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A miniaturized confocal microscope was developed that could be integrated in the distal tip of a conventional colonoscope. With this technique, denoted confocal endomicroscopy, subsurface analysis of the gut mucosa and in-vivo histology during ongoing endoscopy are possible in full resolution by point scanning laser analysis. The diagnostic spectrum of confocal endomicroscopy is expanding from screening and surveillance for colorectal cancer to Barrett's esophagus, Helicobacter pylori-associated gastritis, and gastric cancer. The new detailed images seen with confocal laser endomicroscopy allow a unique look on cellular structures at and below the surface of the gut. This review describes the optical and diagnostic possibilities of confocal laser endomicroscopy.
Collapse
Affiliation(s)
- Ralf Kiesslich
- 1st Medical Clinic, Johannes Gutenberg University Mainz, Mainz, Germany.
| | | | | | | | | |
Collapse
|