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Aoyama N, Nakajo K, Sasabe M, Inaba A, Nakanishi Y, Seno H, Yano T. Effects of artificial intelligence assistance on endoscopist performance: Comparison of diagnostic performance in superficial esophageal squamous cell carcinoma detection using video-based models. DEN OPEN 2026; 6:e70083. [PMID: 40322543 PMCID: PMC12046500 DOI: 10.1002/deo2.70083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 01/16/2025] [Accepted: 02/06/2025] [Indexed: 05/08/2025]
Abstract
Objectives Superficial esophageal squamous cell carcinoma (ESCC) detection is crucial. Although narrow-band imaging improves detection, its effectiveness is diminished by inexperienced endoscopists. The effects of artificial intelligence (AI) assistance on ESCC detection by endoscopists remain unclear. Therefore, this study aimed to develop and validate an AI model for ESCC detection using endoscopic video analysis and evaluate diagnostic improvements. Methods Endoscopic videos with and without ESCC lesions were collected from May 2020 to January 2022. The AI model trained on annotated videos and 18 endoscopists (eight experts, 10 non-experts) evaluated their diagnostic performance. After 4 weeks, the endoscopists re-evaluated the test data with AI assistance. Sensitivity, specificity, and accuracy were compared between endoscopists with and without AI assistance. Results Training data comprised 280 cases (140 with and 140 without lesions), and test data, 115 cases (52 with and 63 without lesions). In the test data, the median lesion size was 14.5 mm (range: 1-100 mm), with pathological depths ranging from high-grade intraepithelial to submucosal neoplasia. The model's sensitivity, specificity, and accuracy were 76.0%, 79.4%, and 77.2%, respectively. With AI assistance, endoscopist sensitivity (57.4% vs. 66.5%) and accuracy (68.6% vs. 75.9%) improved significantly, while specificity increased slightly (87.0% vs. 91.6%). Experts demonstrated substantial improvements in sensitivity (59.1% vs. 70.0%) and accuracy (72.1% vs. 79.3%). Non-expert accuracy increased significantly (65.8% vs. 73.3%), with slight improvements in sensitivity (56.1% vs. 63.7%) and specificity (81.9% vs. 89.2%). Conclusions AI assistance enhances ESCC detection and improves endoscopists' diagnostic performance, regardless of experience.
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Affiliation(s)
- Naoki Aoyama
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
- Department of Gastroenterology and HepatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Keiichiro Nakajo
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
- NEXT Medical Device Innovation CenterNational Cancer Center Hospital EastChibaJapan
| | - Maasa Sasabe
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
- Division of EndoscopySaitama Cancer CenterSaitamaJapan
| | - Atsushi Inaba
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
| | - Yuki Nakanishi
- Department of Gastroenterology and HepatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Hiroshi Seno
- Department of Gastroenterology and HepatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Tomonori Yano
- Department of Gastroenterology and EndoscopyNational Cancer Center Hospital EastChibaJapan
- NEXT Medical Device Innovation CenterNational Cancer Center Hospital EastChibaJapan
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Lin J, Zhu S, Gao X, Liu X, Xu C, Xu Z, Zhu J. Evaluation of super resolution technology for digestive endoscopic images. Heliyon 2024; 10:e38920. [PMID: 39430485 PMCID: PMC11489312 DOI: 10.1016/j.heliyon.2024.e38920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 09/25/2024] [Accepted: 10/02/2024] [Indexed: 10/22/2024] Open
Abstract
Object This study aims to evaluate the value of super resolution (SR) technology in augmenting the quality of digestive endoscopic images. Methods In the retrospective study, we employed two advanced SR models, i.e., SwimIR and ESRGAN. Two discrete datasets were utilized, with training conducted using the dataset of the First Affiliated Hospital of Soochow University (12,212 high-resolution images) and evaluation conducted using the HyperKvasir dataset (2,566 low-resolution images). Furthermore, an assessment of the impact of enhanced low-resolution images was conducted using a 5-point Likert scale from the perspectives of endoscopists. Finally, two endoscopic image classification tasks were employed to evaluate the effect of SR technology on computer vision (CV). Results SwinIR demonstrated superior performance, which achieved a PSNR of 32.60, an SSIM of 0.90, and a VIF of 0.47 in test set. 90 % of endoscopists supported that SR preprocessing moderately ameliorated the readability of endoscopic images. For CV, enhanced images bolstered the performance of convolutional neural networks, whether in the classification task of Barrett's esophagus (improved F1-score: 0.04) or Mayo Endoscopy Score (improved F1-score: 0.04). Conclusions SR technology demonstrates the capacity to produce high-resolution endoscopic images. The approach enhanced clinical readability and CV models' performance of low-resolution endoscopic images.
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Affiliation(s)
- Jiaxi Lin
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, China
- Key Laboratory of Hepatoaplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shiqi Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, China
- Key Laboratory of Hepatoaplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Gao
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, China
- Key Laboratory of Hepatoaplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaolin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, China
- Key Laboratory of Hepatoaplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunfang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, China
| | - Zhonghua Xu
- Department of Orthopedics, Jintan Affiliated Hospital to Jiangsu University, Changzhou, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Suzhou Clinical Center of Digestive Diseases, Suzhou, China
- Key Laboratory of Hepatoaplenic Surgery, Ministry of Education, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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Duan CW, Zhai HH, Xie H, Ma XZ, Yu DL, Yang L, Wang X, Tang YF, Zhang J, Su H, Sheng JQ, Xu JF, Jin P. Standard-definition White-light, High-definition White-light versus Narrow-band Imaging Endoscopy for Detecting Colorectal Adenomas: A Multicenter Randomized Controlled Trial. Curr Med Sci 2024; 44:554-560. [PMID: 38842773 DOI: 10.1007/s11596-024-2882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/03/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE This study aimed to compare the performance of standard-definition white-light endoscopy (SD-WL), high-definition white-light endoscopy (HD-WL), and high-definition narrow-band imaging (HD-NBI) in detecting colorectal lesions in the Chinese population. METHODS This was a multicenter, single-blind, randomized, controlled trial with a non-inferiority design. Patients undergoing endoscopy for physical examination, screening, and surveillance were enrolled from July 2017 to December 2020. The primary outcome measure was the adenoma detection rate (ADR), defined as the proportion of patients with at least one adenoma detected. The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression. RESULTS Out of 653 eligible patients enrolled, data from 596 patients were analyzed. The ADRs were 34.5% in the SD-WL group, 33.5% in the HD-WL group, and 37.5% in the HD-NBI group (P=0.72). The advanced neoplasm detection rates (ANDRs) in the three arms were 17.1%, 15.5%, and 10.4% (P=0.17). No significant differences were found between the SD group and HD group regarding ADR or ANDR (ADR: 34.5% vs. 35.6%, P=0.79; ANDR: 17.1% vs. 13.0%, P=0.16, respectively). Similar results were observed between the HD-WL group and HD-NBI group (ADR: 33.5% vs. 37.7%, P=0.45; ANDR: 15.5% vs. 10.4%, P=0.18, respectively). In the univariate and multivariate logistic regression analyses, neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL (HD-WL: OR 0.91, P=0.69; HD-NBI: OR 1.15, P=0.80). CONCLUSION HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients. It can be concluded that HD-NBI or HD-WL is not superior to SD-WL, but more effective instruction may be needed to guide the selection of different endoscopic methods in the future. Our study's conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources, especially advanced imaging technologies.
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Affiliation(s)
- Chang-Wei Duan
- Chinese PLA General Hospital and Medical School, Beijing, 100853, China
| | - Hui-Hong Zhai
- Department of Gastroenterology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Hui Xie
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Xian-Zong Ma
- Chinese PLA General Hospital and Medical School, Beijing, 100853, China
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Dong-Liang Yu
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Lang Yang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xin Wang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Yu-Fen Tang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Jie Zhang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Hui Su
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China.
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Jun-Feng Xu
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
| | - Peng Jin
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700, China.
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
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Galati JS, Lin K, Gross SA. Recent advances in devices and technologies that might prove revolutionary for colonoscopy procedures. Expert Rev Med Devices 2023; 20:1087-1103. [PMID: 37934873 DOI: 10.1080/17434440.2023.2280773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) is the third most common malignancy and second leading cause of cancer-related mortality in the world. Adenoma detection rate (ADR), a quality indicator for colonoscopy, has gained prominence as it is inversely related to CRC incidence and mortality. As such, recent efforts have focused on developing novel colonoscopy devices and technologies to improve ADR. AREAS COVERED The main objective of this paper is to provide an overview of advancements in the fields of colonoscopy mechanical attachments, artificial intelligence-assisted colonoscopy, and colonoscopy optical enhancements with respect to ADR. We accomplished this by performing a comprehensive search of multiple electronic databases from inception to September 2023. This review is intended to be an introduction to colonoscopy devices and technologies. EXPERT OPINION Numerous mechanical attachments and optical enhancements have been developed that have the potential to improve ADR and AI has gone from being an inaccessible concept to a feasible means for improving ADR. While these advances are exciting and portend a change in what will be considered standard colonoscopy, they continue to require refinement. Future studies should focus on combining modalities to further improve ADR and exploring the use of these technologies in other facets of colonoscopy.
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Affiliation(s)
- Jonathan S Galati
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Kevin Lin
- Department of Internal Medicine, NYU Langone Health, New York, NY, USA
| | - Seth A Gross
- Division of Gastroenterology, NYU Langone Health, New York, NY, USA
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Moon SY, Lee JY, Lee JH. Comparison of adenoma detection rate between high-definition colonoscopes with different fields of view: 170 degrees versus 140 degrees. Medicine (Baltimore) 2023; 102:e32675. [PMID: 36637919 PMCID: PMC9839301 DOI: 10.1097/md.0000000000032675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/27/2022] [Indexed: 01/14/2023] Open
Abstract
In newer generation colonoscopes, the field of view (FOV) varies approximately between 170° and 140°, depending on the type of colonoscopy. To the best of our knowledge, no study has investigated whether the visual field difference of the colonoscope affects quality indicators, such as the adenoma detection rate (ADR), without using additional devices to expand the FOV in colonoscopes with the same resolution. This study aimed to investigate the difference in quality indicators, such as ADR, between 170° and 140° FOV in colonoscopes with the same high-definition resolution. We retrospectively analyzed the medical records of patients who underwent screening or surveillance colonoscopy at the Dong-A University Hospital in Busan, South Korea, between March 2021 and February 2022. We calculated the overall ADR ratios for patients who underwent colonoscopy with 140° and 170° FOV. Polyp detection rate (PDR), sessile serrated PDR, and advanced neoplasia detection rate were calculated for each group. Factors associated with adenoma detection were identified using a logistical regression analysis. A total of 1711 patients were included in the study (838 patients in the 170° group and 873 patients in the 140° group). ADR (43.79 vs 41.92%, P = .434) did not significantly differ between the 2 groups. The generational differences were not statistically significant either for PDR (56.44 vs 53.49%, P = .220), sessile serrated PDR (1.19 vs 0.92%, P = .575), or advanced neoplasia detection rate (5.00 vs 4.58%, P = .735). Multivariate regression analysis revealed that, age, male sex, and long withdrawal time were the most significant factors affecting adenoma detection. This study revealed that there were no differences in ADR while employing high definition colonoscopes with a 170° FOV and a 140° FOV.
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Affiliation(s)
- Sang Yi Moon
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Jong Yoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, South Korea
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Mazurek M, Murray A, Heitman SJ, Ruan Y, Antoniou SA, Boyne D, Murthy S, Baxter NN, Datta I, Shorr R, Ma C, Swain MG, Hilsden RJ, Brenner DR, Forbes N. Association Between Endoscopist Specialty and Colonoscopy Quality: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2022; 20:1931-1946. [PMID: 34450297 DOI: 10.1016/j.cgh.2021.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Colonoscopy quality indicators provide measurable assessments of performance, but significant provider-level variations exist. We performed a systematic review and meta-analysis to assess whether endoscopist specialty is associated with adenoma detection rate (ADR) - the primary outcome - or cecal intubation rate, adverse event rates, and post-colonoscopy colorectal cancer rates. METHODS We searched EMBASE, Google Scholar, MEDLINE, and the Cochrane Central Registry of Controlled Trials from inception to December 14, 2020. Two reviewers independently screened titles and abstracts. Citations underwent duplicate full-text review, with disagreements resolved by a third reviewer. Data were abstracted in duplicate. The DerSimonian and Laird random effects model was used to calculate pooled odds ratios (ORs) with respective 95% confidence intervals (CIs). Risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. RESULTS Of 11,314 citations, 36 studies representing 3,500,832 colonoscopies were included. Compared with colonoscopies performed by gastroenterologists, those by surgeons were associated with lower ADRs (OR, 0.81; 95% CI, 0.74-0.88) and lower cecal intubation rates (OR, 0.76; 95% CI, 0.63-0.92). Compared with colonoscopies performed by gastroenterologists, those by other (non-gastroenterologist, non-surgeon) endoscopists were associated with lower ADRs (OR, 0.91; 95% CI, 0.87-0.96), higher perforation rates (OR, 3.02; 95% CI, 1.65-5.51), and higher post-colonoscopy colorectal cancer rates (OR, 1.23; 95% CI, 1.14-1.33). Substantial to considerable heterogeneity existed for most analyses, and overall certainty in the evidence was low according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. CONCLUSION Colonoscopies performed by surgeons or other endoscopists were associated with poorer quality metrics and outcomes compared with those performed by gastroenterologists. Targeted quality improvement efforts may be warranted.
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Affiliation(s)
- Matthew Mazurek
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alistair Murray
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada
| | - Steven J Heitman
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
| | - Yibing Ruan
- Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stavros A Antoniou
- Surgical Service, Mediterranean Hospital of Cyprus, Limassol, Cyprus; Medical School, European University Cyprus, Nicosia, Cyprus
| | - Devon Boyne
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sanjay Murthy
- Division of Gastroenterology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nancy N Baxter
- St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Indraneel Datta
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Risa Shorr
- Learning Services, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Christopher Ma
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark G Swain
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada
| | - Robert J Hilsden
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada
| | - Darren R Brenner
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada; Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Alberta, Canada; Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nauzer Forbes
- Department of Medicine, Cumming School of Medicines, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Forzani & MacPhail Colon Cancer Screening Centre, University of Calgary, Calgary, Alberta, Canada.
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Li YC, Chen HX, Xu WT, Li CK, Qi XS. Factors affecting colorectal adenoma detection rate. Shijie Huaren Xiaohua Zazhi 2022; 30:450-457. [DOI: 10.11569/wcjd.v30.i10.450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ying-Chao Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Graduate School of Dalian Medical University, Dalian 116044, Liaoning Province, China
| | - Hong-Xin Chen
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Graduate School of Liaoning University of Traditional Chinese Medicine, Shenyang 110031, Liaoning Province, China
| | - Wen-Tao Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
| | - Cheng-Kun Li
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
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Spada C, Koulaouzidis A, Hassan C, Amaro P, Agrawal A, Brink L, Fischbach W, Hünger M, Jover R, Kinnunen U, Ono A, Patai Á, Pecere S, Petruzziello L, Riemann JF, Staines H, Stringer AL, Toth E, Antonelli G, Fuccio L, on behalf of the ECQI Group. Factors Associated with Polyp Detection Rate in European Colonoscopy Practice: Findings of The European Colonoscopy Quality Investigation (ECQI) Group. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3388. [PMID: 35329077 PMCID: PMC8954761 DOI: 10.3390/ijerph19063388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/07/2023]
Abstract
Background: The European Colonoscopy Quality Investigation (ECQI) Group aims to raise awareness for improvement in colonoscopy standards across Europe. We analysed data collected on a sample of procedures conducted across Europe to evaluate the achievement of the polyp detection rate (PDR) target. We also investigated factors associated with PDR, in the hope of establishing areas that could lead to a quality improvement. Methods: 6445 form completions from 12 countries between 2 June 2016 and 30 April 2018 were considered for this analysis. We performed an exploratory analysis looking at PDR according to European Society of Gastrointestinal Endoscopy (ESGE) definition. Stepwise multivariable logistic regression analysis was conducted to determine the most influential associated factors after adjusting for the other pre-specified variables. Results: In our sample there were 3365 screening and diagnostic procedures performed in those over 50 years. The PDR was 40.5%, which is comparable with the ESGE minimum standard of 40%. The variables found to be associated with PDR were in descending order: use of high-definition equipment, body mass index (BMI), patient gender, age group, and the reason for the procedure. Use of HD equipment was associated with a significant increase in the reporting of flat lesions (14.3% vs. 5.7%, p < 0.0001) and protruded lesions (34.7% vs. 25.4%, p < 0.0001). Conclusions: On average, the sample of European practice captured by the ECQI survey meets the minimum PDR standard set by the ESGE. Our findings support the ESGE recommendation for routine use of HD colonoscopy.
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Affiliation(s)
- Cristiano Spada
- Digestive Endoscopy Unit and Gastroenterology, Fondazione Poliambulanza, 25124 Brescia, Italy
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.P.); (L.P.)
| | - Anastasios Koulaouzidis
- Department of Medicine, OUH Svendborg Sygehus, 5700 Svendborg, Denmark;
- Department of Clinical Research, University of Southern Denmark (SDU), 5000 Odense, Denmark
- Surgical Research Unit, OUH, 5000 Odense, Denmark
- Department of Social Medicine and Public Health, Pomeranian Medical University, 70-204 Szczecin, Poland
| | - Cesare Hassan
- Endoscopy Unit, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy;
| | - Pedro Amaro
- Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Anurag Agrawal
- Gastroenterology, Doncaster Royal Infirmary, Doncaster DN2 5LT, UK;
| | - Lene Brink
- Gastro Unit, Division of Endoscopy, Herlev and Gentofte Hospital, Copenhagen University, 2730 Herlev, Denmark;
| | | | - Matthias Hünger
- Independent Researcher for Internal Medicine, 97070 Würzburg, Germany;
| | - Rodrigo Jover
- Instituto de Investigación Sanitaria ISABIAL—Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Urpo Kinnunen
- Department of Gastroenterology, Tampere University Hospital, 33521 Tampere, Finland;
| | - Akiko Ono
- Department of Gastroenterology, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Árpád Patai
- Department of Gastroenterology and Medicine, Markusovszky University Teaching Hospital, 9700 Szombathely, Hungary;
| | - Silvia Pecere
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.P.); (L.P.)
- Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (S.P.); (L.P.)
- Digestive Endoscopy Unit, Fondazione Policlinico Gemelli IRCCS, 00168 Rome, Italy
| | - Jürgen Ferdinand Riemann
- Department of Medicine C, Klinikum Ludwigshafen, 67063 Ludwigshafen, Germany;
- LebensBlicke Foundation, 67063 Ludwigshafen, Germany
| | - Harry Staines
- Sigma Statistical Services Ltd., Saint Andrews KY16 0BD, UK;
| | | | - Ervin Toth
- Department of Gastroenterology, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden;
| | - Giulio Antonelli
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, Sapienza University of Rome, 00185 Rome, Italy;
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli Hospital, 00040 Rome, Italy
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, 40138 Bologna, Italy;
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Lee JY, Kang YW, Koh M, Kim DK, Jang JS, Lee JH. The impact of face shields on the quality of gastrointestinal endoscopy during the COVID-19 pandemic. BMC Gastroenterol 2022; 22:38. [PMID: 35093022 PMCID: PMC8800408 DOI: 10.1186/s12876-022-02114-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/24/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has become a global pandemic, with healthcare workers at a high risk of exposure. During this pandemic, endoscopists must wear personal protective equipment (PPE), including face shields, to prevent COVID-19 transmission; however, few studies have reported the impact of face shields on the quality of gastrointestinal (GI) endoscopy. We aimed to determine whether the use of PPE, including face shields, affected the quality of GI endoscopy during the COVID-19 pandemic. Methods The medical records of patients who had undergone screening or surveillance colonoscopy and gastric endoscopic submucosal dissection (ESD) at Dong-A University Hospital between June 2020 and March 2021 were retrospectively reviewed. Endoscopists wore isolation gowns, disposable gloves, and KF94 masks from June 2020 to October 2020. From November 2020, endoscopists also wore face shields. We compared GI endoscopy quality indicators between the first five months (no face shields) and the second five months (with face shields). In the non-face shield and face shield groups, we calculated the overall adenoma detection rates (ADRs), polyp detection rate (PDR), sessile serrated lesion detection rate (SSLDR), advanced neoplasia detection rate (ANDR), complete resection rate (CRR), number of polyps and/or adenomas per colonoscopy, and gastric ESD procedure time. Results In total, 1359 study patients had undergone screening or surveillance colonoscopy (face shield group, n = 679; non-face shield group, n = 680). No statistically significant between-group differences were observed (PDR, 49.04 vs. 52.50%, p = 0.202; ADR, 38.59 vs. 38.97%, p = 0.884; SSPDR, 1.91 vs. 1.32%, p = 0.388; ANDR, 3.98 vs. 3.97%, p = 0.991, respectively). No difference was found in colonoscopy quality indicators between patients examined by experienced and trainee endoscopists with and without face shields. Of 144 study patients who had undergone gastric ESD for gastric neoplasms, there were 72 patients in each group. No statistically significant differences were found in the CRR (94.44 vs 93.05%, p = 1.000) and procedure times (19.22 ± 9.33 vs. 19.03 ± 11.49, p = 0.911). Conclusions Wearing face shields during the COVID-19 pandemic did not affect the quality indicators for GI endoscopy.
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Latest Generation High-Definition Colonoscopy Increases Adenoma Detection Rate by Trainee Endoscopists. Dig Dis Sci 2021; 66:2756-2762. [PMID: 32808142 DOI: 10.1007/s10620-020-06543-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adenoma detection rate (ADR) is an important quality indicator of colonoscopy. High-definition (HD) colonoscopy has been reported to increase ADR compared to standard-definition (SD) colonoscopy. Although there are few reports comparing the latest generation and the previous generation of HD colonoscopy equipment, there are reports that the latest generation colonoscopy equipment improves ADR. However, there are no reports on the impact of the latest generation HD colonoscopy on the ADR of trainee endoscopists. AIMS The aim of this study was to investigate whether the latest generation HD colonoscopy increases the ADR of trainee endoscopists compared with the previous generation HD colonoscopy. METHOD We conducted a retrospective review of medical records of patients aged 40-79 years old, who underwent screening or surveillance colonoscopy performed by nine gastroenterology fellows at Dong-A University Hospital from March 2019 to February 2020. We calculated the overall ratios of the ADR: the ADRs of the group using the older generation HD colonoscopy equipment and the group using the latest HD colonoscopy equipment. Polyp detection rate (PDR), sessile serrated polyp detection rate (SSPDR), and advanced neoplasia detection rate (ANDR) were calculated for each group. Factors related to adenoma detection were identified using logistic regression analysis. RESULTS Altogether, 2189 patients were included in the study (the older HD colonoscopy group comprising 1183 and the latest HD colonoscopy group comprising 1006). We found that PDR (45.98 vs. 51.69%, p = 0.008) and ADR (35.67 vs. 40.85%, p = 0.013) were significantly higher in the latest generation HD colonoscopy group. The generational differences were not statistically significant for SSPDR (1.94 vs. 2.78%, p = 0.195) or ANDR (4.65 vs. 4.97%, p = 0.726). In the multivariate regression analysis, age, male sex, the latest generation HD colonoscopy, and long withdrawal time were the most significant factors affecting adenoma detection. CONCLUSIONS The latest generation HD colonoscopy improved PDR and ADR by trainee endoscopists. These findings suggest that latest generation, higher-resolution colonoscopy equipment can improve the quality of colonoscopy for less experienced endoscopists.
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Abstract
INTRODUCTION Colonoscopy is an imperfect gold standard for detecting colorectal neoplasms because some proportion of adenomas may be missed, mainly small lesions. This proportion is expected to be higher in case of inadequate bowel cleansing, which is frequently seen in routine practice. We estimated the proportions of neoplasms that are in principle detectable by colonoscopy but might be missed in case of incomplete bowel preparation. METHODS For 8,193 participants of screening colonoscopy in South-Western Germany, recruited between 2005 and 2016, the prevalence and numbers of different findings were extracted from colonoscopy reports and compared according to the reported bowel preparation quality. RESULTS Bowel preparation quality was reported as good, poor, or was unspecified in 30.3%, 11.1%, and 58.6% of colonoscopy records. Reported prevalences of nonadvanced adenomas (NAAs) were similar among participants with poor and unspecified bowel preparation quality but substantially lower than among participants with good bowel preparation (adjusted prevalence rate ratio [RR] 0.86, 95% confidence interval [CI]: 0.77-0.96). The differences were observed for proximal but not for distal NAAs (RRs 0.82, 95% CI: 0.71-0.95 and 0.95, 95% CI: 0.82-1.10). DISCUSSION Our study suggests that a significant proportion of NAAs located in the proximal colon might be missed during colonoscopy if bowel cleansing is not adequate. Major efforts should be made to further facilitate and enhance high-quality bowel preparation in routine screening practice.
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Impact of Prepackaged Low-Residue Diet on Bowel Preparation for Colonoscopy: A Meta-analysis. Gastroenterol Nurs 2021; 44:E29-E37. [PMID: 33795626 DOI: 10.1097/sga.0000000000000588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/13/2021] [Indexed: 01/08/2023] Open
Abstract
This meta-analysis aimed to evaluate the impact of prepackaged low-residue diet (PLRD) on bowel preparation for colonoscopy. We searched PubMed, Web of Science, EMBASE, and Cochrane Library databases from inception to August 2020. Randomized controlled trials (RCTs) comparing PLRD with clear liquid diet (CLD) or self-prepared LRD were considered for inclusion. The analysis calculated the odds ratio (OR) for the rate of adequate bowel preparation, patient tolerance, willingness to repeat bowel preparation, tolerability of bowel preparation, and overall adverse effects. Five RCTs published between 2006 and 2019 (N = 561) were included in our meta-analysis. Compared with the traditional CLD or self-prepared LRD, PLRD showed significantly higher rates of adequate bowel preparation (OR, 2.16; 95% confidence interval [CI], 1.18-3.98; p = .01), patient tolerance (OR, 1.99; 95% CI, 1.30-3.07; p = .002), and willingness to repeat the bowel preparation (OR, 1.68; 95% CI, 1.05-2.70; p = .03), with no differences in adverse events (OR, 0.93; 95% CI, 0.59-1.46; p = .75). Prepackaged low-residue diet improved bowel preparation quality, patient tolerance, and willingness to repeat bowel preparations. Importantly, PLRD does not increase the incidence of adverse events. This suggests that it is effective and safe to use PLRD for bowel preparation before colonoscopy.
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Rezasoltani S, Hadizadeh M, Golmohammadi M, Nazemalhossini-Mojarad E, Salari S, Rezvani H, Asadzadeh-Aghdaei H, Ladomery M, Young C, Anaraki F, Almond S, Ashrafian Bonab M. APC and AXIN2 Are Promising Biomarker Candidates for the Early Detection of Adenomas and Hyperplastic Polyps. Cancer Inform 2020; 19:1176935120972383. [PMID: 33239858 PMCID: PMC7672736 DOI: 10.1177/1176935120972383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/19/2020] [Indexed: 01/05/2023] Open
Abstract
Aberrant activation of the WNT/CTNNB1 pathway is notorious in colorectal cancer (CRC). Here, we demonstrate that the expression of specific and crucial WNT signaling pathway genes is linked to disease progression in colonic adenomatous (AP) and hyperplastic (HP) polyps in an Iranian patient population. Thus, we highlight potential gene expression profiles as candidate novel biomarkers for the early detection of CRC. From a 12-month study (2016-2017), 44 biopsy samples were collected during colonoscopy from the patients with colorectal polyps and 10 healthy subjects for normalization. Clinical and demographic data were collected in all cases, and mRNA expression of APC, CTNNB1, CDH1, AXIN1, and AXIN2 genes was investigated using real-time polymerase chain reaction (PCR). CTNNB1 and CDH1 expression levels were unaltered in AP and HP subjects, whereas mRNA expression of APC was decreased in AP contrasted with HP subjects, with a significant association between APC downregulation and polyp size. Although AXIN1 showed no changes between AP and HP groups, a significant association between AXIN1 and dysplasia grade was found. Also, significant upregulation of AXIN2 in both AP and HP subjects was detected. In summary, we have shown increased expression of AXIN2 and decreased expression of APC correlating with grade of dysplasia and polyp size. Hence, AXIN2 and APC should be explored as biomarker candidates for early detection of AP and HP polyps in CRC.
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Affiliation(s)
- Sama Rezasoltani
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mina Golmohammadi
- Gastroenterology and Liver Diseases Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ehsan Nazemalhossini-Mojarad
- Gastroenterology and Liver Diseases Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Salari
- Department of Medical Oncology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Rezvani
- Department of Medical Oncology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh-Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Centre, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael Ladomery
- Department of Applied Sciences, University of the West of England (UWE-Bristol), Bristol, UK
| | - Chris Young
- Leicester School of Allied Health Sciences, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Fakhrosadat Anaraki
- Colorectal Division of Department of Surgery, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sarah Almond
- Department of Applied Sciences, University of the West of England (UWE-Bristol), Bristol, UK
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Wang S, Kim AS, Church TR, Perdue DG, Shaukat A. Adenomas per colonoscopy and adenoma per positive participant as quality indicators for screening colonoscopy. Endosc Int Open 2020; 8:E1560-E1565. [PMID: 33140011 PMCID: PMC7581461 DOI: 10.1055/a-1261-9074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/30/2020] [Indexed: 12/09/2022] Open
Abstract
Background and study aims Adenomas per colonoscopy (APC) and adenomas per positive patient (APP) have been proposed as additional quality indicators but their association with adenoma detection rate (ADR) is not well studied. The aim of our study was to evaluate the variability in APC and APP, their association with ADR, and associated risk factors in screening colonoscopies from a community practice. Patients and methods We calculated the APC, APP, and ADR from all screening colonoscopies performed over 5 years. We used adjusted hierarchical logistic regression to assess the association of factors with APC, APP, and ADR. Results There were 80,915 screening colonoscopies by 60 gastroenterologists. The median (Q1-Q3) APC, APP, and ADR were 0.41 (0.36 - 0.53), 1.33 (1.23 - 1.40), and 0.32 (0.28 - 0.38), respectively. Despite the high correlation between APC and ADR, 47.6 % of endoscopists with the lowest APC had a higher ADR, and no endoscopists with the highest APC had a lower ADR. Of endoscopists with the lowest APP, 74.3 % had a higher ADR and 5.6 % of endoscopists with the highest APP had a lower ADR. Factors associated with higher APC after multivariable adjustment included: older patients age (OR 1.003; 95 % CI 1.002 - 1.005), male patients (OR 1.123; 95 % CI 1.090 - 1.156), younger endoscopist age (OR 0.943; 95 % CI 0.941 - 0.945), and longer withdrawal time (OR 3.434; 95 % CI 2.941 - 4.010). Factors associated with higher APP were male sex, younger endoscopist age, and longer withdrawal time. Conclusion APC and APP provides additional information about endoscopist performance. Younger endoscopist age and longer withdrawal time are associated with colonoscopy quality.
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Affiliation(s)
- Shuo Wang
- Division of Epidemiology & Community Health, School of Public health, University of Minnesota, Minneapolis, Minnesota, United States
| | - Adam S. Kim
- Minnesota Gastroenterology PA – GI, Minneapolis, Minnesota, United States
| | - Timothy R. Church
- Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States
| | - David G. Perdue
- Minnesota Gastroenterology PA – GI, Minneapolis, Minnesota, United States
| | - Aasma Shaukat
- Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States,Department of Medicine, School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States,Division of Gastroenterology, Minneapolis VA Medical Center, Minneapolis, Minnesota, United States
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Choi YI, Lee JJ, Chung JW, Kim KO, Kim YJ, Kim JH, Park DK, Kwon KA. Efficacy and Patient Tolerability Profiles of Probiotic Solution with Bisacodyl Versus Conventional Cleansing Solution for Bowel Preparation: A Prospective, Randomized, Controlled Trial. J Clin Med 2020; 9:jcm9103286. [PMID: 33066237 PMCID: PMC7602042 DOI: 10.3390/jcm9103286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/02/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022] Open
Abstract
Although adequate bowel preparation is essential in screening colonoscopy, patient intolerability to bowel cleansing agents is problematic. Recently, a probiotic mixture solution with bisacodyl emerged to improve patient tolerability. We investigated the efficacy, safety, and patient tolerability profiles of probiotics with bisacodyl versus conventional polyethylene glycol (PEG) solution for bowel preparation for screening colonoscopies in healthy patients in this prospective, randomized, case-control study. In total, 385 volunteers were randomly assigned to receive 2 L of water + 200 mL of probiotic solution (case group, n = 195) or 4 L of PEG solution (control group, n = 190). The efficacy of the bowel cleansing was evaluated using the Ottawa scale system, polyp detection rate, and adenoma detection rate, and the patient tolerability profiles were assessed using a questionnaire. The demographics were not significantly different between groups. When the Ottawa score for each bowel segment was stratified into an adequate vs. inadequate level (Ottawa score ≤ 3 vs. >3), there were no statistical differences between groups in each segment of the colon. There were no significant differences in the polyp and adenoma detection rates between groups (38.42% vs. 32.42, p = 0.30; 25.79% vs. 18.97%, p = 0.11). The case group showed significantly fewer events than the control group, especially nausea, vomiting, and abdominal bloating events. Regarding the overall satisfaction grade, the case group reported significantly more “average” scores (95% vs. 44%, p < 0.001) and were more willing to use the same agents again (90.26% vs. 61.85%, p < 0.001). As patient compliance with bowel preparation agents is associated with an adequate level of bowel cleansing, a probiotic solution with bisacodyl might be a new bowel preparation candidate, especially in patients who show a poor compliance with conventional bowel preparation agents.
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Affiliation(s)
| | | | | | | | | | | | | | - Kwang An Kwon
- Correspondence: ; Tel.: +82-32-460-3778; Fax: +82-32-460-3408
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Michopoulos S, Axiaris G, Baxevanis P, Stoupaki M, Gkagkari V, Leonidakis G, Zampeli E, Sotiropoulou M, Petraki K. Retroflexion, a costless endoscopic maneuver, increases adenoma detection rate in the ascending colon. Ann Gastroenterol 2020; 34:53-60. [PMID: 33414622 PMCID: PMC7774652 DOI: 10.20524/aog.2020.0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022] Open
Abstract
Background Missed polyps during colonoscopy are considered an important factor for interval cancer appearance, especially in the ascending colon (AC). We evaluated the contribution of retroflexion to polyp and adenoma detection in the AC. Methods This prospective observational study included consecutive patients who underwent a complete colonoscopy between 06/2017 and 06/2018. The AC was examined in 2 phases: the first included 2 forward views from the hepatic flexure to the cecum; the second involved a retroflexion in the cecum, inspection up to the hepatic flexure and reinsertion to the cecum. Results The study included 655 patients, 628 (95.88%) with successful retroflexion (mean age: 62.5±10.8 years, 332 male). Indications for colonoscopy were screening in 33.28%, follow up in 36.03%, and diagnostic assessment in 30.69%. In total, 286 polyps and 220 adenomas were detected in the AC. Phase 1 identified 119 adenomas, yielding an adenoma detection rate (ADR) in the AC of 14.2% (95% confidence interval [CI] 11.52-16.84%) while phase 2 identified 86 additional adenomas, improving the ADR in the AC to 22.75% (95%CI 19.54-25.96%; P<0.01). Adenoma miss rate was 39.1% (86/225) and per-patient adenoma miss rate was 11.15% (73/655). Retroflexion proved beneficial mainly in the upper third of the AC (odds ratio [OR] 4.29, 95%CI 1.84-11.56; P<0.01) and for small (<5 mm) adenomas (OR 1.61, 95%CI 1.02-2.56; P=0.04). Multivariate analysis showed that age >60 years, detection of adenomas in forward views and the indication “follow up” influenced ADR during retroflexion. Conclusion Retroflexion is a simple and safe maneuver that increases the ADR in the AC and should complete a second forward view.
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Affiliation(s)
- Spyridon Michopoulos
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | - Georgios Axiaris
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | - Panagiotis Baxevanis
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | - Maria Stoupaki
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | - Vassiliki Gkagkari
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | - Georgios Leonidakis
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | - Evanthia Zampeli
- Gastroenterology Department, "Alexandra" Hospital, Athens (Spyridon Michopoulos, Georgios Axiaris, Panagiotis Baxevanis, Maria Stoupaki, Vassiliki Gkagkari, Georgios Leoniakis, Evanthia Zampeli)
| | | | - Kalliopi Petraki
- Pathology Department, "Metropolitan" Hospital, P. Faliro (Kalliopi Petraki), Greece
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Liu A, Wang H, Lin Y, Fu L, Liu Y, Yan S, Chen H. Gastrointestinal endoscopy nurse assistance during colonoscopy and polyp detection: A PRISMA-compliant meta-analysis of randomized control trials. Medicine (Baltimore) 2020; 99:e21278. [PMID: 32846754 PMCID: PMC7447493 DOI: 10.1097/md.0000000000021278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Previous studies showed difference results about the effect of nurse in improvement of the colonoscopy detection rate. This meta-analysis aims to investigate whether nurse participation during colonoscopy can help in improving the detection rate of polyps and adenomas. METHODS Original studies in English were searched from the MEDLINE database, PubMed, Web of Science, and the Cochrane Library database. Randomized control trials (RCT) comparing colonoscopy with and without nurse participation for the detection of colorectal polyps and adenomas were identified. A meta-analysis was performed using Revman 5.3 software. RESULTS A total of 2268 patients from 4 RCTs were included in this meta-analysis. Outcomes of colonoscopy with nurse participation were compared with those of colonoscopy without nurse participation. The results showed that nurses' participation during colonoscopy could significantly increase both, polyp detection rate and adenoma detection rate. CONCLUSION Nurse assistance during colonoscopy can help improve the rate of detection of polyps and adenomas.
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Affiliation(s)
- Aihong Liu
- Department of Gastrointestinal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Huashe Wang
- Department of Gastrointestinal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Yijia Lin
- Department of Gastrointestinal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Liping Fu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University. Guangzhou
| | - Yanan Liu
- Department of Gastrointestinal Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University. Guangzhou
| | - Shuhong Yan
- Department of Gastrointestinal Surgery, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou
| | - Honglei Chen
- Gastrointestinal Endoscopy Center, The Eighth Affiliated Hospital, Sun Yat-sen University. Shenzhen, Guangdong, P.R. China
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Shandro BM, Emrith K, Slabaugh G, Poullis A, Smith ML. Optical imaging technology in colonoscopy: Is there a role for photometric stereo? World J Gastrointest Endosc 2020; 12:138-148. [PMID: 32477448 PMCID: PMC7243575 DOI: 10.4253/wjge.v12.i5.138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer. However, up to a third of adenomas may be missed at colonoscopy, and the majority of post-colonoscopy colorectal cancers are thought to arise from these. Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa. However, these topographic features are not enhanced by white light colonoscopy, and the endoscopist must infer these from two-dimensional cues. This may contribute to the number of missed lesions. A variety of optical imaging technologies have been developed commercially to enhance surface topography. However, existing techniques enhance surface topography indirectly, and in two dimensions, and the evidence does not wholly support their use in routine clinical practice. In this narrative review, co-authored by gastroenterologists and engineers, we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate, and review the development of photometric stereo (PS) for colonoscopy. PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography. This imaging technique has several potential clinical applications in colonoscopy, including adenoma detection, polyp classification, and facilitating polypectomy, an inherently three-dimensional task. However, the development of PS for colonoscopy is at an early stage. We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.
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Affiliation(s)
- Benjamin M Shandro
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Khemraj Emrith
- Centre for Machine Vision, University of the West of England, Bristol BS16 1QY, United Kingdom
| | - Gregory Slabaugh
- Department of Computer Science, City, University of London, London EC1V 0HB, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Melvyn L Smith
- Centre for Machine Vision, University of the West of England, Bristol BS16 1QY, United Kingdom
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Tziatzios G, Gkolfakis P, Lazaridis LD, Facciorusso A, Antonelli G, Hassan C, Repici A, Sharma P, Rex DK, Triantafyllou K. High-definition colonoscopy for improving adenoma detection: a systematic review and meta-analysis of randomized controlled studies. Gastrointest Endosc 2020; 91:1027-1036.e9. [PMID: 31954133 DOI: 10.1016/j.gie.2019.12.052] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Previous meta-analysis showed marginal benefit of high-definition white-light endoscopy (HD-WLE) over standard-definition colonoscopy (SDC) for adenoma detection, but with residual uncertainty due to inclusion of nonrandomized studies. We aimed to further assess the effect of HD-WLE on adenoma detection by including only randomized controlled trials (RCTs). METHODS A literature search was performed for RCTs evaluating HD-WLE versus SDC in terms of adenoma, advanced adenoma, and serrated sessile adenoma detection rates as well as the mean number of adenomas per colonoscopy (MAC), the mean number of advanced adenomas per colonoscopy (MAAC), and the mean number of sessile serrated adenomas per colonoscopy (MSSAC). The effect size on study outcomes is presented as the risk ratio (RR; 95% confidence interval [CI]) or mean difference (MD; 95% CI). We assessed the strength of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Six RCTs involving 4594 individuals (HD-WLE, 2323; SDC, 2271) were included. Clinical indications were screening (1 study), positive result for fecal occult blood test, personal/family history of colorectal cancer (1 study), and mixed indications (4 studies). Withdrawal time was similar between the 2 arms (MD, -0.06; 95% CI, -0.25 to 0.12; P = .50). The adenoma detection rate was significantly higher in the HD-WLE arm compared with the SDC arm (40% vs 35%; RR, 1.13; 95% CI, 1.05-1.22; P = .001; I2 = 0%; GRADE, low). This effect was consistent for advanced and sessile serrated adenoma detection rates (RR, 1.33; 95% CI, 1.03-1.72; P = .03; I2 = 0%; GRADE, low; and RR, 1.55; 95% CI, 1.05-2.28; P = .03; I2 = 0%; GRADE, low, respectively). In contrast, the difference was not significant for MAC, MAAC, and MSSAC. CONCLUSIONS Meta-analyses of RCT data support the use of HD-WLE in clinical practice, although the additional benefit is limited.
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Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Lazaros Dimitrios Lazaridis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia AOU, Ospedali Riunity Viale Pinto, Foggia, Italy
| | - Giulio Antonelli
- Endoscopy Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano, Italy
| | - Prateek Sharma
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas, Missouri; Department of Gastroenterology, Veteran Affairs Medical Center, Kansas, Missouri
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, USA
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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Cap-Assisted Chromo-Colonoscopy: Are 2 Techniques Better Than None? Am J Gastroenterol 2020; 115:365-366. [PMID: 32142483 DOI: 10.14309/ajg.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cap-assisted and chromo-colonoscopy are 2 techniques which may increase adenoma detection; however, chromo-colonoscopy is limited by increased time requirement. In this edition of The American Journal of Gastroenterology, Kim et al. present data from a randomized controlled trial comparing standard colonoscopy with an arm using both techniques (CAP/CHROMO). The indigo carmine was applied using a simpler method than previous studies, resulting in shorter times. The CAP/CHROMO adenoma detection was higher than the controls (54.4% vs 44.9%; P < 0.001), but there was no difference for advanced neoplasia. If endoscopists find these data convincing, they should trial these techniques separately because each technique may have a different impact.
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Kim H, Goong HJ, Ko BM, Myung YS, Ho Jung Y, Jeon SR, Kim HG, Lee MS. Randomized, back-to-back trial of a new generation NBI with a high-definition white light (HQ290) for detecting colorectal polyps. Scand J Gastroenterol 2019; 54:1058-1063. [PMID: 31430183 DOI: 10.1080/00365521.2019.1650953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The benefits of narrow band imaging (NBI) for improving the detection rate of colorectal polyps remain unclear. New generation NBI using the 290 system (290-NBI) provides an at least two-fold brighter image than that of the previous version. We aimed to compare polyp miss rates between 290-NBI colonoscopy and high-definition white light endoscopy (HDWL). Methods: In total, 117 patients were randomized to undergo either 290-NBI or HDWL from June 2015 to February 2017. In the HDWL group, we performed HDWL as an initial inspection, followed by a second inspection with NBI. In the 290-NBI group, NBI was performed as the initial inspection, followed by a second inspection with HDWL. We compared polyp and adenoma detection rates and polyp miss rates (PMR) between the two groups and analyzed the factors associated with the PMR. Results: In total, 127 polyps were detected in the 117 patients. No differences in adenoma or polyp detection rates were observed between the two groups. The PMR for 290-NBI was 20.6% and that for HDWL was 33.9% (p = .068). However, the non-adenomatous PMR for 290-NBI was significantly lower than that of HDWL (11.5% vs. 52.2%, p = .002). Furthermore, the miss rates of polyps on the left side of the colon, flat-type polyps, and non-adenomatous polyps were significantly lower in the 290-NBI than HDWL. Conclusions: New generation NBI may reduce PMR, especially of flat-type and non-adenomatous polyps and those on the left side of the colon. (UMIN000025505).
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Affiliation(s)
- Haewon Kim
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Hyeon Jeong Goong
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Bong Min Ko
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Yu Sik Myung
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Yun Ho Jung
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Seong Ran Jeon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
| | - Moon Sung Lee
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine , Bucheon , Korea
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Pioche M, Denis A, Allescher HD, Andrisani G, Costamagna G, Dekker E, Fockens P, Gerges C, Groth S, Kandler J, Lienhart I, Neuhaus H, Petruzziello L, Schachschal G, Tytgat K, Wallner J, Weingart V, Touzet S, Ponchon T, Rösch T. Impact of 2 generational improvements in colonoscopes on adenoma miss rates: results of a prospective randomized multicenter tandem study. Gastrointest Endosc 2018; 88:107-116. [PMID: 29410020 DOI: 10.1016/j.gie.2018.01.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/18/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Numerous randomized studies have shown that changing certain features of colonoscopes, usually incorporated when switching from one endoscope generation to the next, mostly do not increase adenoma yield. There is, however, indirect evidence that it may be necessary to skip one instrument generation (ie, changing from one generation to the next but one) to achieve this effect. METHODS We compared the latest-generation colonoscopes from one company (Olympus Exera III, 190-C) with the next to last one (Olympus 160/5-C) in a prospective multicenter study randomized for the order of colonoscopes in a tandem fashion, involving 2 different examiners. Patients with increased risk for colorectal neoplasia undergoing colonoscopy (positive fecal occult blood test, personal/familial history of colorectal cancer/adenoma, rectal bleeding, recent change in bowel movements) were included. The primary outcome was the adenoma miss rate with the 190 (190-C) colonoscope in comparison with the 160/5 colonoscope (160/5-C). RESULTS A total of 856 patients (48.8% male; mean age, 58.3 years) with a personal (41%) or family (38%) history of colorectal neoplasia, rectal bleeding (19%), and other indications were included. Of the 429 patients in the 190-C first group, 16.6% (95% confidence interval [CI], 13.0%-20.1%) had at least one adenoma missed during the first procedure, compared with 30.2% (95% CI, 25.9%-34.6%) in the group with 160/5-C first (P < .001). Similarly, the adenoma detection rate during the first colonoscopy was 43.8% versus 36.5% (P = .030) for 190-C versus 160/5-C, respectively. CONCLUSIONS This randomized tandem trial showed lower adenoma miss rates and higher adenoma detection rates for the newer 190 colonoscopes compared with the 160/5 series. These results suggest that it takes multiple improvements, such as those implemented over 2 instrument generations, before an effect on adenoma (miss) rate can be observed. (Study registration number: ISRCTN 2010-A01256-33.).
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Affiliation(s)
- Mathieu Pioche
- Gastroenterology and Endoscopy Division, Hôpital Edouard Herriot, Lyon, France
| | - Angélique Denis
- Hospices Civils de Lyon, Pôle Information médicale Evaluation Recherche, Lyon, France; Université de Lyon, Laboratoire Health Services and Performance Research (HESPER) Lyon, France
| | - Hans-Dieter Allescher
- Department of Medicine, Klinikum Garmisch-Partenkirchen, Academic Teaching Hospital of the LMU Munich, Garmisch-Partenkirchen, Germany
| | | | | | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Christian Gerges
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Germany
| | - Stefan Groth
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jennis Kandler
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Germany
| | - Isabelle Lienhart
- Gastroenterology and Endoscopy Division, Hôpital Edouard Herriot, Lyon, France
| | - Horst Neuhaus
- Department of Gastroenterology, Evangelisches Krankenhaus, Dusseldorf, Germany
| | | | - Guido Schachschal
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kristien Tytgat
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, Netherlands
| | - Jürgen Wallner
- Department of Medicine, Klinikum Garmisch-Partenkirchen, Academic Teaching Hospital of the LMU Munich, Garmisch-Partenkirchen, Germany
| | - Vincens Weingart
- Department of Medicine, Klinikum Garmisch-Partenkirchen, Academic Teaching Hospital of the LMU Munich, Garmisch-Partenkirchen, Germany
| | - Sandrine Touzet
- Hospices Civils de Lyon, Pôle Information médicale Evaluation Recherche, Lyon, France; Université de Lyon, Laboratoire Health Services and Performance Research (HESPER) Lyon, France
| | - Thierry Ponchon
- Gastroenterology and Endoscopy Division, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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23
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Perrod G, Samaha E, Rahmi G, Khater S, Abbes L, Savale C, Perkins G, Zaanan A, Chatellier G, Malamut G, Cellier C. Impact of an optimized colonoscopic screening program for patients with Lynch syndrome: 6-year results of a specialized French network. Therap Adv Gastroenterol 2018; 11:1756284818775058. [PMID: 29872454 PMCID: PMC5974573 DOI: 10.1177/1756284818775058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/03/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite colonoscopic screening, colorectal cancer (CRC) remains frequent in patients with Lynch syndrome (LS). The objective of this study was to evaluate the impact of an optimized colorectal screening program within a French dedicated network. METHODS All LS patients followed at our institution were consecutively included in the Prédisposition au Cancer Colorectal-Ile de France (PRED-IdF) network. Patients were offered an optimized screening program allowing an adjustment of the interval between colonoscopies, depending on bowel preparation, chromoendoscopy achievement and adenoma detection. Colonoscopies were defined as optimal when all the screening criteria were respected. We compared colonoscopy quality and colonoscopy detection rate before and after PRED-IdF inclusion, including polyp detection rate (PDR), adenoma detection rate (ADR) and cancer detection rate (CDR). RESULTS Between January 2010 and January 2016, 144 LS patients were consecutively included (male/female = 50/94, mean age = 51 ± 13 years and mutations: MLH1 = 39%, MSH2 = 44%, MSH6 = 15%, PMS2 = 1%). A total of 564 colonoscopies were analyzed, 353 after inclusion and 211 before. After PRED-IdF inclusion, 98/144 (68%) patients had optimal screening colonoscopies versus 33/132 (25%) before (p < 0.0005). The optimal colonoscopy rate was 304/353 (86%) after inclusion versus 87/211 (41%) before, (p < 0.0001). PRED-IdF inclusion was associated with a reduction of CRC occurrence with a CDR of 1/353 (0.3%) after inclusion versus 6/211 (2.8%) before (p = 0.012). ADR and PDR were 99/353 (28%) versus 60/211 (28.8%) (p > 0.05) and 167/353 (48.1%) versus 90/211 (42.2%) (p > 0.05), respectively after and before inclusion. CONCLUSIONS An optimized colonoscopic surveillance program in LS patients seems to improve colonoscopic screening quality and might possibly decrease colorectal interval cancer occurrence. Long-term cohort studies are needed to confirm these results.
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Affiliation(s)
| | - Elia Samaha
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Gabriel Rahmi
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Sherine Khater
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Leila Abbes
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Camille Savale
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France
| | - Geraldine Perkins
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’oncologie digestive, Paris, France
| | - Aziz Zaanan
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’oncologie digestive, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Gilles Chatellier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Unité d’Epidémiologie et de Recherche Clinique, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Georgia Malamut
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France,Faculté de médecine René Descartes, Paris, France
| | - Christophe Cellier
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Service d’hépato-gastro-entérologie et d’endoscopie, Paris, France,Faculté de médecine René Descartes, Paris, France
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Abstract
BACKGROUND Adenoma detection rate (ADR) is defined as the number of colonoscopies with at least one adenoma, expressed as the ratio of the total number of colonoscopies performed. Recently, an application of a conversion factor to estimate the ADR from the polyp detection rate (PDR) was described. AIM In this meta-analysis, we examined the correlation between ADR and PDR in the published studies and assessed the relative ratio of these ratios for a better and more accurate estimation. METHODS English Medical literature searches were performed for 'PDR' AND 'ADR'. A meta-analysis was carried out for papers that fulfilled the inclusion criteria using comprehensive meta-analysis software. RESULTS Twenty-five studies and 42 sets of data, including 31 623 patients, from nine countries published till 31 August 2017, were found. Funnel plot did not indicate a significant publication bias. relative ratio for ADR calculated from PDR was 0.688, 95% confidence intervals: 0.680-0.695, P value of less than 0.0001 in the meta-analysis fixed model. Heterogeneity (the proportion of inconsistency in individual studies) between studies was significant, with Q=492.753, d.f. (Q) 41, P<0.0001, and I 91.679. CONCLUSION We found the ratio of 0.688 can be used to calculate ADR from PDR for the individual endoscopist or for a group of endoscopists before receiving the formal results from the pathology department.
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Affiliation(s)
- Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ngu WS, Rees C. Can technology increase adenoma detection rate? Therap Adv Gastroenterol 2018; 11:1756283X17746311. [PMID: 29383029 PMCID: PMC5784538 DOI: 10.1177/1756283x17746311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/16/2017] [Indexed: 02/04/2023] Open
Abstract
Colorectal cancer is the third most common cancer worldwide and the second most common cause of cancer-related death in Europe and North America. Colonoscopy is the gold standard investigation for the colon but is not perfect, and small or flat adenomas can be missed which increases the risk of patients subsequently developing colorectal cancer. Adenoma detection rate is the most widely used marker of quality, and low rates are associated with increased rates of post-colonoscopy colorectal cancer. Standards of colonoscopy and adenoma detection vary widely between different endoscopists. Interventions to improve adenoma detection rate are therefore required. Many devices have been purported to increase adenoma detection rate. This review looks at current available evidence for device technology to improve adenoma detection rate during colonoscopy.
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Affiliation(s)
- Wee Sing Ngu
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, UK
| | - Colin Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Shields, NE34 0PL, UK
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