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Hagen R, Srivastava A, Anderson JC. The serrated pathway and colorectal cancer: what the gastroenterologist should know. Expert Rev Gastroenterol Hepatol 2025; 19:593-606. [PMID: 40409278 DOI: 10.1080/17474124.2025.2509797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2025] [Revised: 04/28/2025] [Accepted: 05/19/2025] [Indexed: 05/25/2025]
Abstract
INTRODUCTION Serrated polyps can progress to colorectal cancer (CRC), through a pathway that is distinct from the conventional adenoma-carcinoma sequence. This pathway includes hyperplastic polyps (HPs), sessile serrated polyps (SSPs), and traditional serrated adenomas (TSAs). AREAS COVERED Our review includes the histology and pathological challenges, carcinogenesis, risk factors, detection, emerging technologies, resection, and surveillance. EXPERT OPINION Serrated polyp management presents many detection, diagnosis, resection, and surveillance challenges. Missed serrated polyps contribute to preventable CRCs. A new SSP detection rate benchmark will guide endoscopists with a goal when improving detection. Furthermore, new SSP-specific surveillance strategies may also aid in reducing CRC burden. Histologic differentiation remains a challenge, underscoring the need for standardized pathology practices and exploring novel ways to stratify risk independent of histology, given interobserver variation. Moreover, the clinical significance of proximal HPs requires further clarification. Which HPs < 1 cm require closer surveillance intervals? Molecular profiling may help identify markers that separate proximal low risk from high-risk HP. The best approach for resection of serrated polyps also needs to be clarified. There is also a lack of robust longitudinal outcome data to guide surveillance recommendations since current guidelines are based on low quality of evidence.
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Affiliation(s)
- Rachael Hagen
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Amitabh Srivastava
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joseph C Anderson
- Department of Medicine, University of Connecticut, Farmington, CT, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, White River Junction VAMC, White River Junction, VT, USA
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Dell’Anna G, Mandarino F, Centanni L, Lodola I, Fanizza J, Fasulo E, Bencardino S, Fuccio L, Facciorusso A, Donatelli G, Parigi TL, Furfaro F, D’Amico F, Massironi S, Malesci A, Ungaro F, Danese S, Annese V. Transforming Gastrointestinal Diagnosis with Molecular Endoscopy: Challenges and Opportunities. Int J Mol Sci 2025; 26:4834. [PMID: 40429975 PMCID: PMC12112569 DOI: 10.3390/ijms26104834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2025] [Revised: 05/09/2025] [Accepted: 05/15/2025] [Indexed: 05/29/2025] Open
Abstract
Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett's esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers. Technologies like Confocal Laser Endomicroscopy (CLE) and Immunoendoscopy are revolutionizing in vivo diagnostics, enabling the real-time visualization of tissue microarchitecture and physiological mechanisms. Fluorescence molecular endoscopy (FME) enhances the detection of precancerous and cancerous lesions, even those undetectable by conventional methods, by highlighting subtle molecular changes. Clinical applications include early tumor detection, therapy response monitoring, and improved lesion characterization. Despite these advancements, challenges persist, including high costs, a lack of standardization, and the need for specialized training. Recent innovations, such as a multi-parametric rigid standard, aim to ensure the reliable performance assessment and quality control of FME systems, addressing subjective variability and improving reproducibility. In addition, the integration of artificial intelligence (AI) with molecular endoscopy offers the potential to further reduce detection errors and significantly enhance diagnostic accuracy. This advancement underscores the potential of molecular endoscopy for personalized GI disease management, while highlighting the need for ongoing research to refine the technology, validate its clinical utility, and overcome the barriers to routine clinical application.
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Affiliation(s)
- Giuseppe Dell’Anna
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
| | - Francesco Mandarino
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Lucia Centanni
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Ilaria Lodola
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Jacopo Fanizza
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Ernesto Fasulo
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Sarah Bencardino
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Lorenzo Fuccio
- Unit of Gastroenterology, Department of Medical and Surgical Sciences, S. Orsola-Malpighi University Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy;
| | - Antonio Facciorusso
- Faculty of Medicine and Surgery, University of Salento, Piazza Tancredi 7, 73100 Lecce, Italy;
| | - Gianfranco Donatelli
- Unité d’Endoscopie Interventionnelle, Hopital Privé des Peupliers, Ramsay Générale de Santé, 75013 Paris, France;
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
| | - Tommaso Lorenzo Parigi
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Ferdinando D’Amico
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Sara Massironi
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Alberto Malesci
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Federica Ungaro
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Via Olgettina 60, 20132 Milan, Italy; (G.D.); (F.M.); (L.C.); (I.L.); (J.F.); (E.F.); (S.B.); (T.L.P.); (F.F.); (F.D.); (S.M.); (A.M.); (F.U.); (S.D.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
| | - Vito Annese
- Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, 20097 San Donato Milanese, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 56, 20132 Milan, Italy
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Bahceci D, Sejben A, Yassan L, Miller G, Liao X, Ko HM, Salomao M, Yozu M, Lauwers GY, Choi WT. Inflammatory bowel disease-associated serrated lesions with dysplasia are frequently associated with advanced neoplasia: supporting a unified classification approach. Histopathology 2025. [PMID: 40104985 DOI: 10.1111/his.15448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Revised: 03/06/2025] [Accepted: 03/10/2025] [Indexed: 03/20/2025]
Abstract
AIMS Inflammatory bowel disease (IBD)-associated serrated lesions are categorized into three distinct subtypes: traditional serrated adenoma (TSA)-like lesion, sessile serrated lesion (SSL)-like lesion, and serrated lesion, not otherwise specified (NOS). Although the risk of neoplastic progression of serrated lesions without dysplasia has not been shown to exceed that of sporadic cases, the clinicopathologic features of the three serrated subtypes with dysplasia remain poorly understood in the context of IBD. METHODS AND RESULTS We analysed 87 serrated lesions with dysplasia (collectively referred to as serrated dysplasia) identified endoscopically in 58 IBD patients, including 51 (59%) TSA-like dysplasia, 24 (28%) SSL-like dysplasia, and 12 (14%) serrated dysplasia NOS. Inclusion criteria required all three serrated subtypes to show morphologic evidence of dysplasia and to be located within areas of colitis. We also compared the clinicopathologic features of serrated dysplasia with those of 239 conventional (adenomatous) dysplastic lesions from 149 IBD patients. The cohort included 39 (67%) men and 19 (33%) women, with a mean age of 54 years and a mean IBD duration of 20 years. Most patients had ulcerative colitis (n = 41; 71%) and pancolitis (n = 48; 83%). The majority of serrated lesions with dysplasia had a polypoid or visible endoscopic appearance (n = 73; 84%), with a mean size of 1.4 cm, and were found in the left colon (n = 66; 76%). Most lesions (n = 73; 84%) demonstrated low-grade dysplasia at the time of biopsy diagnosis, whereas high-grade dysplasia (HGD) was identified in the remaining 14 (16%) lesions. SSL-like dysplasia was more frequently associated with ulcerative colitis (94%) compared to TSA-like dysplasia (67%) and serrated dysplasia NOS (56%) (P = 0.042). Although only seven (12%) patients had a concurrent history of primary sclerosing cholangitis, it was exclusively identified in the TSA-like dysplasia group (19% versus 0% in both the SSL-like dysplasia group and the serrated dysplasia NOS group; P = 0.017). Serrated dysplasia NOS more commonly demonstrated HGD at the time of biopsy diagnosis (42%) compared to TSA-like dysplasia (12%) and SSL-like dysplasia (13%) (P = 0.022). Serrated dysplasia NOS was also more frequently associated with synchronous and/or metachronous nonconventional dysplasia (60%) compared to TSA-like dysplasia (16%) and SSL-like dysplasia (9%) (P = 0.037). Serrated dysplasia, regardless of subtype, was associated with high rates of advanced neoplasia (HGD or colorectal cancer) at the previous biopsy site or in the same colonic segment during follow-up. Within a mean follow-up time of 13 months, advanced neoplasia was detected in 50% of the TSA-like dysplasia group, 67% of the SSL-like dysplasia group, and 100% of the serrated dysplasia NOS group (P = 0.622). Moreover, at least one-third of patients in each group (58% in the TSA-like dysplasia group, 44% in the SSL-like dysplasia group, and 33% in the serrated dysplasia NOS group; P = 0.332) developed synchronous/metachronous dysplasia, with at least 50% of these lesions progressing to advanced neoplasia within a mean follow-up time of 11 months (P = 1.000). The serrated dysplasia group showed nearly six times the incidence of advanced neoplasia upon follow-up (59%) compared to the conventional dysplasia group (10%) (P < 0.001). CONCLUSION TSA-like dysplasia, SSL-like dysplasia, and serrated dysplasia NOS show distinct clinicopathologic features. However, all three serrated subtypes were associated with high rates of advanced neoplasia (50%-100%) during follow-up, suggesting that these lesions could potentially be combined into one diagnostic category, such as serrated dysplasia.
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Affiliation(s)
- Dorukhan Bahceci
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
| | - Anita Sejben
- Department of Pathology, Albert Szent-Györgyi Medical School, Szeged, Hungary
| | - Lindsay Yassan
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Gregory Miller
- Envoi Specialist Pathologists, Kelvin Grove, Queensland, Australia
| | - Xiaoyan Liao
- Department of Pathology, University of Rochester, Rochester, NY, USA
| | - Huaibin Mabel Ko
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | | | - Masato Yozu
- Histopathology Department, Middlemore Hospital, Auckland, New Zealand
| | - Gregory Y Lauwers
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Won-Tak Choi
- Department of Pathology, University of California at San Francisco, San Francisco, CA, USA
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Makar J, Abdelmalak J, Con D, Hafeez B, Garg M. Use of artificial intelligence improves colonoscopy performance in adenoma detection: a systematic review and meta-analysis. Gastrointest Endosc 2025; 101:68-81.e8. [PMID: 39216648 DOI: 10.1016/j.gie.2024.08.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/17/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND AIMS Artificial intelligence (AI) is increasingly used to improve adenoma detection during colonoscopy. This meta-analysis aimed to provide an updated evaluation of computer-aided detection (CADe) systems and their impact on key colonoscopy quality indicators. METHODS We searched the EMBASE, PubMed, and MEDLINE databases from inception until February 15, 2024, for randomized control trials (RCTs) comparing the performance of CADe systems with routine unassisted colonoscopy in the detection of colorectal adenomas. RESULTS Twenty-eight RCTs were selected for inclusion involving 23,861 participants. Random-effects meta-analysis demonstrated a 20% increase in adenoma detection rate (risk ratio [RR], 1.20; 95% confidence interval [CI], 1.14-1.27; P < .01) and 55% decrease in adenoma miss rate (RR, 0.45; 95% CI, 0.37-0.54; P < .01) with AI-assisted colonoscopy. Subgroup analyses involving only expert endoscopists demonstrated a similar effect size (RR, 1.19; 95% CI, 1.11-1.27; P < .001), with similar findings seen in analysis of differing CADe systems and healthcare settings. CADe use also significantly increased adenomas per colonoscopy (weighted mean difference, 0.21; 95% CI, 0.14-0.29; P < .01), primarily because of increased diminutive lesion detection, with no significant difference seen in detection of advanced adenomas. Sessile serrated lesion detection (RR, 1.10; 95% CI, 0.93-1.30; P = .27) and miss rates (RR, 0.44; 95% CI, 0.16-1.19; P = .11) were similar. There was an average 0.15-minute prolongation of withdrawal time with AI-assisted colonoscopy (weighted mean difference, 0.15; 95% CI, 0.04-0.25; P = .01) and a 39% increase in the rate of non-neoplastic resection (RR, 1.39; 95% CI, 1.23-1.57; P < .001). CONCLUSIONS AI-assisted colonoscopy significantly improved adenoma detection but not sessile serrated lesion detection irrespective of endoscopist experience, system type, or healthcare setting.
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Affiliation(s)
- Jonathan Makar
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Abdelmalak
- Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia; Department of Gastroenterology, Alfred Hospital, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Danny Con
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Gastroenterology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Bilal Hafeez
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mayur Garg
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Gastroenterology, Northern Health, Epping, Victoria, Australia
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Wang S, Zhang Q, Meng LR, Wu Y, Fong P, Zhou W. Comparative meta-analysis of cold snare polypectomy and endoscopic mucosal resection for colorectal polyps: assessing efficacy and safety. PeerJ 2024; 12:e18757. [PMID: 39713138 PMCID: PMC11663405 DOI: 10.7717/peerj.18757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 12/03/2024] [Indexed: 12/24/2024] Open
Abstract
Colorectal polyps are commonly treated with surgical procedures, with cold snare polypectomy (CSP) and endoscopic mucosal resection (EMR) being the two most prevalent techniques. This meta-analysis (PROSPERO ID: CRD42022336152) aimed to compare the efficacy and safety of CSP and EMR in the management of colorectal polyps. Comprehensive searches were conducted in PubMed, Embase, CINAHL, Web of Science, and Cochrane Library databases, covering publications up until June 2024. The primary outcome was complete resection rate, and secondary outcomes included en bloc resection rate, immediate and delayed bleeding, perforation, and procedure time. The Mantel-Haenszel method was employed for the analysis of binary endpoints, while the inverse variance method was used for continuous outcomes. Subgroup analysis was performed to explore potential sources of heterogeneity. Six studies involving 15,296 patients and 17,971 polyps were included in the meta-analysis. CSP had a significantly lower complete resection rate compared to EMR (OR: 0.44, 95% CI [0.21-0.94], p = 0.0334). However, there was no significant difference between CSP and EMR in en bloc resection rate, perforation, or procedure time. Interestingly, CSP had a significantly lower delayed bleeding rate compared to EMR (OR: 0.45, 95% CI [0.27-0.77], p = 0.0034), but there was no significant difference in immediate bleeding rate. In conclusion, CSP is a safe, efficient, and effective technique comparable to EMR. The choice of technique should be based on the individual patient and polyp characteristics.
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Affiliation(s)
- Shouqi Wang
- The Second Affiliated Hospital, Soochow University, Soochow, China
| | - Qi Zhang
- The Second Affiliated Hospital, Soochow University, Soochow, China
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Li Rong Meng
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Ying Wu
- The Second Affiliated Hospital, Soochow University, Soochow, China
| | - Pedro Fong
- Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, China
| | - Weixia Zhou
- The Second Affiliated Hospital, Soochow University, Soochow, China
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Xu Z, Rittscher J, Ali S. SSL-CPCD: Self-Supervised Learning With Composite Pretext-Class Discrimination for Improved Generalisability in Endoscopic Image Analysis. IEEE TRANSACTIONS ON MEDICAL IMAGING 2024; 43:4105-4119. [PMID: 38857149 DOI: 10.1109/tmi.2024.3411933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Data-driven methods have shown tremendous progress in medical image analysis. In this context, deep learning-based supervised methods are widely popular. However, they require a large amount of training data and face issues in generalisability to unseen datasets that hinder clinical translation. Endoscopic imaging data is characterised by large inter- and intra-patient variability that makes these models more challenging to learn representative features for downstream tasks. Thus, despite the publicly available datasets and datasets that can be generated within hospitals, most supervised models still underperform. While self-supervised learning has addressed this problem to some extent in natural scene data, there is a considerable performance gap in the medical image domain. In this paper, we propose to explore patch-level instance-group discrimination and penalisation of inter-class variation using additive angular margin within the cosine similarity metrics. Our novel approach enables models to learn to cluster similar representations, thereby improving their ability to provide better separation between different classes. Our results demonstrate significant improvement on all metrics over the state-of-the-art (SOTA) methods on the test set from the same and diverse datasets. We evaluated our approach for classification, detection, and segmentation. SSL-CPCD attains notable Top 1 accuracy of 79.77% in ulcerative colitis classification, an 88.62% mean average precision (mAP) for detection, and an 82.32% dice similarity coefficient for polyp segmentation tasks. These represent improvements of over 4%, 2%, and 3%, respectively, compared to the baseline architectures. We demonstrate that our method generalises better than all SOTA methods to unseen datasets, reporting over 7% improvement.
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Martínez‐Roca A, Cubiella J, García‐Heredia A, Guill‐Berbegal D, Baile‐Maxía S, Mangas‐Sanjuán C, Sala‐Miquel N, Madero‐Velazquez L, Alenda C, Zapater P, González‐Núñez C, Iglesias‐Gómez A, Codesido‐Prado L, Díez‐Martín A, Kaminski MF, Erichsen R, Adami H, Ferlitsch M, Pellisé M, Holme Ø, Dekker E, Bretthauer M, Jover R, For the EPoS Study Group. Prediction of metachronous advanced colorectal neoplasia by KRAS mutation in polyps. United European Gastroenterol J 2024; 12:1179-1189. [PMID: 39400528 PMCID: PMC11578838 DOI: 10.1002/ueg2.12667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/05/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND The potential of molecular markers in the removed polys as reliable predictors of metachronous lesions is still uncertain. AIM Our aim was to evaluate the role of somatic mutations in KRAS in polyps of patients with high-risk adenomas to predict the risk of advanced polyps or colorectal cancer (CRC) within 3 years. METHODS A total of 518 patients were prospectively enrolled. The included patients had adenomas ≥10 mm, high-grade dysplasia, villous component or ≥3 more adenomas at baseline and were scheduled to undergo surveillance colonoscopy at 3 years ± 6 months. Somatic KRAS mutation was performed on 1189 polyps collected from these patients. At surveillance, advanced lesions were defined as adenomas with a size of ≥10 mm. High-grade dysplasia or villous component, serrated polyps ≥10 mm or with dysplasia or CRC. RESULTS At baseline, 81 patients (15.6%) had KRAS mutations in at least one polyp. Patients with KRAS mutated polyps had more frequent villous histological lesions and size ≥20 mm. In the multivariate analysis, adjusted for age and sex, only age (odds ratios [OR], 1.06; 95% confidence interval [CI], 1.02-1.09; p < 0.001), ≥5 adenomas (OR, 3.92; 95% CI, 1.96-7.82), and KRAS mutation (OR, 2.54; 95% CI, 1.48-4.34; p < 0.01) were independently associated with the development of advanced lesions at surveillance. CONCLUSIONS Our results show that, in patients with high-risk adenomas, the presence of somatic mutations in KRAS is an independent risk factor for the development of advanced metachronous polyps.
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Affiliation(s)
- Alejandro Martínez‐Roca
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Joaquín Cubiella
- Department of GastroenterologyResearch Group in Gastrointestinal Oncology‐OurenseCIBEREHDHospital Universitario de OurenseOurenseSpain
| | - Anabel García‐Heredia
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - David Guill‐Berbegal
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Sandra Baile‐Maxía
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Carolina Mangas‐Sanjuán
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Noelia Sala‐Miquel
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Lucía Madero‐Velazquez
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
| | - Cristina Alenda
- Pathology DepartmentAlicante Institute for Health and Biomedical Research (ISABIAL)Dr. Balmis General University HospitalAlicanteSpain
| | - Pedro Zapater
- Clinical Pharmacology DepartmentAlicante Institute for Health and Biomedical Research (ISABIAL)Dr. Balmis General University HospitalAlicanteSpain
| | | | - Agueda Iglesias‐Gómez
- Department of GastroenterologyResearch Group in Gastrointestinal Oncology‐OurenseCIBEREHDHospital Universitario de OurenseOurenseSpain
| | - Laura Codesido‐Prado
- Department of GastroenterologyResearch Group in Gastrointestinal Oncology‐OurenseCIBEREHDHospital Universitario de OurenseOurenseSpain
| | - Astrid Díez‐Martín
- Department of GastroenterologyResearch Group in Gastrointestinal Oncology‐OurenseCIBEREHDHospital Universitario de OurenseOurenseSpain
| | - Michal F. Kaminski
- Department of Oncological GastroenterologyMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
- Department of Cancer PreventionMaria Sklodowska‐Curie National Research Institute of OncologyWarsawPoland
| | - Rune Erichsen
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of SurgeryRanders Regional HospitalRandersDenmark
| | - Hans‐Olov Adami
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Monika Ferlitsch
- Department of Internal Medicine IIIMedical University of ViennaWienAustria
| | - María Pellisé
- Department of GastroenterologyHospital Clínic de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)University of BarcelonaBarcelonaSpain
| | - Øyvind Holme
- Department of GastroenterologySørlandet Sykehus HFKristiansandNorway
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology C2‐115Amsterdam University Medical CentresDuivendrechtThe Netherlands
- Bergman Clinics IZAAmsterdamThe Netherlands
| | | | - Rodrigo Jover
- Servicio de Medicina DigestivaInstituto de Investigación Sanitaria ISABIALHospital General Universitario Dr. BalmisAlicanteSpain
- Departamento de Medicina ClínicaUniversidad Miguel HernándezAlicanteSpain
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8
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Maas MHJ, Rath T, Spada C, Soons E, Forbes N, Kashin S, Cesaro P, Eickhoff A, Vanbiervliet G, Salvi D, Belletrutti PJ, Siersema PD, for the Discovery study team . A computer-aided detection system in the everyday setting of diagnostic, screening, and surveillance colonoscopy: an international, randomized trial. Endoscopy 2024; 56:843-850. [PMID: 38749482 PMCID: PMC11524745 DOI: 10.1055/a-2328-2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/15/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Computer-aided detection (CADe) has been developed to improve detection during colonoscopy. After initial reports of high efficacy, there has been an increasing recognition of variability in the effectiveness of CADe systems. The aim of this study was to evaluate a CADe system in a varied colonoscopy population. METHODS A multicenter, randomized trial was conducted at seven hospitals (both university and non-university) in Europe and Canada. Participants referred for diagnostic, non-immunochemical fecal occult blood test (iFOBT) screening, or surveillance colonoscopy were randomized (1:1) to undergo CADe-assisted or conventional colonoscopy by experienced endoscopists. Participants with insufficient bowel preparation were excluded from the analysis. The primary outcome was adenoma detection rate (ADR). Secondary outcomes included adenomas per colonoscopy (APC) and sessile serrated lesions (SSLs) per colonoscopy. RESULTS 581 participants were enrolled, of whom 497 were included in the final analysis: 250 in the CADe arm and 247 in the conventional colonoscopy arm. The indication was surveillance in 202/497 colonoscopies (40.6 %), diagnostic in 199/497 (40.0 %), and non-iFOBT screening in 96/497 (19.3 %). Overall, ADR (38.4 % vs. 37.7 %; P = 0.43) and APC (0.66 vs. 0.66; P = 0.97) were similar between CADe and conventional colonoscopy. SSLs per colonoscopy was increased (0.30 vs. 0.19; P = 0.049) in the CADe arm vs. the conventional colonoscopy arm. CONCLUSIONS In this study conducted by experienced endoscopists, CADe did not result in a statistically significant increase in ADR. However, the ADR of our control group substantially surpassed our sample size assumptions, increasing the risk of an underpowered trial.
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Affiliation(s)
- Michiel H. J. Maas
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Timo Rath
- Department of Medicine I, Division of Gastroenterology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Cristiano Spada
- Department of Gastroenterology and Endoscopy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elsa Soons
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nauzer Forbes
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Sergey Kashin
- Department of Endoscopy, Yaroslavl Regional Cancer Hospital, Yaroslavl, Russia
| | - Paola Cesaro
- Department of Gastroenterology and Endoscopy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Axel Eickhoff
- Gastroenterology, Diabetology, Infectiology, Klinikum Hanau, Hanau, Germany
| | | | - Daniele Salvi
- Department of Gastroenterology and Endoscopy, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
- Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Peter D. Siersema
- Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
- ErasmusMC – University Medical Center, Rotterdam, the Netherlands
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9
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Baile-Maxía S, Jover R. Response. Gastrointest Endosc 2024; 100:962-963. [PMID: 39515927 DOI: 10.1016/j.gie.2024.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 11/16/2024]
Affiliation(s)
- Sandra Baile-Maxía
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
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10
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Zessner-Spitzenberg J, Waldmann E, Rockenbauer LM, Demschik A, Penz D, Trauner M, Ferlitsch M. Polyp size is associated with colorectal cancer death across histologic polyp subtypes: a retrospective study of a screening colonoscopy registry. Endoscopy 2024; 56:820-827. [PMID: 38936414 DOI: 10.1055/a-2339-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Surveillance colonoscopy after polyps have been detected at screening aims to reduce the risk for subsequent colorectal cancer, so-called post-colonoscopy colorectal cancer (PCCRC). Inconsistencies exist as to whether the risk should be stratified by histologic subtype. We aimed to compare the risk for PCCRC mortality in screening participants with sessile serrated lesions (SSLs)/traditional serrated adenomas (TSAs), hyperplastic polyps (HPPs), or conventional adenomas. METHODS Screening colonoscopy registry data were linked to death registry data between 2010 and 2022. We assessed the association of PCCRC death after a diagnosis of SSL/TSA, conventional adenoma, or HPP by Cox regression, and stratified by polyp size ≥10 and <10 mm. RESULTS 383,801 participants were included in the analysis. There were 1490 HPPs ≥10 mm (2.6%), compared with 1853 SSL/TSAs (19.6%) and 10,960 conventional adenomas (12.9%). When adjusted for polyp location, the association of polyp size ≥10 mm with PCCRC death was of similar magnitude in participants with conventional adenomas (hazard ratio [HR] 3.68, 95%CI 2.49-5.44), SSL/TSAs (HR 2.55, 95%CI 1.13-5.72), and HPPs (HR 5.01, 95%CI 2.45-10.22). Participants with HPPs mostly died of tumors in the distal colon (54.1%; n = 20), while participants with SSL/TSAs more frequently died of proximal tumors (33.3%; n = 3). CONCLUSIONS Across all histologic types, participants with polyps ≥10 mm had at least a two-fold increase in the likelihood of PCCRC death compared with those with polyps <10 mm. These data suggest that size, rather than histologic subtype, should be a determinant for risk stratification after screening colonoscopy.
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Affiliation(s)
- Jasmin Zessner-Spitzenberg
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
| | - Elisabeth Waldmann
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
| | - Lisa-Maria Rockenbauer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
| | - Alexandra Demschik
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
| | - Daniela Penz
- Department of Internal Medicine I, St. John of God Hospital, Vienna, Austria
| | - Michael Trauner
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Quality Assurance Working Group, Austrian Society for Gastroenterology and Hepatology, Vienna, Austria
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11
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Baile-Maxía S, Mangas-Sanjuán C, Ladabaum U, Sánchez-Ardila C, Sala-Miquel N, Hassan C, Rutter MD, Bretthauer M, Zapater P, Jover R. Risk factors for metachronous colorectal cancer or advanced lesions after endoscopic resection of serrated polyps: a systematic review and meta-analysis. Gastrointest Endosc 2024; 100:605-615.e14. [PMID: 38851458 DOI: 10.1016/j.gie.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/04/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND AND AIMS Serrated polyps (SPs) are precursors to 15% to 20% of colorectal cancers (CRCs). However, there are uncertainties regarding which SPs require surveillance and at what intervals, with recommendations adapted from those for adenomas in the absence of solid evidence. Our aim was to assess which SP risk characteristics relate to a higher risk of metachronous CRC or advanced polyps. METHODS We systematically searched PubMed, Embase, and Cochrane for cohort studies, case-control studies, and clinical trials from inception to December 31, 2023, of CRC or advanced polyps (advanced adenoma [AA] or advanced SP) incidence at surveillance stratified by baseline SP size, dysplasia, location, and multiplicity. We defined advanced SPs as those ≥10 mm or with dysplasia. CRC and advanced polyp incidence per 1000 person-years were estimated. We performed a meta-analysis by calculating pooled relative risks (RRs) using a random-effects model. RESULTS A total of 5903 studies were reviewed, and 14 were included with 493,949 patients (mean age, 59.5 years; 55% men). The mean follow-up was 4.9 years. CRC incidence per 1000 person-years was 2.09 (95% confidence interval [CI], 1.29-2.90) for advanced SPs, 1.52 (95% CI, 0.78-2.25) for SPs of ≥10 mm, 5.86 (95% CI, 2.16-9.56) for SPs with dysplasia, 1.18 (95% CI, 0.77-1.60) for proximal SPs, 0.52 (95% CI, 0.08-1.12) for ≥3 SPs, 0.50 (95% CI, 0.35-0.66) for nonadvanced SPs, and 0.44 (95% CI, 0.41-0.46) for normal colonoscopy findings. Metachronous CRC risk was higher in advanced SPs versus nonadvanced SPs (RR, 1.84; 95% CI, 1.11-3.04) and versus normal colonoscopy findings (RR, 2.92; 95% CI, 2.26-3.77), in SPs of ≥10 mm versus <10 mm (RR, 2.61; 95% CI, 1.43-4.77) and versus normal colonoscopy findings (RR: 3.52; 95% CI, 2.17-5.69); and in SPs with dysplasia versus normal colonoscopy findings (RR: 2.71; 95% CI, 2.00-3.67). No increase in CRC or advanced polyp risk was found in patients with proximal versus distal SPs, nor in ≥3 SPs versus 1 or 2 SPs. CONCLUSIONS CRC risk is significantly higher in patients with baseline advanced SPs after 4.9 years of follow-up, with risk magnitudes similar to those described for AA, supporting the current recommendation for 3-year surveillance in patients with advanced SPs.
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Affiliation(s)
- Sandra Baile-Maxía
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Carolina Mangas-Sanjuán
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | | | - Noelia Sala-Miquel
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - Cesare Hassan
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; Humanitas Clinical and Research Center-IRCCS, Endoscopy Unit, Rozzano, Italy
| | - Matthew D Rutter
- North Tees and Hartlepool National Health Service Foundation Trust, Stockton-On-Tees, Hardwick Road, Stockton on Tees, Cleveland, Yorkshire, United Kingdom; Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Pedro Zapater
- Clinical Pharmacology Department, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica ISABIAL, Centro de investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Alicante, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr Balmis, Instituto de Investigación Biomédica Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain.
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12
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Nagarajan KV, Bhat N. Imaging colonic polyps in 2024. Indian J Gastroenterol 2024; 43:954-965. [PMID: 39347933 DOI: 10.1007/s12664-024-01679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/19/2024] [Indexed: 10/01/2024]
Abstract
Screening colonoscopy and polypectomy are the cornerstone in decreasing the incidence and mortality of colorectal cancer. Despite the low incidence of colorectal cancer in India, there has been a rising trend in the incidence of colonic polyps and cancer over the last decade. It is, hence, imperative that we are well equipped in the management of colonic polyps. Adequate training in the detection and characterization of polyps to aid in their management is necessary. Detection of polyps can be increased by adhering to the standards of colonoscopy, including good bowel preparation, cecal intubation rate, adequate withdrawal time and use of distal attachment devices. A detected polyp needs optimal characterization to predict histology in real time and decide on the management strategies. Characterization of the polyps requires high-definition-white light endoscopy and/or image-enhanced endoscopy (dye based or digital). Various factors that help in predicting histology include size, location and morphology of the polyp and the pit pattern, vascular and surface pattern of the polyp. Polyps can be differentiated as neoplastic or non-neoplastic with reasonable accuracy with the above features. Prediction of advanced pathology including high-grade dysplasia and deep sub-mucosal invasion is essential, as it helps in deciding if the lesion is amenable to endotherapy and the technique of endoscopic resection. Adequate training in image-enhanced endoscopy is necessary to assess advanced pathology in polyps. Technology pertaining to image-enhanced endoscopy includes narrow banding imaging and blue laser imaging; newer variations are being introduced every few years making it necessary to be abreast with growing information. The recent advances in gastrointestinal (GI) endoscopy with the advent of endocytoscopy and artificial intelligence seem promising and are predicted to be the future of GI endoscopy.
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Affiliation(s)
- Kayal Vizhi Nagarajan
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Aster CMI Hospital, Bengaluru, 560 092, India
| | - Naresh Bhat
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Aster CMI Hospital, Bengaluru, 560 092, India.
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13
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Kane LE, Flood B, Manils J, McSkeane DE, Smith AP, Tosetto M, Alalawi F, Fay J, Kay E, Dunne C, McQuaid S, Loughrey MB, O'Sullivan J, Ryan EJ, Sheahan K, Doherty GA, Creagh EM. Caspase-4 Has Potential Utility as a Colorectal Tissue Biomarker for Dysplasia and Early-Stage Cancer. GASTRO HEP ADVANCES 2024; 4:100552. [PMID: 39866724 PMCID: PMC11760840 DOI: 10.1016/j.gastha.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 09/09/2024] [Indexed: 01/28/2025]
Abstract
Background and Aims Colorectal cancer (CRC) is the second most deadly cancer globally. The rapidly rising incidence rate of CRC, coupled with increased diagnoses in individuals <50 years, indicates that early detection of CRC, and those at an increased risk of CRC development, is paramount to improve the survival rates of these patients. Here, we profile caspase-4 expression across 2 distinct CRC development pathways, sporadic CRC (sCRC) and inflammatory bowel disease-associated CRC (IBD-CRC), to examine its utility as a novel biomarker for CRC risk and diagnosis. Methods Tissue samples from patients with CRC, colonic polyps, IBD-CRC, and sCRC were assessed by immunohistochemistry for caspase-4 expression in epithelial and stromal compartments. RNAseq expression data for caspase-4 in CRC and normal tissue samples were mined from online databases. Results Epithelial caspase-4 expression is selectively elevated in CRC tumor tissue compared to adjacent normal tissue, where it is not expressed. In the sCRC pathway, caspase-4 is expressed in the epithelial and stromal tissue of all histological subtypes of colonic polyps, with a significant increase in epithelial expression from low-grade dysplasia to high-grade dysplasia progression. For the IBD-CRC pathway, caspase-4 epithelial expression was specifically upregulated in dysplastic and neoplastic tissue of IBD-CRC but was not expressed in normal or inflamed tissue. Conclusion This study demonstrates that epithelial caspase-4 is selectively expressed in colon tissue during the development of dysplasia. As such, epithelial caspase-4 represents a promising novel tissue biomarker for CRC risk and diagnosis.
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Affiliation(s)
- Laura E Kane
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Brian Flood
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Joan Manils
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Serra Húnter Programme, Immunology Unit, Department of Pathology and Experimental Therapy, School of Medicine, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Donna E McSkeane
- School of Biological Sciences, Technological University Dublin, Dublin, Ireland
- Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Aoife P Smith
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Miriam Tosetto
- Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Fatema Alalawi
- Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Joanna Fay
- Pathology Department, Royal College of Surgeons Ireland and Beaumont Hospital, Dublin, Ireland
| | - Elaine Kay
- Pathology Department, Royal College of Surgeons Ireland and Beaumont Hospital, Dublin, Ireland
| | - Cara Dunne
- Department of Surgery, Trinity St. James's Cancer Institute and Trinity Translational Medicine Institute, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Stephen McQuaid
- Precision Medicine Centre of Excellence, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Maurice B Loughrey
- Department of Cellular Pathology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jacintha O'Sullivan
- Department of Surgery, Trinity St. James's Cancer Institute and Trinity Translational Medicine Institute, St. James's Hospital and Trinity College Dublin, Dublin, Ireland
| | - Elizabeth J Ryan
- Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Biological Sciences, Limerick Digital Cancer Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran Sheahan
- Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
- Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland
| | - Glen A Doherty
- Centre for Colorectal Disease, St Vincent's University Hospital and School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
| | - Emma M Creagh
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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14
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Polychronidis G, He MM, Vithayathil M, Knudsen MD, Wang K, Song M. Risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps: a comprehensive evaluation of risk factors and surveillance use. Gut 2024; 73:1675-1683. [PMID: 38839270 DOI: 10.1136/gutjnl-2023-331729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Surveillance colonoscopy after polyp removal is recommended to prevent subsequent colorectal cancer (CRC). It is known that advanced adenomas have a substantially higher risk than non-advanced ones, but optimal intervals for surveillance remain unclear. DESIGN We prospectively followed 156 699 participants who had undergone a colonoscopy from 2007 to 2017 in a large integrated healthcare system. Using multivariable Cox proportional hazards regression we estimated the subsequent risk of CRC and high-risk polyps, respectively, according to index colonoscopy polyps, colonoscopy quality measures, patient characteristics and the use of surveillance colonoscopy. RESULTS After a median follow-up of 5.3 years, we documented 309 CRC and 3053 high-risk polyp cases. Compared with participants with no polyps at index colonoscopy, those with high-risk adenomas and high-risk serrated polyps had a consistently higher risk of CRC during follow-up, with the highest risk observed at 3 years after polypectomy (multivariable HR 5.44 (95% CI 3.56 to 8.29) and 8.35 (95% CI 4.20 to 16.59), respectively). Recurrence of high-risk polyps showed a similar risk distribution. The use of surveillance colonoscopy was associated with lower risk of CRC, with an HR of 0.61 (95% CI 0.39 to 0.98) among patients with high-risk polyps and 0.57 (95% CI 0.35 to 0.92) among low-risk polyps. Among 1548 patients who had high-risk polyps at both index and surveillance colonoscopies, 65% had their index polyps in the proximal colon and 30% had index and interval polyps in the same segments. CONCLUSION Patients with high-risk polyp findings were at higher risk of subsequent CRC and high-risk polyps and may benefit from early surveillance within 3 years. The subsite distribution of the index and recurrent high-risk polyps suggests the contribution of incomplete resection and missed lesions to the development of interval neoplasia.
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Affiliation(s)
- Georgios Polychronidis
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of General,Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
- Study Centre of the German Surgical Society, German Surgical Society/Heidelberg University Hospital, Heidelberg, Germany
| | - Ming-Ming He
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- State Key Laboratory of Oncology in South China, Department of Medical Oncology, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Mathew Vithayathil
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Imperial College Healthcare NHS Trust, London, UK
| | - Markus D Knudsen
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Section for Colorectal Cancer Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Transplantation Medicine, Division of Surgery,Inflammatory Diseases and Transplantation, Oslo University Hospital, Oslo, Norway
| | - Kai Wang
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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15
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Maoz A, Rodriguez NJ, Yurgelun MB, Syngal S. Gastrointestinal Cancer Precursor Conditions and Their Detection. Hematol Oncol Clin North Am 2024; 38:783-811. [PMID: 38760197 PMCID: PMC11537157 DOI: 10.1016/j.hoc.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Gastrointestinal cancers are a leading cause of cancer morbidity and mortality. Many gastrointestinal cancers develop from cancer precursor lesions, which are commonly found in individuals with hereditary cancer syndromes. Hereditary cancer syndromes have advanced our understanding of cancer development and progression and have facilitated the evaluation of cancer prevention and interception efforts. Common gastrointestinal hereditary cancer syndromes, including their organ-specific cancer risk and surveillance recommendations, are reviewed in this article. The management of common gastroesophageal, pancreatic, and colonic precursor lesions is also discussed, regardless of their genetic background. Further research is needed to advance chemoprevention and immunoprevention strategies.
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Affiliation(s)
- Asaf Maoz
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA. https://twitter.com/asaf_maoz
| | - Nicolette J Rodriguez
- Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston MA 02115, USA; Division of Cancer Genetics and Prevention, 450 Brookline Avenue, Boston MA 02215, USA. https://twitter.com/Dr_NJRodriguez
| | - Matthew B Yurgelun
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA; Harvard Medical School, Boston, MA, USA. https://twitter.com/MattYurgelun
| | - Sapna Syngal
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
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16
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Andrea MK, Jepsen RK, Klein MF, Gögenur I, Kuhlmann TP. Predictors for dMMR colorectal cancer in patients with serrated lesions and polyps - A register-based cohort study. Cancer Epidemiol 2024; 91:102601. [PMID: 38905781 DOI: 10.1016/j.canep.2024.102601] [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: 03/18/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Serrated lesions and polyps (SP) are precursors of up to 30 % of colorectal cancers (CRC) through the serrated pathway. This often entails early BRAF mutations and MLH1 hypermethylation leading to mismatch repair deficient (dMMR) CRC. We investigated predictors of dMMR CRC among patients with co-occurrence of CRC and SP to increase our knowledge on the serrated pathway. METHODS We used data from The Danish Pathology Registry and Danish Colorectal Cancer Groups Database from the period 2010-2021 to investigate risk factors for development of dMMR CRC. We used logistic regression models to identify difference in risk factors of developing dMMR CRC in comparison to CRC with proficient MMR (pMMR). RESULTS We included 3273 patients with a median age of 70.7 years [64.3,76.4] of which 1850 (56.5 %) were male. dMMR CRC was present in 592 patients (18.1 %), with loss of MLH1/PMS2 being most common. The risk of dMMR CRC was significantly higher in females OR 3.47 [2.87;4.20]. When adjusting for age, SP subtype, conventional adenomas (CA), anatomical location and lifestyle factors, female sex remained the strongest predictor OR 2.84 [2.27;3.56]. The presence of sessile serrated lesions with or without dysplasia was related to higher risk OR 1.60 [1.11;2.31] and OR 1.42 [1.11;1.82] respectively, while conventional adenomas constituted a lower risk OR 0.68 [0.55;0.84]. CONCLUSION In conclusion we found several predictors of whom female sex had the strongest correlation with dMMR CRC in patients with SP.
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Affiliation(s)
- Mille Kyhn Andrea
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
| | - Rikke Karlin Jepsen
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Falk Klein
- Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ismail Gögenur
- Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Center for Surgical Sciences, University Hospital Zealand, Køge, Denmark; Department of Surgery, University Hospital Zealand, Køge, Denmark
| | - Tine Plato Kuhlmann
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Zhang QQ, Wu JD, Li XY, Fang FF, Li GP, Bai T, Song J. Clinical and endoscopic characteristics of colorectal sessile serrated lesions with or without dysplasia/carcinoma: A systematic review and meta-analysis. J Dig Dis 2024; 25:424-435. [PMID: 39104049 DOI: 10.1111/1751-2980.13302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/05/2024] [Accepted: 06/29/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE We aimed to compare the clinical and endoscopic characteristics of sessile serrated lesions (SSLs) with dysplasia/carcinoma (SSLD/Cs) and SSLs without dysplasia in this systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and Cochrane Library databases and Clinicaltrials.gov were searched for relevant studies published up to August 28, 2023. The primary outcome was lesion size in SSLD/Cs and SSLs without dysplasia. The secondary outcomes included risk of dysplasia/carcinoma, morphology (classified based on the Paris classification), and lesion features such as mucus cap and nodules/protrusions in the two groups. RESULTS Thirteen studies with 14 381 patients were included. The proportion of SSLD/Cs ≥10 mm was significantly higher than that of SSLs without dysplasia (odds ratio [OR] 3.82, 95% confidence interval [CI] 1.21-12.02, p = 0.02). There was no significant difference in the risk of dysplasia/carcinoma between the proximal (OR 0.80, 95% CI 0.57-1.14) and distal colon (OR 1.25, 95% CI 0.88-1.77, p = 0.21). The 0-Ip (OR 2.47, 95% CI 1.50-4.09) and 0-IIa + Is (OR 10.38, 95% CI 3.08-34.98) morphologies were more prevalent among SSLD/Cs, whereas the 0-IIa morphology (OR 0.38, 95% CI 0.22-0.65) was more prevalent among SSLs without dysplasia (all p < 0.001). Furthermore, mucus cap (OR 0.61, 95% CI 0.42-0.89, p = 0.01) was more common among SSLs without dysplasia, whereas nodules/protrusions (OR 7.80, 95% CI 3.07-19.85, p < 0.001) were more common in SSLD/Cs. CONCLUSION SSLs >10 mm, 0-Ip or 0-IIa + Is morphologies, and those with nodules/protrusions are significantly associated with dysplasia/carcinoma.
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Affiliation(s)
- Qing Qing Zhang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jian Di Wu
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xue Yan Li
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Fei Fei Fang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Gang Ping Li
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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18
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Troelsen FS, Sørensen HT, Erichsen R. Risk of a post-colonoscopy colorectal cancer in patients with diverticular disease: a population-based cohort study. Endoscopy 2024; 56:471-481. [PMID: 38331045 DOI: 10.1055/a-2264-8199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Post-colonoscopy colorectal cancers (PCCRCs) may account for up to 30% of all colorectal cancers (CRCs) diagnosed in patients with diverticular disease; however, absolute and relative risks of PCCRC among these patients undergoing colonoscopy remain unknown. METHODS We performed a cohort study (1995-2015) including patients with and without diverticular disease who underwent colonoscopy. We calculated 7-36-month cumulative incidence proportions (CIPs) of PCCRC. We used Cox proportional hazards regression models to compute hazard ratios (HRs) of PCCRC, comparing patients with and without diverticular disease, as a measure of relative risk. We calculated 3-year PCCRC rates, as per World Endoscopy Organization recommendations, to estimate the proportion of CRC patients with and without diverticular disease who were considered to have PCCRC. We stratified all analyses by PCCRC location. RESULTS We observed 373 PCCRCs among 56 642 patients with diverticular disease and 1536 PCCRCs among 306 800 patients without diverticular disease. The PCCRC CIP after first-time colonoscopy was 0.45% (95%CI 0.40%-0.51%) for patients with and 0.36% (95%CI 0.34%-0.38%) for patients without diverticular disease. Comparing patients with and without diverticular disease undergoing first-time colonoscopy, the adjusted HR was 0.84 (95%CI 0.73-0.97) for PCCRC and 1.23 (95%CI 1.01-1.50) for proximal PCCRCs. The 3-year PCCRC rate was 19.0% (22.3% for proximal PCCRCs) for patients with and 6.5% for patients without diverticular disease. CONCLUSIONS Although the absolute risk was low, the relative risk of proximal PCCRCs may be elevated in patients with diverticular disease undergoing colonoscopy compared with patients without the disease.
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Affiliation(s)
- Frederikke S Troelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
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Vu NTH, Le HM, Vo DT, Le NQ, Ho DDQ, Quach DT. Endoscopic characteristics and performance of WASP classification in the diagnosis of colorectal sessile-serrated lesions in Vietnamese patients. JGH Open 2024; 8:e13109. [PMID: 38919272 PMCID: PMC11196833 DOI: 10.1002/jgh3.13109] [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: 01/08/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND/AIMS Sessile-serrated lesions (SSLs) are challenging to detect due to their typically subtle appearance. The Workgroup serrAted polypS and Polyposis (WASP) classification was developed to diagnose SSLs endoscopically. This study aimed to evaluate the endoscopic characteristics of SSLs and the performance of the WASP classification in the Vietnamese population. METHODS This cross-sectional study was carried out on patients with lower gastrointestinal symptoms who underwent colonoscopy at a Vietnamese tertiary hospital. Univariate and multivariate analyses were performed to identify endoscopic features associated with SSLs. The performance of the WASP classification for diagnosing SSLs was assessed, and SSLs were diagnosed according to the 2019 World Health Organization (WHO) criteria. RESULTS There were 2489 patients, with a mean age of 52.1 ± 13.1 years and a female-to-male ratio of 1:1.1. A total of 121 specimens from 105 patients were diagnosed with SSLs. According to multivariate analysis, the endoscopic features significantly associated with SSLs were proximal location (odds ratio [OR]: 2.351; 95% confidence interval [CI]: 1.475-3.746), size >5 mm (OR: 2.447; 95% CI: 1.551-3.862), flat morphology (OR: 2.781; 95% CI: 1.533-5.044), irregular shape (OR: 4.516; 95% CI: 2.173-9.388), varicose microvascular vessels (OR: 5.030; 95% CI: 2.657-9.522), and dark spots inside the crypts (OR: 5.955; 95% CI: 3.291-10.776). The accuracy of the WASP classification for diagnosing SSLs was 94.0% (95% CI: 92.8%-95.0%). CONCLUSION Proximal location, size >5 mm, flat morphology, irregular shape, varicose microvascular vessels, and dark spots inside the crypts were significantly associated with SSLs. The WASP classification had high accuracy in the diagnosis of SSLs.
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Affiliation(s)
- Nhu Thi Hanh Vu
- Department of Internal MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
- GI Endoscopy DepartmentUniversity Medical Center Ho Chi Minh CityHo Chi MinhVietnam
| | - Huy Minh Le
- GI Endoscopy DepartmentUniversity Medical Center Ho Chi Minh CityHo Chi MinhVietnam
- Department of Histology‐Embryology and PathologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
| | - Diem Thi‐Ngoc Vo
- Department of Histology‐Embryology and PathologyUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
| | - Nhan Quang Le
- GI Endoscopy DepartmentUniversity Medical Center Ho Chi Minh CityHo Chi MinhVietnam
| | | | - Duc Trong Quach
- Department of Internal MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi MinhVietnam
- GI Endoscopy DepartmentUniversity Medical Center Ho Chi Minh CityHo Chi MinhVietnam
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20
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Rouphael C, El Halabi J, Bena J, McMichael J, Burke CA. Impact of Clinical and Endoscopic Features on the Development of Metachronous Colorectal Advanced Serrated Lesions. Clin Gastroenterol Hepatol 2024; 22:1117-1126.e6. [PMID: 37544421 DOI: 10.1016/j.cgh.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS High-risk adenomas predict metachronous advanced adenomatous neoplasia. Limited data exist on predictors of metachronous advanced serrated lesions (mASLs). We analyzed clinical and endoscopic predictors of mASLs. METHODS In this retrospective cohort study, adults with >1 outpatient colonoscopy between 2008 and 2019 at a tertiary center were included. Serrated lesions (SLs) included sessile SLs (SSLs), traditional serrated adenomas (TSAs), and hyperplastic polyps (HPs). Patient and endoscopic characteristics were obtained using electronic medical records. Five-year cumulative incidence of mASL (HP ≥10 mm, SSL ≥10 mm or with dysplasia, any TSA) and factors associated with mASL were evaluated using Kaplan-Meier estimates and Cox proportional hazards models. RESULTS A total of 4990 patients were included and 45.4% were women. Mean age was 60.9 ± 9.2 years and median follow-up time was 3.7 years. Female sex and active smoking were associated with mASL. Endoscopically, any SSL and TSA were associated with mASL. The 5-year cumulative incidence for mASL was 26% (95% confidence interval [CI], 18%-32%) for SSL ≥10 mm, 17% (95% CI, 3.5%-29%) for HP ≥10 mm, 21% (95% CI, 0%-42%) for 3-4 SSLs <10 mm, 18% (95% CI, 0%-38%) for TSA, and 27% (95% CI, 3.6%-45%) for SSL with low-grade dysplasia. Baseline synchronous nonadvanced SL and nonadvanced adenoma were not associated with mASL. CONCLUSIONS Our data support current recommendations for a 3-year surveillance interval in patients with baseline SSL ≥10 mm, SSL with dysplasia, and TSA. A 3-year interval may be more appropriate than 3-5 years for patients with baseline HP ≥10 mm or 3-4 SSLs <10 mm. Patients with synchronous nonadvanced SLs and adenomas do not appear to be at increased risk of mASL.
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Affiliation(s)
- Carol Rouphael
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio.
| | | | - James Bena
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - John McMichael
- Digestive Disease and Surgery Institute, Cleveland Clinic, Ohio
| | - Carol A Burke
- Department of Gastroenterology, Hepatology, and Nutrition, Cleveland Clinic, Cleveland, Ohio
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21
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Soo JMP, Koh FHX. Detection of sessile serrated adenoma using artificial intelligence-enhanced endoscopy: an Asian perspective. ANZ J Surg 2024; 94:362-365. [PMID: 38149749 DOI: 10.1111/ans.18785] [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: 05/09/2023] [Accepted: 11/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND As the serrated pathway has gained prominence as an alternative colorectal carcinogenesis pathway, sessile serrated adenomas or polyps (SSA/P) have been highlighted as lesions to rule out during colonoscopy. These lesions are however morphologically difficult to detect on endoscopy and can be mistaken for hyperplastic polyps due to similar endoscopic features. With the underlying nature of rapid progression and malignant transformation, interval cancer is a likely consequence of undetected or overlooked SSA/P. Real-time artificial intelligence (AI)-assisted colonoscopy via the computer-assisted detection system (CADe) is an increasingly useful tool in improving adenoma detection rate by providing a second eye during the procedure. In this article, we describe a guide through a video to illustrate the detection of SSA/P during AI-assisted colonoscopy. METHODS Consultant-grade endoscopists utilized real-time AI-assisted colonoscopy device, as part of a larger prospective study, to detect suspicious lesions which were later histopathologically confirmed to be SSA/P. RESULTS All lesions were picked up by the CADe where a real-time green box highlighted suspicious polyps to the clinician. Three SSA/P of varying morphology are described with reference to classical SSA/P features and with comparison to the features of the hyperplastic polyp found in our study. All three SSA/P observed are in keeping with the JNET Classification (Type 1). CONCLUSION In conclusion, CADe is a most useful aid to clinicians during endoscopy in the detection of SSA/P but must be complemented with factors such as good endoscopy skill and bowel prep for effective detection, and biopsy coupled with subsequent accurate histological diagnosis.
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Affiliation(s)
- Joycelyn Mun-Peng Soo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Frederick Hong-Xiang Koh
- Colorectal Service, Department of General Surgery, Sengkang General Hospital, SingHealth Services, Singapore, Singapore
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22
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Barnell EK, Wurtzler EM, La Rocca J, Fitzgerald T, Petrone J, Hao Y, Kang Y, Holmes FL, Lieberman DA. Multitarget Stool RNA Test for Colorectal Cancer Screening. JAMA 2023; 330:1760-1768. [PMID: 37870871 PMCID: PMC10594178 DOI: 10.1001/jama.2023.22231] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
Importance Noninvasive tests for colorectal cancer screening must include sensitive detection of colorectal cancer and precancerous lesions. These tests must be validated for the intended-use population, which includes average-risk individuals 45 years or older. Objective To evaluate the sensitivity and specificity of a noninvasive, multitarget stool RNA (mt-sRNA) test (ColoSense) test compared with results from a colonoscopy. Design, Setting, and Participants This phase 3 clinical trial (CRC-PREVENT) was a blinded, prospective, cross-sectional study to support a premarket approval application for a class III medical device. A total of 8920 participants were identified online using social media platforms and enrolled from June 2021 to June 2022 using a decentralized nurse call center. All participants completed the mt-sRNA test, which incorporated a commercially available fecal immunochemical test (FIT), concentration of 8 RNA transcripts, and participant-reported smoking status. Stool samples were collected prior to participants completing a colonoscopy at their local endoscopy center. The mt-sRNA test results (positive or negative) were compared with index lesions observed on colonoscopy. Over the course of 12 months, individuals 45 years and older were enrolled in the clinical trial using the decentralized recruitment strategy. Participants were enrolled from 49 US states and obtained colonoscopies at more than 3800 different endoscopy centers. Main Outcomes and Measures The primary outcomes included the sensitivity of the mt-sRNA test for detecting colorectal cancer and advanced adenomas and the specificity for no lesions on colonoscopy. Results The mean (range) age of participants was 55 (45-90) years, with 4% self-identified as Asian, 11% as Black, and 7% as Hispanic. Of the 8920 eligible participants, 36 (0.40%) had colorectal cancer and 606 (6.8%) had advanced adenomas. The mt-sRNA test sensitivity for detecting colorectal cancer was 94%, sensitivity for detecting advanced adenomas was 46%, and specificity for no lesions on colonoscopy was 88%. The mt-sRNA test showed significant improvement in sensitivity for colorectal cancer (94% vs 78%; McNemar P = .01) and advanced adenomas (46% vs 29%; McNemar P < .001) compared with results of the FIT. Conclusions and Relevance In individuals 45 years and older, the mt-sRNA test showed high sensitivity for colorectal neoplasia (colorectal cancer and advanced adenoma) with significant improvement in sensitivity relative to the FIT. Specificity for no lesions on colonoscopy was comparable to existing molecular diagnostic tests. Trial Registration ClinicalTrials.gov Identifier: NCT04739722.
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Affiliation(s)
- Erica K. Barnell
- Department of Medicine, Washington University School of Medicine, St Louis, Missouri
- McDonnell Genome Institute, Washington University School of Medicine, St Louis, Missouri
- Geneoscopy Inc, St Louis, Missouri
| | | | | | | | | | - Yansheng Hao
- University of Rochester Medical Center, Rochester, New York
| | | | | | - David A. Lieberman
- Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland
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Wang RG, Ren YT, Jiang X, Wei L, Zhang XF, Liu H, Jiang B. Usefulness of analyzing endoscopic features in identifying the colorectal serrated sessile lesions with and without dysplasia. World J Clin Cases 2023; 11:6995-7003. [PMID: 37946753 PMCID: PMC10631427 DOI: 10.12998/wjcc.v11.i29.6995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Sessile serrated lesions (SSLs) are often missed on colonoscopy, and studies have shown this to be an essential cause of interstitial colorectal cancer. The SSLs with dysplasia (SSL-D+), in particular, have a faster rate of carcinogenesis than conventional tubular adenomas. Therefore, there is a clinical need for some endoscopic features with independent diagnostic value for SSL-D+s to assist endoscopists in making immediate diagnoses, thus improving the quality of endoscopic examination and treatment. AIM To compare the characteristics of SSLs, including those with and without dysplasia (SSL-D+ and SSL-D-), based on white light and image-enhanced endoscopy, to achieve an immediate differential diagnosis for endoscopists. METHODS From January 2017 to February 2023, cases of colorectal SSLs confirmed by colonoscopy and histopathology at the Gastrointestinal Endoscopy Center of Beijing Tsinghua Changgung Hospital were collected. The general, endoscopic, and histopathological data were reviewed and analyzed to determine the diagnostic utility. Univariate analysis was used to find potential diagnostic factors, and then multivariate regression analysis was performed to derive endoscopic features with independent diagnostic values for the SSL-D+. RESULTS A total of 228 patients with 253 lesions were collected as a result. There were 225 cases of colorectal SSL-D-s and 28 cases of SSL-D+s. Compared to the colorectal SSL-D-, the SSL-D+ was more common in the right colon (P = 0.027) with complex patterns of depression, nodule, and elevation based on cloud-like surfaces (P = 0.003), reddish (P < 0.001), microvascular varicose (P < 0.001), and mixed type (Pit II, II-O, IIIL, IV) of crypt opening based on Pit II-O (P < 0.001). Multifactorial logistic regression analysis indicated that lesions had a reddish color [odds ratio (OR) = 18.705, 95% confidence interval (CI): 3.684-94.974], microvascular varicose (OR = 6.768, 95%CI: 1.717-26.677), and mixed pattern of crypt opening (OR = 20.704, 95%CI: 2.955-145.086) as the independent predictors for SSL-D+s. CONCLUSION The endoscopic feature that has independent diagnostic value for SSL-D+ is a reddish color, microvascular varicose, and mixed pattern of crypt openings.
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Affiliation(s)
- Rui-Gang Wang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Yu-Tang Ren
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xuan Jiang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Lai Wei
- Center for Hepatobiliary and Pancreatic Diseases, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xiao-Fei Zhang
- Center for Clinical Epidemiology and Statistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Hao Liu
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Bo Jiang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Wu Z, Yao L, Liu W, Zhang S, Zhang L, Lu Z, Wang J, Chen B, Luo R, Li X, Gong R, Luo C, Xu Y, Zeng Z, Yu H. Development and Validation of a Deep Learning-Based Histologic Diagnosis System for Diagnosing Colorectal Sessile Serrated Lesions. Am J Clin Pathol 2023; 160:394-403. [PMID: 37279532 DOI: 10.1093/ajcp/aqad058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
OBJECTIVES The histopathologic diagnosis of colorectal sessile serrated lesions (SSLs) and hyperplastic polyps (HPs) is of low consistency among pathologists. This study aimed to develop and validate a deep learning (DL)-based logical anthropomorphic pathology diagnostic system (LA-SSLD) for the differential diagnosis of colorectal SSL and HP. METHODS The diagnosis framework of the LA-SSLD system was constructed according to the current guidelines and consisted of 4 DL models. Deep convolutional neural network (DCNN) 1 was the mucosal layer segmentation model, DCNN 2 was the muscularis mucosa segmentation model, DCNN 3 was the glandular lumen segmentation model, and DCNN 4 was the glandular lumen classification (aberrant or regular) model. A total of 175 HP and 127 SSL sections were collected from Renmin Hospital of Wuhan University during November 2016 to November 2022. The performance of the LA-SSLD system was compared to 11 pathologists with different qualifications through the human-machine contest. RESULTS The Dice scores of DCNNs 1, 2, and 3 were 93.66%, 58.38%, and 74.04%, respectively. The accuracy of DCNN 4 was 92.72%. In the human-machine contest, the accuracy, sensitivity, and specificity of the LA-SSLD system were 85.71%, 86.36%, and 85.00%, respectively. In comparison with experts (pathologist D: accuracy 83.33%, sensitivity 90.91%, specificity 75.00%; pathologist E: accuracy 85.71%, sensitivity 90.91%, specificity 80.00%), LA-SSLD achieved expert-level accuracy and outperformed all the senior and junior pathologists. CONCLUSIONS This study proposed a logical anthropomorphic diagnostic system for the differential diagnosis of colorectal SSL and HP. The diagnostic performance of the system is comparable to that of experts and has the potential to become a powerful diagnostic tool for SSL in the future. It is worth mentioning that a logical anthropomorphic system can achieve expert-level accuracy with fewer samples, providing potential ideas for the development of other artificial intelligence models.
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Affiliation(s)
- Zhifeng Wu
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Liwen Yao
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Wen Liu
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiying Zhang
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihui Zhang
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Zihua Lu
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Jing Wang
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Boru Chen
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Renquan Luo
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Xun Li
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Rongrong Gong
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Chaijie Luo
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Youming Xu
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
| | - Zhi Zeng
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Honggang Yu
- Department of Gastroenterology, Key Laboratory of Hubei Province for Digestive System Disease, Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision
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Baile-Maxía S, Jover R. Surveillance after colorectal polyp resection. Best Pract Res Clin Gastroenterol 2023; 66:101848. [PMID: 37852710 DOI: 10.1016/j.bpg.2023.101848] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 07/02/2023] [Indexed: 10/20/2023]
Abstract
Post-polypectomy surveillance has proven to reduce colorectal cancer (CRC) incidence in patients with high-risk polyps, but it implies a major burden on colonoscopy units. Therefore, it should be targeted to individuals with a higher risk. Different societies have published guidelines on surveillance after resection of polyps, with notable discrepancies among them, and many recommendations come from low-quality evidence based on surrogate measures, such as risk of advanced adenoma, and not CRC risk. In this review, we aimed to summarize the evidence supporting post-polypectomy surveillance, compare the recently updated major guidelines, and discuss the existing discrepancies on this topic. Briefly, patients with adenomas ≥10 mm or high-grade dysplasia and patients with serrated polyps ≥10 mm or dysplasia are generally considered to have an increased risk of metachronous CRC and require surveillance, whereas the indication of surveillance is not clearly established in patients without these high-risk features.
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Affiliation(s)
- Sandra Baile-Maxía
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain
| | - Rodrigo Jover
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Instituto de Investigación Biomédica ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
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Butterly LF, Hisey WM, Robinson CM, Limburg PJ, Kneedler BL, Anderson JC. What do 'false-positive' stool tests really mean? Data from the New Hampshire colonoscopy registry. Prev Med Rep 2023; 35:102309. [PMID: 37449002 PMCID: PMC10336791 DOI: 10.1016/j.pmedr.2023.102309] [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: 02/27/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
We utilized the population-based New Hampshire Colonoscopy Registry to calculate false discovery rates (FDR) and positive predictive values (PPVs) using three 'positive' colonoscopy definitions. Understanding the frequency of meaningful 'true positive' mt-sDNA and Fecal Immunochemical Test (FIT) results can optimize the use of these colorectal cancer (CRC) screening tests. We calculated FDR (positive stool test followed by negative colonoscopy divided by all positive stool tests) and PPV for mt-sDNA and FIT cohorts using the following definitions: 1) DeeP-C Study (CRC, adenomas/serrated polyps ≥ 1 cm, villous/High Grade Dysplasia); 2) < 10 year US Multi-Society Task Force (USMSTF) follow-up: DeeP-C findings & ≥1 sessile serrated polyps (SSPs) < 1 cm (with/without dysplasia) or ≥ 1 tubular adenomas < 1 cm. 3) Clinically Significant: DeeP-C + USMSTF + clinically significant serrated polyps: traditional serrated adenomas, SSPs, hyperplastic polyps (HPs) > 1 cm, and 5-9 mm proximal HPs. The sample included 549 mt-sDNA + and 410 FIT + and patients (mean age 66.4, 43.0% male). Using the most limited definition of positive colonoscopy, DeeP-C, FDR was 71.9% for mt-sDNA + and 81.7% for FIT +. Using the USMSTF definition, FDR decreased substantially: mt-sDNA+:33.2% and FIT+:47.6%. Adding all CSSPs resulted in the lowest FDR: mt-sDNA+:32.2% and FIT+:47.1%. Decreasing FDRs corresponded to increasing PPVs: mt-sDNA+:28.1% and FIT+:18.3% (DeeP-C definition) and mt-sDNA+:67.8% and FIT+:52.9% (DeeP-C + USMSTF + CSSP) (Table 1). FDRs decreased substantially when the definition of positive exams included all significant precancerous findings. These data present a comprehensive understanding of false positive outcomes at colonoscopies following positive stool tests, which to our knowledge is the first such analysis.
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Affiliation(s)
- Lynn F. Butterly
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- NH Colonoscopy Registry, Lebanon, NH, United States
| | - William M. Hisey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- NH Colonoscopy Registry, Lebanon, NH, United States
| | - Christina M. Robinson
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States
- NH Colonoscopy Registry, Lebanon, NH, United States
| | - Paul J. Limburg
- Mayo Clinic, Rochester, MN, United States
- Exact Sciences, Madison, WI, United States
| | | | - Joseph C. Anderson
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
- White River Junction VAMC White River Junction VT, United States
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Nagai M, Suzuki S, Minato Y, Ishibashi F, Mochida K, Ohata K, Morishita T. Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials. Clin Endosc 2023; 56:553-562. [PMID: 37491990 PMCID: PMC10565430 DOI: 10.5946/ce.2023.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 07/27/2023] Open
Abstract
Colonoscopy plays an important role in reducing the incidence and mortality of colorectal cancer by detecting adenomas and other precancerous lesions. Image-enhanced endoscopy (IEE) increases lesion visibility by enhancing the microstructure, blood vessels, and mucosal surface color, resulting in the detection of colorectal lesions. In recent years, various IEE techniques have been used in clinical practice, each with its unique characteristics. Numerous studies have reported the effectiveness of IEE in the detection of colorectal lesions. IEEs can be divided into two broad categories according to the nature of the image: images constructed using narrowband wavelength light, such as narrowband imaging and blue laser imaging/blue light imaging, or color images based on white light, such as linked color imaging, texture and color enhancement imaging, and i-scan. Conversely, artificial intelligence (AI) systems, such as computer-aided diagnosis systems, have recently been developed to assist endoscopists in detecting colorectal lesions during colonoscopy. To better understand the features of each IEE, this review presents the effectiveness of each type of IEE and their combination with AI for colorectal lesion detection by referencing the latest research data.
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Affiliation(s)
- Mizuki Nagai
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Yohei Minato
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Fumiaki Ishibashi
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Kentaro Mochida
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
| | - Ken Ohata
- Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tetsuo Morishita
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Chiba, Japan
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van Toledo D, IJspeert J, Spaander M, Nagtegaal I, van Leerdam M, Lansdorp-Vogelaar I, Dekker E. Colorectal cancer risk after removal of polyps in fecal immunochemical test based screening. EClinicalMedicine 2023; 61:102066. [PMID: 37528844 PMCID: PMC10388570 DOI: 10.1016/j.eclinm.2023.102066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 08/03/2023] Open
Abstract
Background Colonoscopy surveillance intervals are based on the predicted risk of metachronous colorectal cancer (CRC) after polyp removal. However, risk estimation per polyp subtype is difficult due to the fact that many patients have multiple polyps. To enable risk estimation per polyp subtypes we examined the metachronous CRC risk of subgroups based on presence or absence of co-occurring findings. Methods Using high-quality screening colonoscopies performed after a positive fecal immunochemical test between 2014 and 2020 within the Dutch CRC screening program, we applied Cox regression analysis to evaluate the association between findings at baseline colonoscopy and metachronous CRCs. For our primary outcome, we appointed each patient to unique subgroups based on removed polyp subtypes that were present or absent at baseline colonoscopy and used the groups without polyps as reference. High-risk subgroups were individuals with high-risk serrated polyps, defined as serrated polyp ≥10 mm, sessile serrated lesions with dysplasia, or traditional serrated adenomas, as well as high-risk adenomas, defined as adenoma ≥10 mm or containing high-grade dysplasia. Findings In total 253,833 colonoscopies were included. Over a median follow-up of 36 months (IQR, 21-57), we identified 504 metachronous CRCs. Hazard ratios for metachronous CRC was 1.70 (95% CI, 1.07-2.69) for individuals with high-risk serrated polyps without high-risk adenomas, 1.22 (0.96-1.55) for individuals with high-risk adenomas without high-risk serrated polyps, and 2.00 (1.19-3.39) for individuals with high-risk serrated polyps and high-risk adenomas, compared to patients without polyps. Interpretation Accounting for co-occurring findings, we observed an increased metachronous CRC risk for individuals that had high-risk serrated polyps with the presence of high-risk adenomas, or individuals with high-risk serrated polyps without high-risk adenomas. These findings could provide more evidence to support post-polypectomy surveillance guidelines. Funding None.
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Affiliation(s)
- D.E.F.W.M. van Toledo
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - J.E.G. IJspeert
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - M.C.W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - I.D. Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M.E. van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - I. Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - E. Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
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Wang XY, Zhou YJ, Chen HY, Chen JN, Chen SS, Chen HM, Li XB. 5’tiRNA-Pro-TGG, a novel tRNA halve, promotes oncogenesis in sessile serrated lesions and serrated pathway of colorectal cancer. World J Gastrointest Oncol 2023; 15:1005-1018. [PMID: 37389118 PMCID: PMC10302996 DOI: 10.4251/wjgo.v15.i6.1005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/27/2023] [Accepted: 04/17/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Transfer RNA (tRNA)-derived small RNAs (tsRNAs) are small fragments that form when tRNAs severe. tRNA halves (tiRNAs), a subcategory of tsRNA, are involved in the oncogenic processes of many tumors. However, their specific role in sessile serrated lesions (SSLs), a precancerous lesion often observed in the colon, has not yet been elucidated.
AIM To identify SSL-related tiRNAs and their potential role in the development of SSLs and serrated pathway of colorectal cancer (CRC).
METHODS Small-RNA sequencing was conducted in paired SSLs and their adjacent normal control (NC) tissues. The expression levels of five SSL-related tiRNAs were validated by q-polymerase chain reaction. Cell counting kit-8 and wound healing assays were performed to detect cell proliferation and migration. The target genes and sites of tiRNA-1:33-Pro-TGG-1 (5′tiRNA-Pro-TGG) were predicted by TargetScan and miRanda algorithms. Metabolism-associated and immune-related pathways were analyzed by single-sample gene set enrichment analysis. Functional analyses were performed to establish the roles of 5′tiRNA-Pro-TGG based on the target genes.
RESULTS In total, we found 52 upregulated tsRNAs and 28 downregulated tsRNAs in SSLs compared to NC. The expression levels of tiRNA-1:33-Gly-CCC-2, tiRNA-1:33-Pro-TGG-1, and tiRNA-1:34-Thr-TGT-4-M2 5′tiRNAs were higher in SSLs than those in NC, while that of 5′tiRNA-Pro-TGG was associated with the size of SSLs. It was demonstrated that 5′tiRNA-Pro-TGG promoted cell proliferation and migration of RKO cell in vitro. Then, heparanase 2 (HPSE2) was identified as a potential target gene of 5′tiRNA-Pro-TGG. Its lower expression was associated with a worse prognosis in CRC. Further, lower expression of HPSE2 was observed in SSLs compared to normal controls or conventional adenomas and in BRAF-mutant CRC compared to BRAF-wild CRC. Bioinformatics analyses revealed that its low expression was associated with a low interferon γ response and also with many metabolic pathways such as riboflavin, retinol, and cytochrome p450 drug metabolism pathways.
CONCLUSION tiRNAs may profoundly impact the development of SSLs. 5′tiRNA-Pro-TGG potentially promotes the progression of serrated pathway CRC through metabolic and immune pathways by interacting with HPSE2 and regulating its expression in SSLs and BRAF-mutant CRC. In the future, it may be possible to use tiRNAs as novel biomarkers for early diagnosis of SSLs and as potential therapeutic targets in serrated pathway of CRC.
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Affiliation(s)
- Xin-Yuan Wang
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Yu-Jie Zhou
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Hai-Ying Chen
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Jin-Nan Chen
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Shan-Shan Chen
- Department of Spleen and Stomach and Rheumatology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Hui-Min Chen
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
| | - Xiao-Bo Li
- Division of Gastroenterology and Hepatology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200000, China
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Trivedi M, Godil S, Demb J, Earles A, Bustamante R, Patterson OV, Gawron AJ, Kaltenbach T, Mahata S, Liu L, Gupta S. Baseline Characteristics and Longitudinal Outcomes of Traditional Serrated Adenomas: A Cohort Study. Clin Gastroenterol Hepatol 2023; 21:1637-1645. [PMID: 36243354 PMCID: PMC10865336 DOI: 10.1016/j.cgh.2022.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Traditional serrated adenomas (TSAs) may confer increased risk for colorectal cancer (CRC). Our objective with this study was to examine clinical characteristics and long-term outcomes associated with TSA diagnosis. METHODS We conducted a retrospective cohort study of U.S. Veterans ≥18 years of age with ≥1 TSA between 1999 and 2018. Baseline characteristics, colonoscopy findings, and diagnosis of incident and fatal CRC were abstracted. Advanced neoplasia was defined by CRC or adenoma with high-grade dysplasia, villous histology, or size ≥1 cm. Follow-up was through CRC diagnosis, death, or end of study (December 31, 2018). RESULTS A total of 853 Veterans with a baseline TSA were identified; 74% were ≥60 years of age, 96% were men, 14% were Black, and 73% were non-Hispanic White. About 64% were current or former smokers. Over 2044 total person-years at follow-up, there were 11 incident CRC cases and 1 CRC death. Cumulative CRC incidence was 1.34% (95% confidence interval [CI], 0.67%-2.68%), and cumulative CRC death was 0.12% (95% CI, 0.00%-0.35%). Among the subset of 378 TSA patients with ≥1 surveillance colonoscopy, 65.1% had high-risk neoplasia on follow-up. CRC incidence among TSA patients was significantly higher than in a comparison cohort of patients with normal baseline colonoscopy at baseline (hazard ratio, 3.70; 95% CI, 1.63-8.41) and similar to a comparison cohort with baseline conventional advanced adenoma (hazard ratio, 0.86; 95% CI, 0.45-1.64). CONCLUSION Individuals with TSA have substantial risk for CRC based on their cumulative CRC incidence, as well as significant risk of developing other high-risk neoplasia at follow-up surveillance colonoscopy. These data underscore importance of current recommendations for close colonoscopy surveillance after TSA diagnosis.
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Affiliation(s)
- Mehul Trivedi
- Department of Internal Medicine, University of California San Diego, San Diego, California
| | - Suha Godil
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California; Veterans Medical Research Foundation, San Diego, California; Western University of Health Sciences, Pomona, California
| | - Joshua Demb
- Division of Gastroenterology, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California
| | - Ashley Earles
- Veterans Medical Research Foundation, San Diego, California; Jennifer Moreno Veteran Affairs San Diego Healthcare System, San Diego, California
| | - Ranier Bustamante
- Moores Cancer Center, University of California San Diego, La Jolla, California; Jennifer Moreno Veteran Affairs San Diego Healthcare System, San Diego, California
| | - Olga V Patterson
- Division of Epidemiology, University of Utah, Salt Lake City, Utah; VA Salt Lake City Medical Center, Salt Lake City, Utah
| | - Andrew J Gawron
- VA Salt Lake City Health Care System, Salt Lake City, Utah; Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Tonya Kaltenbach
- San Francisco VA Medical Center, San Francisco, California; School of Medicine, University of California, San Francisco, San Francisco, California
| | - Sumana Mahata
- School of Medicine, University of California San Diego, San Diego, California
| | - Lin Liu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Jennifer Moreno Veteran Affairs San Diego Healthcare System, San Diego, California
| | - Samir Gupta
- Division of Gastroenterology, University of California San Diego, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Jennifer Moreno Veteran Affairs San Diego Healthcare System, San Diego, California.
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Wang RG, Wei L, Jiang B. Current progress on the endoscopic features of colorectal sessile serrated lesions. World J Clin Oncol 2023; 14:171-178. [PMID: 37124132 PMCID: PMC10134204 DOI: 10.5306/wjco.v14.i4.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023] Open
Abstract
Along with the discovery and refinement of serrated pathways, the World Health Organization amended the classification of digestive system tumors in 2019, recommending the renaming of sessile serrated adenomas/polyps to sessile serrated lesions (SSLs). Given the particularity of the endoscopic appearance of SSLs, it could easily be overlooked and missed in colonoscopy screening, which is crucial for the occurrence of interval colorectal cancer. Existing literature has found that adequate bowel preparation, reasonable withdrawal time, and awareness of colorectal SSLs have improved the quality and accuracy of detection. More particularly, with the continuous advancement and development of endoscopy technology, equipment, and accessories, a potent auxiliary tool is provided for accurate observation and immediate diagnosis of SSLs. High-definition white light endoscopy, chromoendoscopy, and magnifying endoscopy have distinct roles in the detection of colorectal SSLs and are valuable in identifying the size, shape, character, risk degree, and potential malignant tendency. This article delves into the relevant factors influencing the detection rate of colorectal SSLs, reviews its characteristics under various endoscopic techniques, and expects to attract the attention of colonoscopists.
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Affiliation(s)
- Rui-Gang Wang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Lai Wei
- Department of Digestive Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Bo Jiang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Bateman AC, Booth AL, Gonzalez RS, Shepherd NA. Microvesicular hyperplastic polyp and sessile serrated lesion of the large intestine: a biological continuum or separate entities? J Clin Pathol 2023:jcp-2023-208783. [PMID: 36927607 DOI: 10.1136/jcp-2023-208783] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023]
Abstract
The range of lesions with a serrated appearance within the large intestine has expanded and become more complex over the last 30 years. The majority of these were previously known as metaplastic polyps but are today called hyperplastic polyps (HPs). HPs show two main growth patterns: microvesicular and goblet cell-rich. The former type shows morphological and molecular similarities (eg, BRAF mutations) to the more recently described sessile serrated lesion (SSL). In this review, we debate whether these lesions represent a biological spectrum or separate entities. Whichever view is held, microvesicular HPs and SSLs are distinct from the goblet cell-rich HP and the traditional serrated adenoma (TSA), which may themselves share molecular changes (eg, KRAS mutations), with the goblet cell-rich HP representing a precursor to the TSA. Both SSLs and the goblet cell-rich HP-TSA pathway are routes to colorectal cancer within the serrated pathway and overlaps between them can occur, for example, a (BRAF-mutated) TSA may arise from an SSL.
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Affiliation(s)
- Adrian C Bateman
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Adam L Booth
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raul S Gonzalez
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Neil A Shepherd
- Gloucestershire Cellular Pathology Laboratory, Cheltenham, UK
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Vithayathil M, Smith S, Song M. Epidemiology of overall and early-onset serrated polyps versus conventional adenomas in a colonoscopy screening cohort. Int J Cancer 2023; 152:1085-1094. [PMID: 36178673 DOI: 10.1002/ijc.34306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/12/2022] [Accepted: 09/23/2022] [Indexed: 01/21/2023]
Abstract
Serrated polyps (SPs) are precursors to one-third of colorectal cancers (CRCs), with histological subtypes: hyperplastic polyps (HPs), sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs). The incidence of early-onset CRC before the age of 50 is increasing, with limited understanding of SPs in younger cohorts. Using a large colonoscopy-based cohort, we characterized epidemiologic profiles of SP subtypes, compared to conventional adenomas, with secondary analysis on early-onset polyps. Ninety-four thousand four hundred and twenty-seven patients underwent screening colonoscopies between 2010 and 2018. Demographic, endoscopic and histopathologic characteristics of each polyp subtype were described. High-risk polyps included SSLs ≥10 mm/with dysplasia and conventional adenomas ≥10 mm/with tubulovillous/villous histology/high-grade dysplasia. We examined polyp prevalence with age and compared early- (age < 50) and late-onset polyps (age ≥ 50). Eighteen thousand one hundred and twenty-five patients had SPs (4357 SSLs, 15 415 HPs, 120 TSAs) and 26 699 had conventional adenomas. High-risk SSLs were enriched in the ascending colon (44.1% vs 2.6-35.8% for other locations; P < .003). Early- and late-onset SPs had similar subsite distribution. Early-onset conventional adenomas were more enriched in the distal colon/rectum (51.8% vs 43.4%, P < .001). Multiple conventional adenomas were more represented in late-onset groups (40.8% vs 33.8%, P < .001), with no difference in SSLs. The prevalence of conventional adenomas/high-risk conventional adenomas increased continuously with age, whereas the prevalence of SSLs/high-risk SSLs was stable from age 40 years onwards. A higher proportion of women were diagnosed with early-onset than late-onset SSLs (62.9% vs 57.6%, P = .03). Conventional adenomas, SSLs, early- and late-onset polyps have distinct epidemiology. The findings have implications for improved colonoscopy screening and surveillance and understanding the etiologic heterogeneity of CRC.
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Affiliation(s)
- Mathew Vithayathil
- Department of Epidemiology and Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Scott Smith
- Department of Epidemiology and Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Mingyang Song
- Department of Epidemiology and Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Laugesen K, Mengel-From J, Christensen K, Olsen J, Hougaard DM, Boding L, Olsen A, Erikstrup C, Hetland ML, Høgdall E, Kjaergaard AD, Sørensen E, Brügmann A, Petersen ERB, Brandslund I, Nordestgaard BG, Jensen GB, Skajaa N, Troelsen FS, Fuglsang CH, Svingel LS, Sørensen HT. A Review of Major Danish Biobanks: Advantages and Possibilities of Health Research in Denmark. Clin Epidemiol 2023; 15:213-239. [PMID: 36852012 PMCID: PMC9960719 DOI: 10.2147/clep.s392416] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/20/2023] [Indexed: 02/23/2023] Open
Abstract
Biobank research may lead to an improved understanding of disease etiology and advance personalized medicine. Denmark (population ~5.9 million) provides a unique setting for population-based health research. The country is a rich source of biobanks and the universal, tax-funded healthcare system delivers routinely collected data to numerous registries and databases. By virtue of the civil registration number (assigned uniquely to all Danish citizens), biological specimens stored in biobanks can be combined with clinical and demographic data from these population-based health registries and databases. In this review, we aim to provide an understanding of advantages and possibilities of biobank research in Denmark. As knowledge about the Danish setting is needed to grasp the full potential, we first introduce the Danish healthcare system, the Civil Registration System, the population-based registries, and the interface with biobanks. We then describe the biobank infrastructures, comprising the Danish National Biobank Initiative, the Bio- and Genome Bank Denmark, and the Danish National Genome Center. Further, we briefly provide an overview of fourteen selected biobanks, including: The Danish Newborn Screening Biobank; The Danish National Birth Cohort; The Danish Twin Registry Biobank; Diet, Cancer and Health; Diet, Cancer and Health - Next generations; Danish Centre for Strategic Research in Type 2 Diabetes; Vejle Diabetes Biobank; The Copenhagen Hospital Biobank; The Copenhagen City Heart Study; The Copenhagen General Population Study; The Danish Cancer Biobank; The Danish Rheumatological Biobank; The Danish Blood Donor Study; and The Danish Pathology Databank. Last, we inform on practical aspects, such as data access, and discuss future implications.
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Affiliation(s)
- Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Jonas Mengel-From
- Epidemiology, Biostatistics and Biodemography, the Danish Twin Registry, and the Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, the Danish Twin Registry, and the Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Genetics, Odense University Hospital, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - David M Hougaard
- iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark.,Center for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Lasse Boding
- The Danish National Biobank, Statens Serum Institut, Copenhagen, Denmark
| | - Anja Olsen
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Merete Lund Hetland
- The DANBIO Registry and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Estrid Høgdall
- Department of Clinical Medicine, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark.,Bio- and GenomeBank Denmark (RBGB), Molecular Unit, Department of Pathology, Herlev Hospital, Herlev, Denmark
| | - Alisa D Kjaergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Erik Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Anja Brügmann
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Ivan Brandslund
- Department of Clinical Biochemistry and Immunology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Børge G Nordestgaard
- The Copenhagen General Population Study, Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev Gentofte, University of Copenhagen, Herlev, Denmark
| | - Gorm B Jensen
- The Copenhagen City Heart Study, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark
| | - Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | | | | | - Lise Skovgaard Svingel
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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35
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Laursen ASD, Jensen BW, Strate LL, Sørensen TIA, Baker JL, Sørensen HT. Birth weight, childhood body mass index, and risk of diverticular disease in adulthood. Int J Obes (Lond) 2023; 47:207-214. [PMID: 36698028 DOI: 10.1038/s41366-023-01259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Adult overweight is associated with increased risk of diverticular disease (DD). We investigated associations between birthweight and childhood body mass index (BMI) and DD. METHODS Cohort study of 346,586 persons born during 1930-1996 with records in the Copenhagen School Health Records Register. Data included birthweight, and height and weight from ages 7 through 13. We used Cox proportional hazard regression to examine associations between birthweight and BMI z-scores and DD registered in the Danish National Patient Registry. Due to non-proportionality, we followed participants from age 18-49 and from age 50. RESULTS During follow-up, 5459 (3.2%) women and 4429 (2.5%) men had DD. For low and high BMI in childhood, we observed a higher risk of DD before age 50. Among women with z-scores <0 at age 13, the hazard ratio (HR) was 1.16 [95% confidence interval (CI): 0.98-1.39] per one-point lower z-score. For z-scores ≥0 at age 13, the HR was 1.30 (95% CI: 1.11-1.51) per one-point higher z-score. Among men with z-scores <0 at age 13, the HR was 1.02 (95% CI: 0.85-1.22). For z-scores ≥0 at age 13, the HR was 1.54 (95% CI: 1.34-1.78). Z-scores ≥0 were not associated with DD after age 50. Among women only, birthweight was inversely associated with DD before age 50 [HR = 0.90 (95% CI: 0.83-0.99) per 500 g higher birthweight]. CONCLUSION BMI z-scores below and above zero in childhood were associated with higher risk of DD before age 50. In addition, we observed lower risk of DD among women, the higher their birthweight.
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Affiliation(s)
- Anne Sofie D Laursen
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
| | - Britt W Jensen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Lisa L Strate
- Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, USA
| | - Thorkild I A Sørensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Genomic Physiology and Translation Program, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Department of Public Health, Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henrik T Sørensen
- Department of Clinical Medicine, Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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36
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Anderson JC, Hisey WM, Robinson CM, Limburg PJ, Kneedler BL, Butterly LF. Serrated Polyp Yield at Colonoscopy in Patients with Positive FIT, Positive mt-sDNA, and Colonoscopy Only: Data from the New Hampshire Colonoscopy Registry. Cancer Epidemiol Biomarkers Prev 2023; 32:226-232. [PMID: 36409472 PMCID: PMC9900318 DOI: 10.1158/1055-9965.epi-22-0527] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/25/2022] [Accepted: 11/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stool-based screening with fecal immunochemical (FIT) or multitarget-stool DNA (mt-sDNA) tests is associated with increased colonoscopy polyp yield. mt-sDNA includes methylated markers, which improve detection of serrated polyps (SP) versus FIT. We compared SP detection in colonoscopies performed for positive FIT or mt-sDNA tests, as well as in colonoscopies without a preceding stool test, using the New Hampshire Colonoscopy Registry, a comprehensive statewide population-based registry. METHODS Across the three groups, we compared the frequency of clinically relevant SPs (CRSP: sessile SPs, hyperplastic polyps ≥10 mm, and traditional serrated adenomas). We also compared SP size, histology, number, and bulk (combined sizes). RESULTS Our sample included 560 mt-sDNA+ (age ± SD: 66.5 ± 7.9), 414 FIT+ (age ± SD: 66.3 ± 8.8), and 59,438 colonoscopy-only patients (age ± SD: 61.7 ± 8.0). mt-sDNA+ patients were more likely to have a higher yield of CRSPs and CRSP bulk than FIT+ (P < 0.0001) or colonoscopy-only patients (P < 0.0001). More mt-sDNA+ patients had CRSPs without large adenomas or colorectal cancers (17.9% vs. 9.9% of FIT+ and 8% of colonoscopy-only patients). After adjusting for synchronous large adenomas, colorectal cancers, and other risk factors, mt-sDNA+ patients were more likely (OR, 1.82; 95% CI, 1.18-2.85) than FIT+ patients to have CRSPs. CONCLUSIONS mt-sDNA+ patients had a higher SP yield than FIT+ or colonoscopy-only patients, particularly in the absence of synchronous large adenomas or colorectal cancer. IMPACT Our results suggest that screening with mt-sDNA tests could improve colorectal cancer screening by identifying more patients at increased risk from the serrated pathway.
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Affiliation(s)
- Joseph C. Anderson
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- White River Junction VAMC, WRJ, Vermont
| | - William M. Hisey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- NH Colonoscopy Registry, Lebanon, New Hampshire
| | - Christina M. Robinson
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- NH Colonoscopy Registry, Lebanon, New Hampshire
| | - Paul J. Limburg
- Mayo Clinic, Rochester, Minnesota
- Exact Sciences Corporation, Madison, Wisconsin
| | | | - Lynn F. Butterly
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- NH Colonoscopy Registry, Lebanon, New Hampshire
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37
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van Toledo DEFWM, Breekveldt ECH, IJspeert JEG, van Vuuren AJ, van Kemenade FJ, Ramakers C, Nagtegaal ID, van Leerdam ME, Spaander MCW, Lansdorp-Vogelaar I, Toes-Zoutendijk E, Dekker E. Advanced serrated polyps as a target of screening: detection rate and positive predictive value within a fecal immunochemical test-based colorectal cancer screening population. Endoscopy 2023; 55:526-534. [PMID: 36323332 DOI: 10.1055/a-1971-3488] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND : Advanced serrated polyps (ASPs) have a comparable risk to advanced adenomas for progression to colorectal cancer (CRC). The yield of most CRC screening programs, however, is based on advanced adenomas and CRC only. We assessed the ASP detection rate, and positive predictive value (PPV) including ASPs in a fecal immunochemical test (FIT)-based screening program. METHODS : We analyzed the findings of follow-up colonoscopies of FIT-positive screenees in the Dutch CRC screening program from 2014 until 2020. Data were retrieved from the national screening and pathology database. An ASP was defined as any serrated polyp of ≥ 10 mm, sessile serrated lesion with dysplasia, or traditional serrated adenoma. The ASP detection rate was defined as the proportion of colonoscopies with ≥ 1 ASP. PPV was originally defined as the proportion of individuals with a CRC or advanced adenoma. The updated PPV definition included CRCs, advanced adenomas, and/or ASPs. RESULTS : 322 882 colonoscopies were included in the analyses. The overall detection rate of ASPs was 5.9 %. ASPs were detected more often in women than men (6.3 % vs. 5.6 %; P < 0.001). ASP detection rates in individuals aged 55-59, 60-64, 65-69, and 70 + were 5.2 %, 6.1 %, 6.1 %, and 5.9 %, respectively (P < 0.001). The PPV for CRCs and advanced adenomas was 41.1 % and increased to 43.8 % when including ASPs. The PPV increase was larger in women than in men (3.2 vs. 2.4 percentage points). CONCLUSIONS : 5.9 % of FIT-positive screenees had ASPs, but half of these were detected in combination with a CRC or advanced adenoma. Therefore, including ASPs results in a small increase in the yield of FIT-based screening.
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Affiliation(s)
- David E F W M van Toledo
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Emilie C H Breekveldt
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joep E G IJspeert
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Anneke J van Vuuren
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Folkert J van Kemenade
- Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Christian Ramakers
- Department of Clinical Chemistry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Gastroenterology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, The Netherlands
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38
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Zhang Z, Liu X, Yang X, Jiang Y, Li A, Cong J, Li Y, Xie Q, Xu C, Liu D. Identification of faecal extracellular vesicles as novel biomarkers for the non-invasive diagnosis and prognosis of colorectal cancer. J Extracell Vesicles 2023; 12:e12300. [PMID: 36604402 DOI: 10.1002/jev2.12300] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/22/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common malignancies that is usually detected late in the clinic. The currently available diagnostic tools for CRC are either invasive or insensitive to early lesions due to the dearth of reliable biomarkers. In this study, we discovered that the extracellular vesicles (EVs) in the faeces of CRC patients can act as a potent biomarker for the non-invasive diagnosis and prognosis of CRC. This finding is based on the identification of two transmembrane proteins-CD147 and A33-on faeces-derived EVs (fEVs) that are intrinsically associated with CRC. The detection results show that the levels of CD147 and A33 on fEVs were upregulated in the CRC patients (n = 48), dramatically distinguishing them from the healthy donors (n = 16). The CD147/A33-enriched EVs offer a clinical sensitivity of 89%, much higher than that (40%) of carcinoembryonic antigen (CEA), a clinically-established serum biomarker for CRC diagnosis. In addition, the analysis of longitudinal faeces samples (n = 29) demonstrated that the CD147/A33-enriched fEVs can be utilized to track the prognosis of CRC. Due to the high compliance of faeces-based detection, the CD147/A33-enriched fEVs could serve as new-generation CRC biomarkers for large-scale, non-invasive CRC screening as well as real-time monitoring of patient outcomes during clinical interventions.
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Affiliation(s)
- Zhaowei Zhang
- State Key Laboratory of Medicinal Chemical Biology, Research Center for Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition and Biosensing, College of Chemistry, Nankai University, Tianjin, China
| | - Xuehui Liu
- State Key Laboratory of Medicinal Chemical Biology, Research Center for Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition and Biosensing, College of Chemistry, Nankai University, Tianjin, China.,College of Pharmacy, Third Military Medical University, Chongqing, China
| | - Xiaoqing Yang
- Tianjin Institute of Urology, the 2nd Hospital of Tianjin Medical University, Tianjin, China
| | - Ying Jiang
- State Key Laboratory of Medicinal Chemical Biology, Research Center for Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition and Biosensing, College of Chemistry, Nankai University, Tianjin, China
| | - Ang Li
- State Key Laboratory of Medicinal Chemical Biology, Research Center for Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition and Biosensing, College of Chemistry, Nankai University, Tianjin, China
| | - Jiying Cong
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin Institute of Coloproctology, School of Medicine, Nankai University, Tianjin, China
| | - Yuwei Li
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin Institute of Coloproctology, School of Medicine, Nankai University, Tianjin, China
| | - Qinjian Xie
- Gansu Corps Hospital of CAPF, Lanzhou, China
| | - Chen Xu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin Institute of Coloproctology, School of Medicine, Nankai University, Tianjin, China
| | - Dingbin Liu
- State Key Laboratory of Medicinal Chemical Biology, Research Center for Analytical Sciences, and Tianjin Key Laboratory of Molecular Recognition and Biosensing, College of Chemistry, Nankai University, Tianjin, China
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39
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases. Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition. Intest Res 2023; 21:20-42. [PMID: 36751043 PMCID: PMC9911266 DOI: 10.5217/ir.2022.00096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/30/2022] [Accepted: 10/05/2022] [Indexed: 02/09/2023] Open
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Moon Sung Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastrointestinal Endoscopy
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastroenterology
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Association for the Study of Intestinal Diseases
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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40
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Chandan S, Bapaye J, Ramai D, Facciorusso A. Surveillance Colonoscopy After Polypectomy—Current Evidence and Future Directions. TECHNIQUES AND INNOVATIONS IN GASTROINTESTINAL ENDOSCOPY 2023; 25:269-283. [DOI: 10.1016/j.tige.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
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Núñez Rodríguez MªH, Díez Redondo P, Riu Pons F, Cimavilla M, Loza A, Perez-Miranda M. Findings in the distal and proximal colon in colonoscopy screening after positive FIT and related pre-procedure factors. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2022; 114:719-724. [PMID: 35285657 DOI: 10.17235/reed.2022.8409/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Colonoscopy is the gold standard method for the early diagnosis and prevention of colorectal cancer (CRC). Screening programs include immune determination of blood in feces. Regardless of the method used, proximal colon lesions appear to be detected less frequently. OBJECTIVE Analyze the characteristics of proximal and distal lesions and possible predisposing factors. METHODS A cross-sectional study was performed of 692 patients from the CRC screening program with FIT ≥ 100ngHb/ml (October 2017 - October 2018). The right colon was examined twice as patients were participating in a randomized clinical trial to re-evaluate the right colon by forward-viewing endoscope or proximal retroflexion. The adenoma detection rate (ADR), advanced neoplasia (AN) and CRC in the proximal and distal colon, the histological and morphological characteristics in each section were analyzed. RESULTS 52.9% of the patients were male, with a mean age of 59.5 years (SD: 7.6). 1490 polyps were found and the ADR was 57.7% (distal 42% and proximal 37%). Detection rates were 45.8% for AN, 40.9% for advanced adenomas, 5.2% for advanced SSL and CRC was diagnosed in 4.8% of patients. Males had more AN than females. The mean age of patients with AN was significantly higher. AN were associated with smoking and alcohol consumption (p=0.0001). Globally, FIT levels were higher in patients with AN (p=0.003). Sixty-six per cent of cancers were distally located and 61.3% of CRC were diagnosed in the early stages. CONCLUSIONS In an average-risk asymptomatic population undergoing colonoscopy after positive FIT, AN were more common in the distal colon in males, older patients, smokers and those with alcohol intake.
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Affiliation(s)
| | | | | | | | - Andrea Loza
- Endoscopias/Digestivo, Hospital Santos Reyes
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Sung JJY, Chiu HM, Lieberman D, Kuipers EJ, Rutter MD, Macrae F, Yeoh KG, Ang TL, Chong VH, John S, Li J, Wu K, Ng SSM, Makharia GK, Abdullah M, Kobayashi N, Sekiguchi M, Byeon JS, Kim HS, Parry S, Cabral-Prodigalidad PAI, Wu DC, Khomvilai S, Lui RN, Wong S, Lin YM, Dekker E. Third Asia-Pacific consensus recommendations on colorectal cancer screening and postpolypectomy surveillance. Gut 2022; 71:2152-2166. [PMID: 36002247 DOI: 10.1136/gutjnl-2022-327377] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/07/2022] [Indexed: 12/09/2022]
Abstract
The Asia-Pacific region has the largest number of cases of colorectal cancer (CRC) and one of the highest levels of mortality due to this condition in the world. Since the publishing of two consensus recommendations in 2008 and 2015, significant advancements have been made in our knowledge of epidemiology, pathology and the natural history of the adenoma-carcinoma progression. Based on the most updated epidemiological and clinical studies in this region, considering literature from international studies, and adopting the modified Delphi process, the Asia-Pacific Working Group on Colorectal Cancer Screening has updated and revised their recommendations on (1) screening methods and preferred strategies; (2) age for starting and terminating screening for CRC; (3) screening for individuals with a family history of CRC or advanced adenoma; (4) surveillance for those with adenomas; (5) screening and surveillance for sessile serrated lesions and (6) quality assurance of screening programmes. Thirteen countries/regions in the Asia-Pacific region were represented in this exercise. International advisors from North America and Europe were invited to participate.
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Affiliation(s)
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | - Finlay Macrae
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | | | - Vui Heng Chong
- Raja Isteri Pengiran Anak Saleha Hospital, Brunei, Brunei Darussalam
| | - Sneha John
- Digestive Health, Endoscopy, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jingnan Li
- Peking Union Medical College Hospital, Beijing, China
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Simon S M Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Murdani Abdullah
- Division of Gastroenterology, Pancreatibiliar and Digestive Endoscopy. Department of Internal Medicine, Hospital Dr Cipto Mangunkusumo, Jakarta, Indonesia
- Human Cancer Research Center. IMERI. Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nozomu Kobayashi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Masau Sekiguchi
- Cancer Screening Center/ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Division of Screening Technology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Jeong-Sik Byeon
- University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Hyun-Soo Kim
- Yonsei University, Seoul, Korea (the Republic of)
| | - Susan Parry
- National Bowel Screening Programme, New Zealand Ministry of Health, Auckland, New Zealand
- The University of Auckland, Auckland, New Zealand
| | | | | | | | - Rashid N Lui
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, Hong Kong
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Sunny Wong
- Lee Kong Chian School of Medicine, Singapore
| | - Yu-Min Lin
- Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - E Dekker
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Weng L, Jin F, Shi J, Qiu Z, Chen L, Li Q, He C, Cheng Z. Antibiotics use and risk of colorectal neoplasia: An updated meta-analysis. Int J Colorectal Dis 2022; 37:2291-2301. [PMID: 36329204 DOI: 10.1007/s00384-022-04276-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Accumulating evidence indicate that antibiotic use could induce microbiome dysbiosis, which was a critical driver to the onset and progression of colorectal cancer (CRC). But the relationship between antibiotics use and CRC was still disputed. Hence, we conducted this systematic review and meta-analysis to appraise and synthesize the present available evidence to clarify the association. METHODS PubMed, Embase, Web of Science, and Cochrane Library were systematically searched for relevant observational studies from inception to June 5, 2020. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated to explore the association between antibiotics use and CRC using random-effects model. Subgroup analyses, sensitive analyses, and publication bias were conducted to assess the robust reliability of pooled results. RESULTS A total of 15 observational studies containing 5,164,138 patients were included in this meta-analysis. The pooled analysis indicated that the total antibiotic use was correlated with increased risk of CRC (OR, 1.11; 95% CI, 1.05-1.18). The subgroup analyses suggested that antibiotic use significantly elevated risk of colon cancer, but not rectal cancer. Furthermore, we found that penicillin, cephalosporin, anti-anaerobic, and anti-aerobic antibiotics increased the risk of CRC, in particular metronidazole but no significant associations were identified in macrolide, tetracycline, sulfonamides, nitrofurans, and quinolone use. The results of sensitive analyses and publication bias indicated the conclusions were robust. CONCLUSION The findings showed that antibiotics use may be associated with the onset of CRC. Policy-makers and clinicians should adequately assess possible benefits and harms of antibiotics use, especially in some high-risk populations. Also, for high-risk patients with previous antibiotics use, it was suggested to perform early colonoscopy screening to find or even eliminate early-stage CRC.
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Affiliation(s)
- Lifang Weng
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Feng Jin
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Jin Shi
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Zhisong Qiu
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Libin Chen
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Qianqiong Li
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Chunsheng He
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China
| | - Zhicheng Cheng
- Department of Gastroenterology, Cangshan Hospital, The 900Th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Fuzhou, 350000, Fujian, People's Republic of China.
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Wang X, Zou Y, Zhang R, Teng C, Ren X, Zhang H, Zhou L. The relationship between serum lipid levels and colorectal serrated lesions: A systematic review and meta-analysis. Front Physiol 2022; 13:984586. [PMID: 36304580 PMCID: PMC9592854 DOI: 10.3389/fphys.2022.984586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To clarify the relationship between colorectal serrated lesions and serum lipid levels, and provide a scientific basis for the identification and early clinical prevention and treatment of populations that are at risk for colorectal serrated lesions. Methods: Studies comparing serum lipid levels in patients with colorectal serrated lesions and controls were searched in PubMed, Embase, Web of Science, the Cochrane Library, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database. Relevant literature was screened according to the inclusion and exclusion criteria. The mean and standard deviation of the serum lipid levels in patients and controls were extracted from the included literature. The combined weighted mean difference (WMD) and 95% confidence intervals (CIs) were calculated using Review Manager 5.0 software to evaluate the relationship between serum lipid levels and colorectal serrated lesions. Publication bias of the included studies was evaluated by the Egger test. Results: Twenty-three studies were included, comprising 2,063 patients and 63,909 controls. The serum high-density lipoprotein cholesterol (HDL-C) levels in the case group was significantly lower than in the control group (WMD = −0.122 mmol/L, 95% CI: 0.170–0.073). Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and serum triglyceride levels in the case group were significantly higher than in the control group, and the WMDs were 0.180 mmol/L (95% CI: 0.061–0.299), 0.155 mmol/L (95% CI: 0.038–0.273), and 0.241 mmol/L (95% CI: 0.181–0.302), respectively. Conclusion: Colorectal serrated lesions may be related to blood lipid levels. Hyperlipidemia might be a risk factor for colorectal serrated lesions.
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Affiliation(s)
- Xuerui Wang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, China
| | - Yangbin Zou
- Department of Occupational and Environmental Health, School of Public Health, Jilin University, Changchun, China
| | - Ruxuan Zhang
- Department of Occupational and Environmental Health, School of Public Health, Jilin University, Changchun, China
| | - Chunyan Teng
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, China
| | - Xuejiao Ren
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, China
| | - Haishan Zhang
- Department of Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Haishan Zhang, ; Liting Zhou,
| | - Liting Zhou
- Department of Occupational and Environmental Health, School of Public Health, Jilin University, Changchun, China
- *Correspondence: Haishan Zhang, ; Liting Zhou,
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Santos MO, Alves MDC, Lins Neto MADF, Moura FA. MUSCLE DEPLETED OBESITY IN INDIVIDUALS SCREENED FOR COLORECTAL CÂNCER. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:450-455. [PMID: 36515341 DOI: 10.1590/s0004-2803.202204000-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most incident cancer in the world and the second leading cause of cancer death. Significant decreases in incidence and mortality can be achieved by reducing risk factors and adhering to healthy lifestyle recommendations, as well as screening for the disease. OBJECTIVE To evaluate the clinical nutritional profile of individuals at medium risk screened for CRC residing in the city of Piranhas/Alagoas. METHODS Cross-sectional study conducted from September to October 2020, with individuals at medium risk for CRC, of both sexes and aged between 50 and 70 years old. Participants were screened for CRC with fecal immunochemical testing (FIT) and colonoscopy. Personal, socioeconomic, clinical, lifestyle and nutritional assessment data were collected. The latter was performed using anthropometric data (weight, height, arm circumference and triceps skinfold thickness), body composition (bioimpedance) and physical examination. Descriptive analysis of data frequencies and dichotomization according to the presence or absence of overweight was performed, followed by comparison of means and medians and frequencies by chi-square or Fisher's exact test. RESULTS In total, 82 people agreed to undergo the clinical nutritional assessment, most of them female (56.1%; n=46), adults (56.1%; n=46), with a mean age of 59.02 years (±6.30 SD). Pre-cancerous lesions were identified in 54.5% (n=42) of those screened, 52.4% (n=43) were smokers or former smokers, and 65.9% (n=54) did not practice scheduled physical activity. Nutritional assessment showed that 64.6% (n=53) were overweight according to body mass index. On the other hand, the muscle mass, % arm muscle circumference adequacy and body muscle mass (kg) markers showed that 32.9% (n=27) and 47.6% (n=39) of the subjects were muscle depleted, respectively. Above all, overweight participants had, in parallel, lower muscle mass (P<0.05), suggesting sarcopenic obesity in this population. CONCLUSION Obesity is one of the main risk factors for CRC; when concomitant with sarcopenia, it favors worse health outcomes. In this context, evidence shows the need to assess muscle composition in people with obesity, especially through other methods of assessing body composition. Our results add to the evidence on the importance of the population being guided about screening and adherence to healthy lifestyle recommendations, especially strategies aimed at weight control and the practice of physical activity.
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Affiliation(s)
- Monise Oliveira Santos
- Universidade Federal de Alagoas, Programa de Pós-graduação em Nutrição (PPGNUT), Maceió, AL, Brasil
| | - Marla de Cerqueira Alves
- Universidade Federal de Alagoas, Programa de Pós-graduação em Nutrição (PPGNUT), Maceió, AL, Brasil
| | | | - Fabiana Andréa Moura
- Universidade Federal de Alagoas, Programa de Pós-graduação em Nutrição (PPGNUT), Maceió, AL, Brasil.,Universidade Federal de Alagoas, Programa de Pós-graduação em Ciências Médicas (PPGCM), Maceió, AL, Brasil
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46
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY. [Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 80:115-134. [PMID: 36156035 DOI: 10.4166/kjg.2022.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 06/16/2023]
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Division of Gastroenterology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Cheonan Hospital, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
| | - Moon Sung Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University Bucheon Hospital, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea, Korea
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47
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Kim SY, Kwak MS, Yoon SM, Jung Y, Kim JW, Boo SJ, Oh EH, Jeon SR, Nam SJ, Park SY, Park SK, Chun J, Baek DH, Choi MY, Park S, Byeon JS, Kim HK, Cho JY, Lee MS, Lee OY, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases. [Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revised Edition]. Clin Endosc 2022; 80:115-134. [PMID: 36156035 PMCID: PMC9726446 DOI: 10.5946/ce.2022.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: 1) adenoma ≥10 mm in size; 2) 3-5 (or more) adenomas; 3) tubulovillous or villous adenoma; 4) adenoma containing high-grade dysplasia; 5) traditional serrated adenoma; 6) sessile serrated lesion (SSL) containing any grade of dysplasia; 7) serrated polyp of at least 10 mm in size; and 8) 3-5 (or more) SSLs. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.
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Affiliation(s)
- Su Young Kim
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Wook Kim
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Seong Ran Jeon
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seung-Joo Nam
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Seon-Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Mi-Young Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Suyeon Park
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyung Kil Kim
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joo Young Cho
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
| | - Moon Sung Lee
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Oh Young Lee
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastrointestinal Endoscopy
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Society of Gastroenterology
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
| | - Korean Association for the Study of Intestinal Diseases
- Department of Gastroenterology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
- Department of Gastroenterology, Inje University Ilsan Paik Hospital, Goyang, Korea
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
- Department of Gastroenterology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
- National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
- Department of biostatistics, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Applied Statistics, Chung-Ang University, Seoul, Korea
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
- Department of Gastroenterology, CHA Gangnam Medical Center, Seoul, Korea
- Digestive Disease Center, Institute for Digestive Research, Soonchunhyang University College of Medicine, Bucheon, Korea
- Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
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Sonnenberg A, Genta RM. Synchronous occurrence of different polyp types during colonoscopy. Aliment Pharmacol Ther 2022; 56:777-782. [PMID: 35735899 DOI: 10.1111/apt.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/14/2022] [Accepted: 05/26/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS The general probabilities of finding different types of hyperplastic or neoplastic colon lesions clustering in the same patient are unknown. We hypothesised that a systematic analysis of polyp clustering would reveal a high frequency of different concurrent types and that such clustering would be influenced by the underlying histopathology of the individual polyps. METHODS Using an electronic database of histopathologic records, a cross-sectional study of 2,910,174 colonoscopies evaluated the concordant occurrence of hyperplastic and neoplastic mucosal lesions. RESULTS Amongst patients harbouring any colon polyp, one can expect to find another histopathologic type in about 22%. Being the most prevalent type of polyp, tubular adenoma was the most common type of colonic polyp to be associated with other lesions. For instance, 31% of all colonoscopies with sessile serrated adenomas or hyperplastic polyps also revealed tubular adenomas. Hyperplastic polyp, the second most prevalent type of colonic polyp, was also the second most common type of polyp to be found associated with other types of neoplasia. For instance, 25% of all colonoscopies with sessile serrated adenomas and 31% of those with tubular adenomas also revealed hyperplastic polyps. CONCLUSIONS Different types of colon polyps commonly coincide in individual patients. The present set of data from a large nationwide database may provide guidance for the endoscopist of what variety in colon polyps to expect during colonoscopy.
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Affiliation(s)
- Amnon Sonnenberg
- Division of Gastroenterology, Portland VA Medical Center and Oregon Health & Science University, Portland, Oregon, USA
| | - Robert M Genta
- Inform Diagnostics, Irving, Texas, USA.,Baylor College of Medicine, Houston, Texas, USA
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Medina-Prado L, Mangas-Sanjuan C, Baile-Maxía S, Martínez-Roca AA, Murcia Ó, Zarraquiños S, Rodríguez-Camacho E, Aginagalde AH, Álvarez-Urturi C, Valverde-Roig MJ, Zapater P, Bujanda L, Salas D, Portillo I, Pellisé M, Cubiella J, Jover R. Risk of Colorectal Cancer and Advanced Polyps One Year After Excision of High-Risk Adenomas. Dis Colon Rectum 2022; 65:1112-1120. [PMID: 34840293 DOI: 10.1097/dcr.0000000000002068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Patients with multiple or large adenomas are considered to be high-risk for metachronous colorectal cancer. OBJECTIVE Evaluate the risks of detecting colorectal cancer, advanced adenoma, and advanced serrated polyps at 1-year surveillance colonoscopy in patients with >5 adenomas or adenomas >20 mm. DESIGN Descriptive, retrospective, multicentric, cohort study. We calculated the absolute risk of developing colorectal cancer, advanced adenomas, and advanced serrated polyps at the 1-year surveillance colonoscopy. Potential risk factors for advanced neoplasia at follow-up were evaluated with univariable and multivariable logistic regression analyses. SETTINGS This study included data from a multicenter cohort colorectal cancer screening program, conducted from January 2014 to December 2015, based on fecal immunochemical tests in Spain. PATIENTS We included 2119 participants with at least 1 adenoma ≥20 mm or ≥5 adenomas of any size. MAIN OUTCOME MEASURES We calculated the absolute risk of developing colorectal cancer, advanced adenomas, and advanced serrated polyps at the 1-year surveillance colonoscopy. Potential risk factors for advanced neoplasia at follow-up were evaluated with univariable and multivariable logistic regression analyses. RESULTS At 1 year, participants displayed 6 colorectal cancers (0.3%), 228 advanced adenomas (10.5%), and 58 advanced serrated polyps (2.7%). The adjusted analysis identified 2 factors associated with advanced neoplasia: >5 adenomas (odds ratio 1.53; 95% CI: 1.15-2.03; p = 0.004) and polyps in a proximal location (OR 1.52; 95% CI: 1.15-2.02; p = 0.004). LIMITATIONS First, the sample size was relatively small compared to other studies with similar aims. Another limitation was the lack of a comparison group, which could have provided more practical results in terms of surveillance recommendations. CONCLUSIONS The colorectal cancer detection rate at a 1-year colonoscopy surveillance was low among patients classified at high risk of advanced neoplasia. The risk factors for advanced neoplasia were ≥5 adenomas and proximal polyps at baseline. See Video Abstract at http://links.lww.com/DCR/B820 . RIESGO DE CNCER COLORRECTAL Y DE PLIPOS AVANZADOS UN AO DESPUS DE LA RESECCIN DE ADENOMAS DE ALTO RIESGO ANTECEDENTES:Los pacientes con adenomas múltiples o grandes se consideran de alto riesgo para desarrollar cáncer colorrectal metacrónico.OBJETIVO:Evaluar los riesgos de detectar cáncer colorrectal, adenoma avanzado y pólipos serrados avanzados en la colonoscopia de seguimiento al año, en pacientes con un número mayor o igual a 5 adenomas o adenomas de 20 mm o más.DISEÑO:Estudio descriptivo, retrospectivo, multicéntrico, de cohortes. Calculamos el riesgo absoluto de desarrollar cáncer colorrectal, adenomas avanzados y pólipos serrados avanzados en la colonoscopia de vigilancia al año. Los factores de riesgo potenciales para el desarrollo de una neoplasia avanzada en el seguimiento, fueron evaluados mediante un análisis de regresión logística univariable y multivariable.AJUSTES:Este estudio incluyó datos de un programa de cribado de cáncer colorrectal de cohorte multicéntrico, realizado entre enero de 2014 y diciembre de 2015, con base en pruebas inmunoquímicas de materia fecal, en España.PACIENTES:Incluimos 2119 participantes con al menos un adenoma ≥20 mm o con cinco o más adenomas de cualquier tamaño.PRINCIPALES MEDIDAS DE RESULTADO:Calculamos el riesgo absoluto de desarrollar cáncer colorrectal, adenomas avanzados y pólipos serrados avanzados en la colonoscopia de vigilancia al año. Los potenciales factores de riesgo para desarrollar una neoplasia avanzada en el seguimiento, se evaluaron mediante un análisis de regresión logística univariable y multivariable.RESULTADOS:Al año se encontraron en los pacientes participantes, 6 cánceres colorrectales (0,3%), 228 adenomas avanzados (10,5%) y 58 pólipos serrados avanzados (2,7%). Mediante el análisis ajustado se identificaron dos factores asociados con el desarrollo de neoplasia avanzada: un número igual o mayor a 5 adenomas (razón de probabilidades 1,53; IC del 95%: 1,15-2,03; p = 0,004) y la presencia de pólipos en una ubicación proximal (razón de probabilidades 1,52; IC del 95%: 1,15-2,02; p = 0,004).LIMITACIONES:Primero, el tamaño de la muestra fue relativamente pequeño en comparación con otros estudios con objetivos similares. Otra limitación fue la falta de un grupo comparativo, que podría haber proporcionado resultados más prácticos, en términos de recomendaciones de vigilancia.CONCLUSIÓNES:La tasa de detección de cáncer colorrectal mediante una colonoscopia de vigilancia al año, fue baja entre los pacientes clasificados como de alto riesgo de neoplasia avanzada. Los factores de riesgo para desarrollar una neoplasia avanzada fueron; un número igual o mayor a 5 adenomas y la presencia de pólipos proximales en la colonoscopia inicial de base. Consulte Video Resumen en http://links.lww.com/DCR/B820 . ( Traducción-Eduardo Londoño-Schimmer ).
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Affiliation(s)
- Lucía Medina-Prado
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Carolina Mangas-Sanjuan
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Sandra Baile-Maxía
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Alejandro A Martínez-Roca
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Óscar Murcia
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Sara Zarraquiños
- Gastroenterology Department, Complexo Hospitalario de Ourense, Instituto de Investigación Biomédica Galicia Sur, Ourense, Spain
| | | | - Adrián Hugo Aginagalde
- Departamento de Medicina Preventiva y Salud Pública, Universidad del País Vasco / Euskal Herriko Unibertsitate (UPV/EHU), Subdirección de Calidad Asistencial e Innovación, Ministerio de Sanidad
| | | | - Maria J Valverde-Roig
- Oficina del Plan contra el Cáncer, Direcció General de Salut Pública i Addiccions, Valencia, Spain
| | - Pedro Zapater
- Clinical Pharmacology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
| | - Luis Bujanda
- Gastroenterology Department, Instituto Biodonostia. CIBERehd, Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Dolores Salas
- Oficina del Plan contra el Cáncer, Direcció General de Salut Pública i Addiccions, Valencia, Spain
| | - Isabel Portillo
- Departamento de Medicina Preventiva y Salud Pública, Universidad del País Vasco / Euskal Herriko Unibertsitate (UPV/EHU), Subdirección de Calidad Asistencial e Innovación, Ministerio de Sanidad
- The Basque Health Service, Colorectal Cancer Screening Program, Bilbao, Spain
| | - María Pellisé
- Gastroenterology Department, Hospital Clínic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Joaquín Cubiella
- Gastroenterology Department, Complexo Hospitalario de Ourense, Instituto de Investigación Biomédica Galicia Sur, Ourense, Spain
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria ISABIAL, Alicante, Spain
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Anderson JC, Hisey W, Mackenzie TA, Robinson CM, Srivastava A, Meester RGS, Butterly LF, Hanover, New Hampshire; White River Junction, Vermont; New York, New York, USA; Rotterdam, Netherlands. Clinically significant serrated polyp detection rates and risk for postcolonoscopy colorectal cancer: data from the New Hampshire Colonoscopy Registry. Gastrointest Endosc 2022; 96:310-317. [PMID: 35276209 PMCID: PMC9296608 DOI: 10.1016/j.gie.2022.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Higher adenoma detection rates reduce the risk of postcolonoscopy colorectal cancer (PCCRC). Clinically significant serrated polyps (CSSPs; defined as any sessile serrated polyp, traditional serrated adenoma, large [≥1 cm] or proximal hyperplastic polyp >5 mm) also lead to PCCRC, but there are no data on associated CSSP detection rates (CSSDRs). We used data from the New Hampshire Colonoscopy Registry (NHCR) to investigate the association between PCCRC risk and endoscopist CSSDR. METHODS We included NHCR patients with 1 or more follow-up events: either a colonoscopy or a colorectal cancer (CRC) diagnosis identified through linkage with the New Hampshire State Cancer Registry. We defined our outcome, PCCRC, in 3 time periods: CRC diagnosed 6 to 36 months, 6 to 60 months, or all examinations (6 months or longer) after an index examination. We excluded patients with CRC diagnosed at or within 6 months of the index examination, with incomplete examinations, or with inflammatory bowel disease. The exposure variable was endoscopist CSSDR at the index colonoscopy. Cox regression was used to model the hazard of PCCRC on CSSDR controlling for age, sex, index findings, year of examination, personal history of colorectal neoplasia, and having more than 1 surveillance examination. RESULTS One hundred twenty-eight patients with CRC diagnosed at least 6 months after their index examination were included. Our cohort included 142 endoscopists (92 gastroenterologists). We observed that the risk for PCCRC 6 months or longer after the index examination was significantly lower for examinations performed by endoscopists with CSSDRs of 3% to <9% (hazard ratio [HR], .57; 95% confidence interval [CI], .39-.83) or 9% or higher (HR, .39; 95% CI, .20-.78) relative to those with CSSDRs under 3%. CONCLUSIONS Our study is the first to demonstrate a lower PCCRC risk after examinations performed by endoscopists with higher CSSDRs. Both CSSDRs of 9% and 3% to <9% had statistically lower risk of PCCRC than CSSDRs of <3%. These data validate CSSDR as a clinically relevant quality measure for endoscopists.
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Affiliation(s)
- Joseph C. Anderson
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
- White River Junction VAMC, White River Junction, Vermont, USA
| | - William Hisey
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Todd A. Mackenzie
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Christina M. Robinson
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
| | - Amitabh Srivastava
- Department of Pathology, Memorial Sloane Kettering Cancer Center, New York, New York, USA
| | - Reinier G. S. Meester
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Lynn F. Butterly
- Geisel School of Medicine at Dartmouth College, New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- New Hampshire Colonoscopy Registry, Lebanon, New Hampshire, USA
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