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1
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Ang TL, Hang DV, Li JW, Ho JCL, Sy-Janairo ML, Raja Ali RA, Makharia GK, Sundaram S, Chantarojanasiri T, Kim HG, Isayama H, Pausawasdi N, Wu K, Syam AF, Aye TT, Rehman S, Niriella MA, Jurawan R, Wang L, Leung WK, Liou JM, Rizan C, Wu JCY, Ooi CJ. APAGE Position Statements on Green and Sustainability in Gastroenterology, Hepatology, and Gastrointestinal Endoscopy. J Gastroenterol Hepatol 2025; 40:821-831. [PMID: 39888113 DOI: 10.1111/jgh.16896] [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: 12/18/2024] [Revised: 01/13/2025] [Accepted: 01/18/2025] [Indexed: 02/01/2025]
Abstract
BACKGROUND AND AIM The APAGE Position Statements aimed to provide guidance to healthcare practitioners on clinical practices aligned with climate sustainability. METHODS A taskforce convened by APAGE proposed provisional statements. Twenty-two gastroenterologists from the Asian Pacific region participated in online voting and consensus was assessed through an anonymized and iterative Delphi process. RESULTS There were five sections that addressed the rationale for climate action, the importance of adopting principles of waste management, clinical practice, gastrointestinal endoscopy, and issues related to advocacy and research. Sixteen statements achieved consensus and included the following: 1. APAGE recommends adopting prompt measures to reduce the carbon footprint of clinical practice due to the importance of climate action and its health cobenefits. 5. APAGE recommends adherence to professional clinical guidelines to optimize clinical care delivery in gastroenterology and hepatology to avoid the environmental impact of unnecessary procedures and tests. 8. APAGE recommends an emphasis on health promotion, disease prevention, and appropriate screening and surveillance, when resources are available, to reduce the environmental impact of managing more advanced diseases that require more intensive resources. 12. APAGE recommends that technological advances in endoscopic imaging and artificial intelligence, when available, be used to improve the precision of endoscopic diagnosis to reduce the risk of missed lesions and need for unnecessary biopsies. 13. APAGE recommends against the routine use of single-use endoscopes. CONCLUSION The position statements provide guidance to healthcare practitioners on clinical practices in gastroenterology, hepatology, and endoscopy that promote climate sustainability.
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Affiliation(s)
- Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Duke-NUS Medical School, Yong Loo Lin School of Medicine, National University of Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Dao Viet Hang
- Endoscopy Centre, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - James Weiquan Li
- Department of Gastroenterology and Hepatology, Changi General Hospital, Duke-NUS Medical School, Yong Loo Lin School of Medicine, National University of Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jacky Chiu Leung Ho
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Govind K Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tanyaporn Chantarojanasiri
- Division of Gastroenterology, Department of Internal Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Hyun-Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Nonthalee Pausawasdi
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kaichun Wu
- Fourth Military Medical University, Xijing Hospital, Xian, China
| | - Ari Fahrial Syam
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
| | - Than Than Aye
- Department of Gastroenterology, Yangon General Hospital. University of Medicine 1, Yangon, Myanmar
| | - Sher Rehman
- Department of Gastroenterology, Khyber Girls Medical College, Hayat Abad Medical Complex, Peshawar, Pakistan
| | - Madunil Anuk Niriella
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Ricardo Jurawan
- Taranaki Base Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Liangjing Wang
- Second Affiliated Hospital of Zhejiang, University School of Medicine, Hangzhou, China
| | - Wai Keung Leung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Jyh-Ming Liou
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chantelle Rizan
- Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Justin Che Yuen Wu
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Choon Jin Ooi
- Duke-NUS Medical School, Gleneagles Medical Centre, Singapore
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Okumura T, Hotta K, Imai K, Ito S, Kishida Y, Takada K, Kawaguchi D, Mori Y, Tanaka Y, Tsushima T, Kawata N, Maeda Y, Yoshida M, Yamamoto Y, Minamide T, Ishiwatari H, Sato J, Matsubayashi H, Ono H. Efficacy of texture and color enhancement imaging for the visibility and diagnostic accuracy of non-polypoid colorectal lesions. DEN OPEN 2025; 5:e380. [PMID: 38817687 PMCID: PMC11136699 DOI: 10.1002/deo2.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 06/01/2024]
Abstract
Objective A newly launched endoscopy system (EVIS X1, CV-1500; Olympus) is equipped with texture and color enhancement imaging (TXI). We aimed to investigate the efficacy of TXI for the visibility and diagnostic accuracy of non-polypoid colorectal lesions. Methods We examined 100 non-polypoid lesions in 42 patients from the same position, angle, and distance of the view in three modes: white light imaging (WLI), narrow-band imaging (NBI), and TXI. The primary outcome was to compare polyp visibility in the three modes using subjective polyp visibility score and objective color difference values. The secondary outcome was to compare the diagnostic accuracy without magnification. Results Overall, the visibility score of TXI was significantly higher than that of WLI (3.7 ± 1.1 vs. 3.6 ± 1.1; p = 0.008) and lower than that of NBI (3.7 ± 1.1 vs. 3.8 ± 1.1; p = 0.013). Color difference values of TXI were higher than those of WLI (11.5 ± 6.9 vs. 9.1 ± 5.4; p < 0.001) and lower than those of NBI (11.5 ± 6.9 vs. 13.1 ± 7.7; p = 0.002). No significant differences in TXI and NBI (visibility score: 3.7 ± 1.0 vs. 3.8 ± 1.1; p = 0.833, color difference values: 11.6 ± 7.1 vs. 12.9 ± 8.3; p = 0.099) were observed for neoplastic lesions. Moreover, the diagnostic accuracy of TXI was significantly higher than that of NBI (65.5% vs. 57.6%, p = 0.012) for neoplastic lesions. Conclusions TXI demonstrated higher visibility than that of WLI and lower than that of NBI. Further investigations are warranted to validate the performance of the TXI mode comprehensively.
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Affiliation(s)
- Taishi Okumura
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Kinichi Hotta
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Kenichiro Imai
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Sayo Ito
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | | | | | - Daiki Kawaguchi
- Division of Gastrointestinal OncologyShizuoka Cancer CenterShizuokaJapan
| | - Yukihiro Mori
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Yusuke Tanaka
- Division of Colon and Rectal SurgeryShizuoka Cancer CenterShizuokaJapan
| | - Takahiro Tsushima
- Division of Gastrointestinal OncologyShizuoka Cancer CenterShizuokaJapan
| | - Noboru Kawata
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Yuki Maeda
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | - Masao Yoshida
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | | | | | | | - Junya Sato
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
| | | | - Hiroyuki Ono
- Division of EndoscopyShizuoka Cancer CenterShizuokaJapan
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3
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Nishio M, Hirasawa K, Saigusa Y, Shiqi Z, Kenemura T, Hama T, Atsusaka R, Azuma D, Ozeki Y, Sawada A, Ikeda R, Fukuchi T, Kobayashi R, Sato C, Ogashiwa T, Chiba S, Inayama Y, Kunisaki R, Maeda S. Usefulness of Magnifying Endoscopy With Narrow-Band Imaging for Diagnosis of Ulcerative Colitis-Associated Neoplasia. J Gastroenterol Hepatol 2025; 40:900-906. [PMID: 39763012 DOI: 10.1111/jgh.16877] [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: 07/12/2024] [Revised: 11/28/2024] [Accepted: 12/23/2024] [Indexed: 04/05/2025]
Abstract
BACKGROUND AND AIM Qualitative diagnosis of ulcerative colitis-associated neoplasia (UCAN) is crucial for surveillance colonoscopy in patients with ulcerative colitis (UC). Although the utility of magnifying endoscopy with narrow-band imaging (ME-NBI) in sporadic neoplasia diagnosis has been reported, its efficacy in UCAN remains unclear. This study aimed to evaluate the usefulness of ME-NBI for qualitative diagnosis of UCAN. METHODS We generated 60 ME-NBI images (30 UCANs and 30 nonneoplasia lesions, including 10 polypoid and 20 nonpolypoid lesions) from patients with UC who underwent colonoscopy at our hospital between 2015 and 2023. Eleven endoscopists (seven experts and four trainees) independently assessed these images. Lesions were categorized into high- (≥ 80%), moderate- (50%-79%), and low- (< 50%) accuracy groups on the basis of the correct diagnostic rate. RESULTS Overall sensitivity, specificity, and correct diagnostic rates were 66.5%, 79.0%, and 71.8%, respectively. Experts tended to exhibit higher specificity than trainees (83% vs. 70%). Polypoid lesions showed higher sensitivity (92% vs. 54%) and lower specificity (61% vs. 88%) than nonpolypoid lesions. Overall, the kappa value was 0.411. In UCAN, 37%, 37%, and 24% were classified into the high-, moderate-, and low-accuracy groups, respectively. All endoscopists assessed one case of UCAN in the low-accuracy group as a nonneoplastic vessel with a surface pattern. Only two nonneoplasias were identified as having nonneoplastic vessel and surface patterns by all endoscopists. CONCLUSIONS This study demonstrated the usefulness of ME-NBI for qualitative diagnosis, along with its limitations. A unique endoscopic diagnostic algorithm for UCAN, incorporating ME-NBI and other modalities, is necessary.
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Affiliation(s)
- Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Zhao Shiqi
- Department of Biostatistics, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Tokomi Kenemura
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Takanori Hama
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Reo Atsusaka
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Daisuke Azuma
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yuichiro Ozeki
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Atsushi Sawada
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Ryosuke Ikeda
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Ryosuke Kobayashi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Chiko Sato
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Tsuyoshi Ogashiwa
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Sawako Chiba
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Yoshida N, Inoue K, Ghoneem E, Inagaki Y, Kobayashi R, Iwai N, Dohi O, Hirose R, Itoh Y. The Interpretation of Magnifying Endoscopy for the Diagnosis of Colorectal Lesions. Digestion 2025; 106:107-114. [PMID: 39904327 DOI: 10.1159/000543996] [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: 07/14/2024] [Accepted: 02/01/2025] [Indexed: 02/06/2025]
Abstract
BACKGROUND Accurate endoscopic diagnosis is crucial for determining the appropriate treatment strategy for colorectal lesions, which may include cold snare polypectomy, endoscopic mucosal resection, or endoscopic submucosal dissection. SUMMARY While white light imaging (WLI) serves as the basic and initial method for endoscopic diagnosis, additional techniques such as narrow band imaging (NBI), blue laser/light imaging (BLI), and magnified observation of pit patterns are necessary when WLI results are inconclusive. These advanced diagnostic methods enable precise differentiation of lesions such as adenoma, T1 cancer, and sessile serrated lesion. Furthermore, recent advancements in endoscopic systems have enhanced image clarity and detail, thereby improving diagnostic accuracy. KEY MESSAGES This review provides an in-depth discussion on how magnified endoscopy, utilizing the Japan NBI Expert Team (JNET) classification with NBI/BLI and pit pattern classification with chromoendoscopy, aids in the accurate diagnosis of colorectal lesions.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Elsayed Ghoneem
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
- Department of Gastroenterology, Mansoura University, Dakahlia, Egypt
| | | | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Naoto Iwai
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Morimoto S, Tanaka H, Takehara Y, Yamamoto N, Tanino F, Kamigaichi Y, Yamashita K, Takigawa H, Urabe Y, Kuwai T, Oka S. Efficiency of Real-time Computer-aided Polyp Detection during Surveillance Colonoscopy: A Pilot Study. J Anus Rectum Colon 2025; 9:127-133. [PMID: 39882234 PMCID: PMC11772792 DOI: 10.23922/jarc.2024-055] [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: 05/28/2024] [Accepted: 10/26/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives Studies have suggested that computer-aided polyp detection using artificial intelligence improves adenoma identification during colonoscopy. However, its real-world effectiveness remains unclear. Therefore, this study evaluated the usefulness of computer-aided detection during regular surveillance colonoscopy. Methods Consecutive patients who underwent surveillance colonoscopy with computer-aided detection between January and March 2023 and had undergone colonoscopy at least twice during the past 3 years were recruited. The clinicopathological findings of lesions identified using computer-aided detection were evaluated. The detection ability was sub-analyzed based on the expertise of the endoscopist and the presence of diminutive adenomas (size ≤5 mm). Results A total of 78 patients were included. Computer-aided detection identified 46 adenomas in 28 patients; however, no carcinomas were identified. The mean withdrawal time was 824 ± 353 s, and the mean tumor diameter was 3.3 mm (range, 2-8 mm). The most common gross type was 0-Is (70%), followed by 0-Isp (17%) and 0-IIa (13%). The most common tumor locations were the ascending colon and sigmoid colon (28%), followed by the transverse colon (26%), cecum (7%), descending colon (7%), and rectum (4%). Overall, 34.1% and 38.2% of patients with untreated diminutive adenomas and those with no adenomas, respectively, had newly detected adenomas. Endoscopist expertise did not affect the results. Conclusions Computer-aided detection may help identify adenomas during surveillance colonoscopy for patients with untreated diminutive adenomas and those with a history of endoscopic resection.
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Affiliation(s)
- Shin Morimoto
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yudai Takehara
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Noriko Yamamoto
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumiaki Tanino
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Kamigaichi
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidehiko Takigawa
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuji Urabe
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshio Kuwai
- Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
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Grega T, Kmochova K, Hejcmanova K, Ngo O, Brodyuk N, Majek O, Bures J, Urbanek P, Zavoral M, Suchanek S. Impact of narrow band imaging in prediction of histology of advanced colorectal neoplasia. Sci Rep 2025; 15:1414. [PMID: 39789214 PMCID: PMC11718093 DOI: 10.1038/s41598-025-85669-w] [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] [Received: 04/11/2024] [Accepted: 01/06/2025] [Indexed: 01/12/2025] Open
Abstract
We assessed the diagnostic performance of the Narrow-Band Imaging (NBI) International Colorectal Endoscopic Classification (NICE) and the Japan NBI Expert Team classification (JNET) in predicting histological outcomes of advanced colorectal lesions. Additionally, we evaluated the sensitivity and positive predictive value (PPV) of the JNET and NICE classifications individually for high-grade lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas). This was a retrospective analysis of prospectively collected data, involving 211 patients (130 men, mean age 60 years) who underwent colonoscopy with endoscopic resection of advanced colorectal neoplasia (lesions ≥ 10 mm). Lesions were classified using both NICE and JNET criteria, and final histopathological results were used for comparison. Of the 257 lesions analyzed, the NICE classification accurately classifies a large proportion of lesions (93.8%). In JNET classification we observed 77.4% correctly classified lesions. Specifically, the sensitivity and positive predictive value (PPV) of the NICE classification for high-grade lesions were 100% and 24.4%, respectively. For the JNET classification, the sensitivity and PPV for high-grade lesions were 56.6% and 57.7%, respectively. The JNET classification, with a positive predictive value of 57.7% for high-grade colorectal lesions (including HGD adenomas, intramucosal carcinomas, and T1 carcinomas), should be used for decision-making regarding appropriate subsequent endoscopic therapy.
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Affiliation(s)
- Tomas Grega
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia.
- Department of Gastrointestinal Oncology, Military University Hospital, Prague, Czechia.
| | - Klara Kmochova
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia
| | | | - Ondrej Ngo
- Institute of Biostatistics and Analyses Masaryk University, Brno, Czechia
| | - Nadija Brodyuk
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia
| | - Ondrej Majek
- Institute of Biostatistics and Analyses Masaryk University, Brno, Czechia
| | - Jan Bures
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia
- Department of Gastrointestinal Oncology, Military University Hospital, Prague, Czechia
| | - Petr Urbanek
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia
| | - Miroslav Zavoral
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia
- Department of Gastrointestinal Oncology, Military University Hospital, Prague, Czechia
| | - Stepan Suchanek
- Department of Internal Medicine, 1st Faculty of Medicine Charles University, Military University Hospital, Prague, Czechia
- Department of Gastrointestinal Oncology, Military University Hospital, Prague, Czechia
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7
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Ikeda R, Kaneko H, Sato H, Anan H, Suzuki Y, Ikeda A, Goda Y, Sue S, Irie K, Maeda S. Risk factors for unclear margin in cold snare polypectomy for colorectal polyp. Eur J Gastroenterol Hepatol 2024; 36:1404-1409. [PMID: 39324929 PMCID: PMC11527374 DOI: 10.1097/meg.0000000000002845] [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: 03/19/2024] [Accepted: 08/14/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVES Cold snare polypectomy (CSP) is a common, simple, and safe procedure; however, it has a high rate of unclear margins. We analyzed the risk factors for unclear margins of colorectal polyp. METHODS We retrospectively investigated colorectal polyps treated with CSP between July 2021 and July 2022, excluding those that could not be retrieved or pathologically nonneoplastic and hyperplastic polyps without margin evaluation. The clinicopathological features and risk factors for unclear margins were analyzed. Furthermore, the polyps were divided into two groups: those resected by experts and those resected by trainees. A 1 : 1 propensity score matching was performed. After matching, the risk factors for unclear margins in each group were analyzed as secondary outcomes. RESULTS We analyzed 237 patients with 572 polyps; the margins were negative in 58.6% (negative group) and unclear in 41.4% (unclear group). The unclear margin was significantly higher at straddling folds ( P = 0.0001), flexure points ( P = 0.005), and in the procedures performed by trainees ( P < 0.0001). Altogether, 198 propensity score matched pairs were explored for secondary outcomes. There were no significant differences in risk factors for unclear margins in the expert group, while in the trainee group, the unclear margin was significantly higher at the straddling folds ( P = 0.0004) and flexure points ( P = 0.005). CONCLUSIONS We demonstrated that straddling folds, flexure points, and procedures performed by the trainees were significant risk factors for unclear margins, and we hypothesized that the rate of unclear margins will reduce as the trainees accumulate experience at difficult sites.
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Affiliation(s)
- Ryosuke Ikeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hiroaki Kaneko
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hiroki Sato
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hideyuki Anan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yuichi Suzuki
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Aya Ikeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Yoshihiro Goda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Soichiro Sue
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Kuniyasu Irie
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
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Meulen LW, Haasnoot KJ, Vlug MS, Wolfhagen FH, Baven-Pronk MA, van der Voorn MP, Schwartz MP, Vogelaar L, de Vos tot Nederveen Cappel WH, Seerden TC, Hazen WL, Schrauwen RW, Alvarez-Herrero L, Schreuder RM, van Nunen AB, Stoop E, de Bruin GJ, Bos P, Marsman WA, Kuiper E, de Bièvre M, Alderlieste YA, Roomer R, Groen J, Bigirwamungu-Bargeman M, Siersema PD, Elias SG, Masclee AA, Moons LM. Effect of optical diagnosis training on recognition and treatment of submucosal invasive colorectal cancer in community hospitals: a prospective multicenter intervention study. Endoscopy 2024; 56:770-779. [PMID: 38657659 PMCID: PMC11436291 DOI: 10.1055/a-2313-4996] [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: 04/07/2023] [Accepted: 04/24/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Recognition of submucosal invasive colorectal cancer (T1 CRC) is difficult, with sensitivities of 35 %-60 % in Western countries. We evaluated the real-life effects of training in the OPTICAL model, a recently developed structured and validated prediction model, in Dutch community hospitals. METHODS In this prospective multicenter study (OPTICAL II), 383 endoscopists from 40 hospitals were invited to follow an e-learning program on the OPTICAL model, to increase sensitivity in detecting T1 CRC in nonpedunculated polyps. Real-life recognition of T1 CRC was then evaluated in 25 hospitals. Endoscopic and pathologic reports of T1 CRCs detected during the next year were collected retrospectively, with endoscopists unaware of this evaluation. Sensitivity for T1 CRC recognition, R0 resection rate, and treatment modality were compared for trained vs. untrained endoscopists. RESULTS 1 year after e-learning, 528 nonpedunculated T1 CRCs were recorded for endoscopies performed by 251 endoscopists (118 [47 %] trained). Median T1 CRC size was 20 mm. Lesions were mainly located in the distal colorectum (66 %). Trained endoscopists recognized T1 CRCs more frequently than untrained endoscopists (sensitivity 74 % vs. 62 %; mixed model analysis odds ratio [OR] 2.90, 95 %CI 1.54-5.45). R0 resection rate was higher for T1 CRCs detected by trained endoscopists (69 % vs. 56 %; OR 1.73, 95 %CI 1.03-2.91). CONCLUSION Training in optical recognition of T1 CRCs in community hospitals was associated with increased recognition of T1 CRCs, leading to higher en bloc and R0 resection rates. This may be an important step toward more organ-preserving strategies.
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Affiliation(s)
- Lonne W.T. Meulen
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Krijn J.C. Haasnoot
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marije S. Vlug
- Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands
| | - Frank H.J. Wolfhagen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | - Matthijs P. Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Lauran Vogelaar
- Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Tom C.J. Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Wouter L. Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Ruud W.M. Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven, Uden, The Netherlands
| | - Lorenza Alvarez-Herrero
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Ramon-Michel Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Annick B. van Nunen
- Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Esther Stoop
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Gijs J. de Bruin
- Department of Gastroenterology and Hepatology, Tergooi Hospital, Hilversum, The Netherlands
| | - Philip Bos
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Willem A. Marsman
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Edith Kuiper
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Marc de Bièvre
- Department of Gastroenterology and Hepatology, Viecuri Medical Center, Venlo, The Netherlands
| | | | - Robert Roomer
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - John Groen
- Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands
| | | | - Peter D. Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd G. Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ad A.M. Masclee
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leon M.G. Moons
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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9
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Cheng Y, Li L, Bi Y, Su S, Zhang B, Feng X, Wang N, Zhang W, Yao Y, Ru N, Xiang J, Sun L, Hu K, Wen F, Wang Z, Bai L, Wang X, Wang R, Lv X, Wang P, Meng F, Xiao W, Linghu E, Chai N. Computer-aided diagnosis system for optical diagnosis of colorectal polyps under white light imaging. Dig Liver Dis 2024; 56:1738-1745. [PMID: 38744557 DOI: 10.1016/j.dld.2024.04.023] [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: 12/31/2023] [Revised: 03/21/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES This study presents a novel computer-aided diagnosis (CADx) designed for optically diagnosing colorectal polyps using white light imaging (WLI).We aimed to evaluate the effectiveness of the CADx and its auxiliary role among endoscopists with different levels of expertise. METHODS We collected 2,324 neoplastic and 3,735 nonneoplastic polyp WLI images for model training, and 838 colorectal polyp images from 740 patients for model validation. We compared the diagnostic accuracy of the CADx with that of 15 endoscopists under WLI and narrow band imaging (NBI). The auxiliary benefits of CADx for endoscopists of different experience levels and for identifying different types of colorectal polyps was also evaluated. RESULTS The CADx demonstrated an optical diagnostic accuracy of 84.49%, showing considerable superiority over all endoscopists, irrespective of whether WLI or NBI was used (P < 0.001). Assistance from the CADx significantly improved the diagnostic accuracy of the endoscopists from 68.84% to 77.49% (P = 0.001), with the most significant impact observed among novice endoscopists. Notably, novices using CADx-assisted WLI outperform junior and expert endoscopists without such assistance. CONCLUSIONS The CADx demonstrated a crucial role in substantially enhancing the precision of optical diagnosis for colorectal polyps under WLI and showed the greatest auxiliary benefits for novice endoscopists.
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Affiliation(s)
- Yaxuan Cheng
- Chinese PLA Medical School, Beijing, 100853, PR China; Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Yawei Bi
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Song Su
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Bo Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xiuxue Feng
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Nanjun Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Wengang Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Yi Yao
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Nan Ru
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Jingyuan Xiang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Lihua Sun
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Kang Hu
- Department of Gastroenterology, The 987 Hospital of PLA Joint Logistic Support Force, Baoji, 721004, PR China
| | - Feng Wen
- Department of Gastroenterology, General Hospital of Central Theater Command of PLA,Wuhan 430070, PR China
| | - Zixin Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Lu Bai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xueting Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Runzi Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Xingping Lv
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Pengju Wang
- Chinese PLA Medical School, Beijing, 100853, PR China; Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Fanqi Meng
- Medical Department, HighWise Medical Technology Co, Ltd, Changsha, 410000, PR China
| | - Wen Xiao
- Medical Department, HighWise Medical Technology Co, Ltd, Changsha, 410000, PR China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China.
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, PR China.
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10
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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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11
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Singh AD, Desai A, Dziegielewski C, Kochhar GS. Endoscopic approaches to the management of dysplasia in inflammatory bowel disease: A state-of-the-art narrative review. Indian J Gastroenterol 2024; 43:905-915. [PMID: 39060902 DOI: 10.1007/s12664-024-01621-2] [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: 01/07/2024] [Accepted: 05/20/2024] [Indexed: 07/28/2024]
Abstract
Patients with inflammatory bowel disease (IBD) are at an increased risk of developing colitis-associated neoplasia (CAN), including colorectal cancer (CRC), through the inflammation-dysplasia-neoplasia pathway. Dysplasia is the most reliable, early and actionable marker for CAN in these patients. While such lesions are frequently encountered, adequate management depends on an accurate assessment, complete resection and close surveillance. With recent advances in endoscopic technologies and research in the field of CAN, the management of dysplastic lesions has significantly improved. The American Gastroenterology Association and Surveillance for Colorectal Endoscopic Neoplasia Detection (SCENIC) provide a guideline framework for approaching dysplastic lesions in patients with IBD. However, there are significant gaps in these recommendations and real-world clinical practice. Accurate lesion assessment remains pivotal for adequate management of CAN. Artificial intelligence-guided modalities are now increasingly being used to aid the detection of these lesions further. As the lesion detection technologies are improving, our armamentarium of resection techniques is also expanding and includes hot or cold polypectomy, endoscopic mucosal resection, endoscopic sub-mucosal dissection and full-thickness resection. With the broadened scope of endoscopic resection, the recommendations regarding surveillance after resection has also changed. Certain patient populations such as those with invisible dysplasia or with prior colectomy and ileal pouch anal anastomosis need special consideration. In the present review, we aim to provide a state-of-the-art summary of the current practice of endoscopic detection, resection and surveillance of dysplasia in patients with IBD and provide some perspective on the future directions based on the latest research.
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Affiliation(s)
- Achintya D Singh
- Department of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Aakash Desai
- Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Gursimran S Kochhar
- Department of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, PA, USA.
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12
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Grimaldi J, Masgnaux LJ, Lafeuille P, de Cristofaro E, Rivory J, Ponchon T, Yzet C, Wallenhorst T, Alexandru L, Legros R, Rostain F, Jérémie J, Pioche M. Endoscopic submucosal dissection with adaptive traction strategy: first prospective multicenter study (with video). Gastrointest Endosc 2024; 100:517-523. [PMID: 38458261 DOI: 10.1016/j.gie.2024.02.032] [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: 01/29/2024] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND AND AIMS Traction has become the reference strategy for colorectal endoscopic submucosal dissection (ESD). One of its major limitations is that the force of traction decreases as dissection progresses. The ATRACT traction device (ATRACT Device and Co, Lyon, France) uses a pulley system to increase traction during the procedure, making it easier and faster. A retrospective study of 54 cases showed interesting results in terms of efficacy and safety throughout the digestive tract. We sought to confirm these initial results with a prospective study of resections of colorectal lesions. METHODS In this prospective multicenter study, 5 experienced operators from 3 different centers each performed 10 procedures using the ATRACT device consecutively for all conventional colorectal ESDs measuring between 4 and 10 cm in conventional locations (no recurrent lesions, appendicular, of the ileocecal valve, in contact with the pectinate line, or measuring more than two-thirds of the circumference). RESULTS Between November 2022 and April 2023, 50 ESDs were performed in 49 patients. On average, the main diameter of the lesions was 66.6 mm, with a surface area of 3066 mm2. The mean operating time was 55.2 minutes, resulting in a mean resection speed of 61.4 mm2/min. En bloc and R0 resection rates were 100% and 98%, respectively. Resections were curative in 94% of cases. Four (8%) perforations occurred, all of which were closed endoscopically without the need for surgery. One (2%) case of delayed hemorrhage was noted. To date, this is the series with the highest resection speeds in the literature for colorectal ESD. For comparison, previous studies reported a speed of 23.5 mm2/min using the "pocket" strategy and a speed of 39.1 mm2/min using the double-clip traction technique. These results need to be confirmed in larger studies and in nonexpert centers. CONCLUSIONS This prospective evaluation confirms the efficacy and safety of the adaptive traction strategy with the ATRACT device for colorectal ESD with high resection speed.
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Affiliation(s)
- Jean Grimaldi
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Louis-Jean Masgnaux
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Elena de Cristofaro
- Department of Systems Medicine, Gastroenterology and Endoscopy Unit, Tor Vergata University of Rome, Rome, Italy
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thierry Ponchon
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Timothée Wallenhorst
- Gastroenterology and Endoscopy Unit, Pontchaillou University Hospital, Rennes, France
| | - Lupu Alexandru
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jacques Jérémie
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
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13
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Kimura H, Takada K, Imai K, Kishida Y, Ito S, Hotta K, Inoue H, Morita Y, Nishida A, Inatomi O, Ono H, Andoh A. Low-power pure-cut hot snare polypectomy for colorectal polyps 10-14 mm in size: a multicenter retrospective study. J Gastroenterol Hepatol 2024; 39:1903-1909. [PMID: 38740465 DOI: 10.1111/jgh.16616] [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: 03/13/2024] [Revised: 04/24/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND AND AIM Hot snare excision using electrocautery is widely used for large colorectal polyps (>10 mm); however, adverse events occur due to deep thermal injury. Colorectal polyps measuring 10-14 mm rarely include invasive cancer. Therefore, less invasive therapeutic options for this size category are demanding. We have developed hot snare polypectomy with low-power pure-cut current (LPPC HSP), which is expected to contribute to less deep thermal damage and lower risk of adverse events. This study aimed to evaluate the efficacy and safety of LPPC HSP for 10-14 mm colorectal polyps, compared with conventional endoscopic mucosal resection (EMR). METHODS In this multicenter, retrospective, observational study, clinical outcomes of EMR and LPPC HSP for 10-14 mm nonpedunculated colorectal polyps between January 2021 and March 2022 were compared using propensity score matching. RESULTS We identified 203 EMR and 208 LPPC HSP cases. After propensity score matching, the baseline characteristics between the groups were comparable, with 120 pairs. The en bloc and R0 resection rates were not significantly different between EMR and LPPC HSP groups (95.8% vs 97.5%, P = 0.72; 90.0% vs 91.7%, P = 0.82). The rates of delayed bleeding and perforation did not differ between the groups. CONCLUSIONS Compared with conventional EMR, LPPC HSP showed a similar resection ability without an increase in adverse events. These results suggest that LPPC HSP is a safe and effective treatment for 10-14 mm nonpedunculated colorectal polyps.
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Affiliation(s)
- Hidenori Kimura
- Division of Digestive Endoscopy, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroto Inoue
- Division of Digestive Endoscopy, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yukihiro Morita
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Atsushi Nishida
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Osamu Inatomi
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Andoh
- Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Otsu, Japan
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14
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Le NQ, Huynh TM, Vo DTN, Le HM, Tran TTL, Tran VTL, Dang LM, Le NQ. Diagnostic performance of the Japanese Narrow-band imaging expert team classification system using dual focus magnification in real-time Vietnamese setting. Medicine (Baltimore) 2024; 103:e38752. [PMID: 38968516 PMCID: PMC11224830 DOI: 10.1097/md.0000000000038752] [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: 04/30/2024] [Accepted: 06/07/2024] [Indexed: 07/07/2024] Open
Abstract
The JNET classification, combined with magnified narrowband imaging (NBI), is essential for predicting the histology of colorectal polyps and guiding personalized treatment strategies. Despite its recognized utility, the diagnostic efficacy of JNET classification using NBI with dual focus (DF) magnification requires exploration in the Vietnamese context. This study aimed to investigate the diagnostic performance of the JNET classification with the NBI-DF mode in predicting the histology of colorectal polyps in Vietnam. A cross-sectional study was conducted at the University Medical Center in Ho Chi Minh City, Vietnam. During real-time endoscopy, endoscopists evaluated the lesion characteristics and recorded optical diagnoses using the dual focus mode magnification according to the JNET classification. En bloc lesion resection (endoscopic or surgical) provided the final pathology, serving as the reference standard for optical diagnoses. A total of 739 patients with 1353 lesions were recruited between October 2021 and March 2023. The overall concordance with the JNET classification was 86.9%. Specificities and positive predictive values for JNET types were: type 1 (95.7%, 88.3%); type 2A (81.4%, 90%); type 2B (96.6%, 54.7%); and type 3 (99.9%, 93.3%). The sensitivity and negative predictive value for differentiating neoplastic from non-neoplastic lesions were 97.8% and 88.3%, respectively. However, the sensitivity for distinguishing malignant from benign neoplasia was lower at 64.1%, despite a specificity of 95.9%. Notably, the specificity and positive predictive value for identifying deep submucosal cancer were high at 99.8% and 93.3%. In Vietnam, applying the JNET classification with NBI-DF demonstrates significant value in predicting the histology of colorectal polyps. This classification guides treatment decisions and prevents unnecessary surgeries.
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Affiliation(s)
- Nhan Quang Le
- Department of GI Endoscopy, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Tien Manh Huynh
- Department of GI Endoscopy, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Viet Nam
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Diem Thi Ngoc Vo
- Department of Histology – Embryology and Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Huy Minh Le
- Department of Histology – Embryology and Pathology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Truc Thanh Le Tran
- Department of GI Endoscopy, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Vy Thao Ly Tran
- Department of GI Endoscopy, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Luan Minh Dang
- Department of GI Endoscopy, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Viet Nam
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nghia Quang Le
- Department of GI Surgery, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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15
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Murakami T, Kamba E, Tsugawa N, Fukushima H, Shibuya T, Yao T, Nagahara A. Usefulness of magnifying endoscopy for diagnosis of sessile serrated lesion with dysplasia or carcinoma: Large retrospective study. Endosc Int Open 2024; 12:E895-E904. [PMID: 38989252 PMCID: PMC11236474 DOI: 10.1055/a-2337-3944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/27/2024] [Indexed: 07/12/2024] Open
Abstract
Background and study aims Sessile serrated lesions (SSLs) are precursor lesions in the serrated neoplasia pathway that lead to invasive carcinoma from dysplasia arising from SSLs. This study aimed to elucidate the clinicopathological and endoscopic features of SSLs with and without dysplasia or carcinoma. Patients and methods We reviewed the clinicopathological and endoscopic data from all colorectal lesions pathologically diagnosed as SSLs at Juntendo University Hospital, Tokyo, Japan, between 2011 and 2022. In addition to conventional endoscopic findings, we retrospectively evaluated magnifying endoscopic findings with narrow-band imaging (NBI) or blue laser imaging (BLI) using the Japan NBI Expert Team system and analyzed pit patterns using magnified chromoendoscopic images. Results Of the 2,132 SSLs, 92.5%, 4.7%, 1.8%, and 0.9% had no dysplasia, low-grade dysplasia, high-grade dysplasia, and submucosal invasive carcinoma, respectively. Older age, the proximal colon, and larger lesions were more frequently associated with SSLs with dysplasia or carcinoma. However, 41.3% of the SSLs with dysplasia or carcinoma were ≤ 10 mm in size. Endoscopic findings, such as (semi)pedunculated morphology, double elevation, central depression, and reddishness, were frequently found in SSLs with dysplasia or carcinoma. Furthermore, magnifying endoscopy using NBI or BLI and magnifying chromoendoscopy showed high sensitivity, specificity, and accuracy for diagnosing dysplasia or carcinoma within SSLs. Conclusions SSLs with and without dysplasia or carcinoma exhibit distinct clinicopathological and endoscopic features. In an SSL series, conventional endoscopic characteristics in addition to use of magnifying endoscopy may be useful for accurately diagnosing advanced histology within an SSL.
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Affiliation(s)
- Takashi Murakami
- Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Eiji Kamba
- Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Naoki Tsugawa
- Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Tomoyoshi Shibuya
- Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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16
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Mandarino FV, Danese S, Uraoka T, Parra-Blanco A, Maeda Y, Saito Y, Kudo SE, Bourke MJ, Iacucci M. Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy. Dig Endosc 2024; 36:761-777. [PMID: 37988279 DOI: 10.1111/den.14727] [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: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023]
Abstract
Precision endoscopy in the management of colorectal polyps and early colorectal cancer has emerged as the standard of care. It includes optical characterization of polyps and estimation of submucosal invasion depth of large nonpedunculated colorectal polyps to select the appropriate endoscopic resection modality. Over time, several imaging modalities have been implemented in endoscopic practice to improve optical performance. Among these, image-enhanced endoscopy systems and magnification endoscopy represent now well-established tools. New advanced technologies, such as endocytoscopy and confocal laser endomicroscopy, have recently shown promising results in predicting the histology of colorectal polyps. In recent years, artificial intelligence has continued to enhance endoscopic performance in the characterization of colorectal polyps, overcoming the limitations of other imaging modes. In this review we retrace the path of precision endoscopy, analyzing the yield of various endoscopic imaging techniques in personalizing management of colorectal polyps and early colorectal cancer.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital IRCSS, Milan, Italy
- Department of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, NSW, Australia
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital IRCSS, Milan, Italy
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gumma, Japan
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Michael J Bourke
- Department of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, NSW, Australia
| | - Marietta Iacucci
- Department of Gastroenterology, University College Cork, Cork, Ireland
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17
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Nakatsugawa Y, Okuyama Y, Fukui A, Tanaka M, Inada Y, Nishimura T, Fujii H, Tomatsuri N, Sato H, Urata Y. A case of disseminated peritoneal metastases after 2-year conservative treatment for intramucosal colon carcinoma due to a perforation during endoscopic submucosal dissection. Clin J Gastroenterol 2024; 17:441-446. [PMID: 38368579 DOI: 10.1007/s12328-024-01925-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: 11/04/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
A 70-year-old man was admitted to our hospital for the treatment of a large granular-type laterally spreading tumor in the splenic flexure of the descending colon. The preoperative diagnosis was intramucosal colon carcinoma and endoscopic submucosal dissection was performed. During treatment, a small perforation occurred accidentally. After conservative treatment with endoscopic suturing, the patient was discharged without additional surgery. The pathological diagnosis was an intramucosal carcinoma. One year after treatment, no local recurrence was observed on endoscopy, and abdominal computed tomography showed no obvious metastasis. Two years later, fluorodeoxyglucose-positron emission tomography/computed tomography, laparoscopic findings, and histopathologic findings by experimental excision of omentum revealed several disseminated peritoneal metastases from previously treated colon carcinoma. To the best of our knowledge, this is the first report of peritoneal dissemination after a small perforation during endoscopic submucosal dissection and conservative therapy for early-stage colon carcinoma. This report suggests the possibility of tumor dissemination in patients with small perforations during endoscopic procedures. Endoscopists should be aware of these rare potential risks and perform later surveillance carefully.
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Affiliation(s)
- Yoshikazu Nakatsugawa
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
- Nakatsugawa Medical Clinic, 117-1, Fushimi-ku, Kyomachi, Kyoto-shi, Kyoto, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
| | - Akifumi Fukui
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Makoto Tanaka
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Takeshi Nishimura
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Hideki Fujii
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Naoya Tomatsuri
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Hideki Sato
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Yoji Urata
- Department of Clinical Pathology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
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18
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Ebigbo A, Nagl S. Endoscopic Assessment of Local Resectability of Colorectal Malignancies. Visc Med 2024; 40:110-115. [PMID: 38873626 PMCID: PMC11166904 DOI: 10.1159/000538317] [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: 01/14/2024] [Accepted: 03/11/2024] [Indexed: 06/15/2024] Open
Abstract
Background The endoscopic assessment of colorectal malignancies primarily aims at deciding on the local resectability. Local resectability is defined by the risk of lymphonodal metastasis. Summary The gross morphology as well as the surface and vessel patterns provide valuable information prior to endoscopic resection. Various classifications have been standardized to assist endoscopists during endoscopic assessment. Key Message The macroscopic assessment of colorectal malignancies should include the Paris and laterally spreading tumor (LST) classification as well as chromoendoscopic assessments such as Kudo's pit pattern and the Japanese NBI Expert Team classifications to describe the vessel and surface patterns.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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19
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Saito Y, Sakamoto T, Dekker E, Pioche M, Probst A, Ponchon T, Messmann H, Dinis-Ribeiro M, Matsuda T, Ikematsu H, Saito S, Wada Y, Oka S, Sano Y, Fujishiro M, Murakami Y, Ishikawa H, Inoue H, Tanaka S, Tajiri H. First report from the International Evaluation of Endoscopic classification Japan NBI Expert Team: International multicenter web trial. Dig Endosc 2024; 36:591-599. [PMID: 37702082 DOI: 10.1111/den.14682] [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: 06/29/2023] [Accepted: 09/10/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Narrow-band imaging (NBI) contributes to real-time optical diagnosis and classification of colorectal lesions. The Japan NBI Expert Team (JNET) was introduced in 2011. The aim of this study was to explore the diagnostic accuracy of JNET when applied by European and Japanese endoscopists not familiar with this classification. METHODS This study was conducted by 36 European Society of Gastrointestinal Endoscopy (ESGE) and 49 Japan Gastroenterological Endoscopy Society (JGES) non-JNET endoscopists using still images of 150 lesions. For each lesion, nonmagnified white-light, nonmagnified NBI, and magnified NBI images were presented. In the magnified NBI, the evaluation area was designated by region of interest (ROI). The endoscopists scored histological prediction for each lesion. RESULTS In ESGE members, the sensitivity, specificity, and accuracy were respectively 73.3%, 94.7%, and 93.0% for JNET Type 1; 53.0%, 64.9%, and 62.1% for Type 2A; 43.9%, 67.7%, and 55.1% for Type 2B; and 38.1%, 93.7%, and 85.1% for Type 3. When Type 2B and 3 were considered as one category of cancer, the sensitivity, specificity, and accuracy for differentiating high-grade dysplasia and cancer from the others were 59.9%, 72.5%, and 63.8%, respectively. These trends were the same for JGES endoscopists. CONCLUSION The diagnostic accuracy of the JNET classification was similar between ESGE and JGES and considered to be sufficient for JNET Type 1. On the other hand, the accuracy for Types 2 and 3 is not sufficient; however, JNET 2B lesions should be resected en bloc due to the risk of cancers and JNET 3 can be treated by surgery due to its high specificity.
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Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- University of Tsukuba, Ibaraki, Japan
| | - Evelien Dekker
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Andreas Probst
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Helmut Messmann
- RISE@CI-IPO, Portuguese Oncology Institute of Porto/Porto Comprehensive Cancer Center, Porto, Portugal
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
- Toho University, Tokyo, Japan
| | | | | | | | - Shiro Oka
- Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | | - Shinji Tanaka
- Hiroshima University, Hiroshima, Japan
- JA Onomichi General Hospital, Hiroshima, Japan
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20
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Kobayashi R, Yoshida N, Tomita Y, Hashimoto H, Inoue K, Hirose R, Dohi O, Inada Y, Murakami T, Morimoto Y, Zhu X, Itoh Y. Detailed Superiority of the CAD EYE Artificial Intelligence System over Endoscopists for Lesion Detection and Characterization Using Unique Movie Sets. J Anus Rectum Colon 2024; 8:61-69. [PMID: 38689788 PMCID: PMC11056537 DOI: 10.23922/jarc.2023-041] [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: 08/17/2023] [Accepted: 11/22/2023] [Indexed: 05/02/2024] Open
Abstract
Objectives Detailed superiority of CAD EYE (Fujifilm, Tokyo, Japan), an artificial intelligence for polyp detection/diagnosis, compared to endoscopists is not well examined. We examined endoscopist's ability using movie sets of colorectal lesions which were detected and diagnosed by CAD EYE accurately. Methods Consecutive lesions of ≤10 mm were examined live by CAD EYE from March-June 2022 in our institution. Short unique movie sets of each lesion with and without CAD EYE were recorded simultaneously using two recorders for detection under white light imaging (WLI) and linked color imaging (LCI) and diagnosis under blue laser/light imaging (BLI). Excluding inappropriate movies, 100 lesions detected and diagnosed with CAD EYE accurately were evaluated. Movies without CAD EYE were evaluated first by three trainees and three experts. Subsequently, movies with CAD EYE were examined. The rates of accurate detection and diagnosis were evaluated for both movie sets. Results Among 100 lesions (mean size: 4.7±2.6 mm; 67 neoplastic/33 hyperplastic), mean accurate detection rates of movies without or with CAD EYE were 78.7%/96.7% under WLI (p<0.01) and 91.3%/97.3% under LCI (p<0.01) for trainees and 85.3%/99.0% under WLI (p<0.01) and 92.6%/99.3% under LCI (p<0.01) for experts. Mean accurate diagnosis rates of movies without or with CAD EYE for BLI were 85.3%/100% for trainees (p<0.01) and 92.3%/100% for experts (p<0.01), respectively. The significant risk factors of not-detected lesions for trainees were right-sided, hyperplastic, not-reddish, in the corner, halation, and inadequate bowel preparation. Conclusions Unique movie sets with and without CAD EYE could suggest it's efficacy for lesion detection/diagnosis.
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Affiliation(s)
- Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuri Tomita
- Department of Gastroenterology, Kosekai Takeda Hosptal, Kyoto, Japan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yasutaka Morimoto
- Department of Gastroenterology, Kyoto Saiseikai Hospital, Kyoto, Japan
| | - Xin Zhu
- Graduate School of Computer Science and Engineering, The University of Aizu, Fukushima, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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21
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Sato M, Kato T, Tezen Y, Hayashi T, Matsui T, Kobayashi K, Sekigawa K, Tajiri R, Mitsui H. Traditional serrated adenoma with superficially serrated adenoma: A case treated with endoscopic submucosal dissection with detailed endoscopic observation and pathological study. DEN OPEN 2024; 4:e247. [PMID: 37273517 PMCID: PMC10235794 DOI: 10.1002/deo2.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/06/2023]
Abstract
A new subtype of serrated lesions, superficially serrated adenoma (SuSA), has been proposed as a lesion that histopathologically exhibits the morphological features of both conventional adenomas and serrated lesions and is difficult to classify as either one. SuSA has been elucidated to be a precursor lesion of KRAS-type traditional serrated adenoma. It has also been reported that SuSA may have malignant potential. We report a case treated with endoscopic submucosal dissection and detailed observation. Endoscopy revealed a raised lesion with a two-tier raised appearance in the sigmoid colon: a tall pinecone-like reddish structure and flattened whitish elevation on white light imaging. Magnifying narrow-band imaging revealed conspicuous blood vessels in the pinecone-like structure and slightly dilated reticular vessels in the flattened area. Crystal violet staining showed that the pinecone-like structure had a type IVH pit pattern and the flattened area had a stellate to slightly elongated type IIIH pit pattern diagnosed based on Kudo's classification and other pit pattern classification systems. Ki67-positive cells were distributed in the basal and middle layers of the gland in the flattened elevated area. Genetic analysis results were positive for KRAS mutation and negative for BRAF mutation. Histopathological examination revealed a traditional serrated adenoma in the pinecone-like structure and SuSA in the adjacent flattened elevated area.
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Affiliation(s)
- Momoka Sato
- Department of GastroenterologyTokyo Teishin HospitalTokyoJapan
| | - Tomoji Kato
- Department of GastroenterologyTokyo Teishin HospitalTokyoJapan
| | - Yu Tezen
- Department of GastroenterologyTokyo Teishin HospitalTokyoJapan
| | - Takeshi Hayashi
- Department of GastroenterologyTokyo Teishin HospitalTokyoJapan
| | - Toru Matsui
- Department of GastroenterologyTokyo Teishin HospitalTokyoJapan
| | | | | | | | - Hiroshi Mitsui
- Department of GastroenterologyTokyo Teishin HospitalTokyoJapan
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22
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Ueda T, Li JW, Ho SH, Singh R, Uedo N. Precision endoscopy in the era of climate change and sustainability. J Gastroenterol Hepatol 2024; 39:18-27. [PMID: 37881033 DOI: 10.1111/jgh.16383] [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: 09/08/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023]
Abstract
Global warming caused by increased greenhouse gas (GHG) emissions has a direct impact on human health. Gastrointestinal (GI) endoscopy contributes significantly to GHG emissions due to energy consumption, reprocessing of endoscopes and accessories, production of equipment, safe disposal of biohazardous waste, and travel by patients. Moreover, GHGs are also generated in histopathology through tissue processing and the production of biopsy specimen bottles. The reduction in unnecessary surveillance endoscopies and biopsies is a practical approach to decrease GHG emissions without affecting disease outcomes. This narrative review explores the role of precision medicine in GI endoscopy, such as image-enhanced endoscopy and artificial intelligence, with a focus on decreasing unnecessary endoscopic procedures and biopsies in the surveillance and diagnosis of premalignant lesions in the esophagus, stomach, and colon. This review offers strategies to minimize unnecessary endoscopic procedures and biopsies, decrease GHG emissions, and maintain high-quality patient care, thereby contributing to sustainable healthcare practices.
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Affiliation(s)
- Tomoya Ueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - James Weiquan Li
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Shiaw-Hooi Ho
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin and Modbury Hospitals, University of Adelaide, Adelaide, Australia
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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23
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Utsumi T, Yamada Y, Diaz-Meco MT, Moscat J, Nakanishi Y. Sessile serrated lesions with dysplasia: is it possible to nip them in the bud? J Gastroenterol 2023; 58:705-717. [PMID: 37219625 PMCID: PMC10366009 DOI: 10.1007/s00535-023-02003-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
The serrated neoplasia pathway constitutes an "alternative route" to colorectal cancer (CRC), and sessile serrated lesions with dysplasia (SSLDs) are an intermediate step between sessile serrated lesions (SSLs) and invasive CRC in this pathway. While SSLs show indolent growth before becoming dysplastic (> 10-15 years), SSLDs are considered to rapidly progress to either immunogenic microsatellite instable-high (MSI-H) CRC (presumably 75% of cases) or mesenchymal microsatellite stable (MSS) CRC. Their flat shapes and the relatively short window of this intermediate state make it difficult to detect and diagnose SSLDs; thus, these lesions are potent precursors of post-colonoscopy/interval cancers. Confusing terminology and the lack of longitudinal observation data of serrated polyps have hampered the accumulation of knowledge about SSLDs; however, a growing body of evidence has started to clarify their characteristics and biology. Together with recent efforts to incorporate terminology, histological studies of SSLDs have identified distinct dysplastic patterns and revealed alterations in the tumor microenvironment (TME). Molecular studies at the single-cell level have identified distinct gene alterations in both the epithelium and the TME. Mouse serrated tumor models have demonstrated the importance of TME in disease progression. Advances in colonoscopy provide clues to distinguish pre-malignant from non-malignant-SSLs. Recent progress in all aspects of the field has enhanced our understanding of the biology of SSLDs. The aim of this review article was to assess the current knowledge of SSLDs and highlight their clinical implications.
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Affiliation(s)
- Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Maria Teresa Diaz-Meco
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Jorge Moscat
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Yuki Nakanishi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
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24
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Zammarchi I, Santacroce G, Iacucci M. Next-Generation Endoscopy in Inflammatory Bowel Disease. Diagnostics (Basel) 2023; 13:2547. [PMID: 37568910 PMCID: PMC10417286 DOI: 10.3390/diagnostics13152547] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Endoscopic healing is recognized as a primary treatment goal in Inflammatory Bowel Disease (IBD). However, endoscopic remission may not reflect histological remission, which is crucial to achieving favorable long-term outcomes. The development of new advanced techniques has revolutionized the field of IBD assessment and management. These tools can accurately assess vascular and mucosal features, drawing endoscopy closer to histology. Moreover, they can enhance the detection and characterization of IBD-related dysplasia. Given the persistent challenge of interobserver variability, a more standardized approach to endoscopy is warranted, and the integration of artificial intelligence (AI) holds promise for addressing this limitation. Additionally, although molecular endoscopy is still in its infancy, it is a promising tool to forecast response to therapy. This review provides an overview of advanced endoscopic techniques, including dye-based and dye-less chromoendoscopy, and in vivo histological examinations with probe-based confocal laser endomicroscopy and endocytoscopy. The remarkable contribution of these tools to IBD management, especially when integrated with AI, is discussed. Specific attention is given to their role in improving disease assessment, detection, and characterization of IBD-associated lesions, and predicting disease-related outcomes.
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Affiliation(s)
| | | | - Marietta Iacucci
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, T12 R229 Cork, Ireland; (I.Z.); (G.S.)
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25
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Moreira P, Cardoso PM, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review. J Clin Med 2023; 12:4777. [PMID: 37510892 PMCID: PMC10381236 DOI: 10.3390/jcm12144777] [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: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15-20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.
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Affiliation(s)
- Pedro Moreira
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (P.M.); (P.M.C.); (G.M.)
| | - Pedro Marílio Cardoso
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (P.M.); (P.M.C.); (G.M.)
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (P.M.); (P.M.C.); (G.M.)
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - João Santos-Antunes
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (P.M.); (P.M.C.); (G.M.)
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4099-030 Porto, Portugal
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-450 Porto, Portugal
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26
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Wang YD, Wu J, Huang BY, Guo CM, Wang CH, Su H, Liu H, Wang MM, Wang J, Li L, Ding PP, Meng MM. Development and validation of an online calculator to predict the pathological nature of colorectal tumors. World J Gastrointest Oncol 2023; 15:1271-1282. [PMID: 37546551 PMCID: PMC10401472 DOI: 10.4251/wjgo.v15.i7.1271] [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: 04/01/2023] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND No single endoscopic feature can reliably predict the pathological nature of colorectal tumors (CRTs).
AIM To establish and validate a simple online calculator to predict the pathological nature of CRTs based on white-light endoscopy.
METHODS This was a single-center study. During the identification stage, 530 consecutive patients with CRTs were enrolled from January 2015 to December 2021 as the derivation group. Logistic regression analysis was performed. A novel online calculator to predict the pathological nature of CRTs based on white-light images was established and verified internally. During the validation stage, two series of 110 images obtained using white-light endoscopy were distributed to 10 endoscopists [five highly experienced endoscopists and five less experienced endoscopists (LEEs)] for external validation before and after systematic training.
RESULTS A total of 750 patients were included, with an average age of 63.6 ± 10.4 years. Early colorectal cancer (ECRC) was detected in 351 (46.8%) patients. Tumor size, left semicolon site, rectal site, acanthosis, depression and an uneven surface were independent risk factors for ECRC. The C-index of the ECRC calculator prediction model was 0.906 (P = 0.225, Hosmer–Lemeshow test). For the LEEs, significant improvement was made in the sensitivity, specificity and accuracy (57.6% vs 75.5%; 72.3% vs 82.4%; 64.2% vs 80.2%; P < 0.05), respectively, after training with the ECRC online calculator prediction model.
CONCLUSION A novel online calculator including tumor size, location, acanthosis, depression, and uneven surface can accurately predict the pathological nature of ECRC.
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Affiliation(s)
- Ya-Dan Wang
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Jing Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100050, China
| | - Bo-Yang Huang
- Department of Gastroenterology, Beijing Shijitan Hospital, the Ninth Clinical Medicine Peking University, Beijing 100038, China
| | - Chun-Mei Guo
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Cang-Hai Wang
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Hui Su
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Hong Liu
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Miao-Miao Wang
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Jing Wang
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Li Li
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Peng-Peng Ding
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Ming-Ming Meng
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Gibiino G, Sbrancia M, Binda C, Coluccio C, Fabbri S, Giuffrida P, Gallo G, Saragoni L, Maselli R, Repici A, Fabbri C. Usefulness of Contrast-Enhanced Endoscopic Ultrasound (CH-EUS) to Guide the Treatment Choice in Superficial Rectal Lesions: A Case Series. Diagnostics (Basel) 2023; 13:2267. [PMID: 37443660 PMCID: PMC10341096 DOI: 10.3390/diagnostics13132267] [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: 05/15/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Large rectal lesions can conceal submucosal invasion and cancer nodules. Despite the increasing diffusion of high-definition endoscopes and the importance of an accurate morphological evaluation, a complete assessment in this setting can be challenging. Endoscopic ultrasound (EUS) plays an established role in the locoregional staging of rectal cancer, although this technique has a tendency toward the over-estimation of the loco-regional (T) staging. However, there are still few data on contrast-enhanced endoscopic ultrasound (CH-EUS), especially if this ancillary technique may increase the accuracy for predicting invasive nodules among large rectal lesions. MATERIAL AND METHODS Consecutive large (≥20 mm) superficial rectal lesions with high-definition endoscopy, characterized by focal areas suggestive for invasive cancer/2B type according to JNET classification, were considered for additional standardized evaluation via CH-EUS with Sonovue ©. RESULTS From 2020 to 2023, we evaluated 12 consecutive superficial rectal lesions with sizes ranging from 20 to 180 mm. This evaluation provided additional elements to support the therapeutic decision made. Lesions were treated with surgical (3/12) or endoscopic treatment (9/12) according to their morphology and CH-EUS evaluation. CONCLUSION Contrast-enhanced endoscopic ultrasound can provide an additional evaluation for large and difficult-to-classify rectal lesions. In our experience, CH-EUS staging corresponded to the final pathological stages in 9/12 (75%) lesions, improving the distinction between T1 and T2 lesions. Larger prospective studies and randomized trials should be conducted to support and standardize this approach.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Graziana Gallo
- Pathology Department, M. Bufalini Hospital, Emilia Romagna, 47521 Cesena, Italy;
| | - Luca Saragoni
- Pathology Department, G.B. Morgagni-L. Pierantoni Hospital, Emilia-Romagna, 47121 Forlì, Italy;
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy; (R.M.); (A.R.)
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy; (R.M.); (A.R.)
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy; (G.G.); (M.S.); (C.C.); (S.F.); (P.G.); (C.F.)
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Crafa F, Vanella S, Morante A, Catalano OA, Pomykala KL, Baiamonte M, Godas M, Antunes A, Costa Pereira J, Giaccaglia V. Non-exposed endoscopic wall-inversion surgery with one-step nucleic acid amplification for early gastrointestinal tumors: Personal experience and literature review. World J Gastroenterol 2023; 29:3883-3898. [PMID: 37426319 PMCID: PMC10324533 DOI: 10.3748/wjg.v29.i24.3883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/11/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Laparoscopic and endoscopic cooperative surgery is a safe, organ-sparing surgery that achieves full-thickness resection with adequate margins. Recent studies have demonstrated the safety and efficacy of these procedures. However, these techniques are limited by the exposure of the tumor and mucosa to the peritoneal cavity, which could lead to viable cancer cell seeding and the spillage of gastric juice or enteric liquids into the peritoneal cavity. Non-exposed endoscopic wall-inversion surgery (NEWS) is highly accurate in determining the resection margins to prevent intraperitoneal contamination because the tumor is inverted into the visceral lumen instead of the peritoneal cavity. Accurate intraoperative assessment of the nodal status could allow stratification of the extent of resection. One-step nucleic acid amplification (OSNA) can provide a rapid method of evaluating nodal tissue, whilst near-infrared laparoscopy together with indocyanine green can identify relevant nodal tissue intraoperatively.
AIM To determine the safety and feasibility of NEWS in early gastric and colon cancers and of adding rapid intraoperative lymph node (LN) assessment with OSNA.
METHODS The patient-based experiential portion of our investigations was conducted at the General and Oncological Surgery Unit of the St. Giuseppe Moscati Hospital (Avellino, Italy). Patients with early-stage gastric or colon cancer (diagnosed via endoscopy, endoscopic ultrasound, and computed tomography) were included. All lesions were treated by NEWS procedure with intraoperative OSNA assay between January 2022 and October 2022. LNs were examined intraoperatively with OSNA and postoperatively with conventional histology. We analyzed patient demographics, lesion features, histopathological diagnoses, R0 resection (negative margins) status, adverse events, and follow-up results. Data were collected prospectively and analyzed retrospectively.
RESULTS A total of 10 patients (5 males and 5 females) with an average age of 70.4 ± 4.5 years (range: 62-78 years) were enrolled in this study. Five patients were diagnosed with gastric cancer. The remaining 5 patients were diagnosed with early-stage colon cancer. The mean tumor diameter was 23.8 ± 11.6 mm (range: 15-36 mm). The NEWS procedure was successful in all cases. The mean procedure time was 111.5 ± 10.7 min (range: 80-145 min). The OSNA assay revealed no LN metastases in any patients. Histologically complete resection (R0) was achieved in 9 patients (90.0%). There was no recurrence during the follow-up period.
CONCLUSION NEWS combined with sentinel LN biopsy and OSNA assay is an effective and safe technique for the removal of selected early gastric and colon cancers in which it is not possible to adopt conventional endoscopic resection techniques. This procedure allows clinicians to acquire additional information on the LN status intraoperatively.
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Affiliation(s)
- Francesco Crafa
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Serafino Vanella
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Aristide Morante
- Division of Gastorenterology and Endoscopy, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Onofrio A Catalano
- Department of Radiology, Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Kelsey L Pomykala
- Department of Nuclear Medicine, Department of Radiological Sciences, University Hospital Essen, University of Duisburg-Essen, Essen 45141, Germany
| | - Mario Baiamonte
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Maria Godas
- Division of General and Surgical Oncology, St. Giuseppe Moscati Hospital, Center of National Excellence and High Specialty, Avellino 83100, Italy
| | - Alexandra Antunes
- Department of General Surgery, Braga Hospital, Braga 4710-243, Portugal
| | | | - Valentina Giaccaglia
- Department of Surgery, Medclinic City Hospital, Dubai 505004, United Arab Emirates
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Seki K, Sakamoto T, Makiguchi ME, Toyoshima N, Takamaru H, Sekiguchi M, Yamada M, Sekine S, Kanemitsu Y, Saito Y. Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer. DEN OPEN 2023; 3:e194. [DOI: 10.1002/deo2.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Kenta Seki
- Endoscopy Division National Cancer Center Tokyo Japan
- Department of Colorectal Surgery National Cancer Center Tokyo Japan
| | - Taku Sakamoto
- Endoscopy Division National Cancer Center Tokyo Japan
- Gastrointestinal Endoscopy Division University of Tsukuba Hospital Ibaraki Japan
| | | | | | | | | | | | - Shigeki Sekine
- Department of Diagnostic Pathology National Cancer Center Tokyo Japan
| | | | - Yutaka Saito
- Endoscopy Division National Cancer Center Tokyo Japan
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30
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Yin Z, Yao C, Zhang L, Qi S. Application of artificial intelligence in diagnosis and treatment of colorectal cancer: A novel Prospect. Front Med (Lausanne) 2023; 10:1128084. [PMID: 36968824 PMCID: PMC10030915 DOI: 10.3389/fmed.2023.1128084] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/29/2023] Open
Abstract
In the past few decades, according to the rapid development of information technology, artificial intelligence (AI) has also made significant progress in the medical field. Colorectal cancer (CRC) is the third most diagnosed cancer worldwide, and its incidence and mortality rates are increasing yearly, especially in developing countries. This article reviews the latest progress in AI in diagnosing and treating CRC based on a systematic collection of previous literature. Most CRCs transform from polyp mutations. The computer-aided detection systems can significantly improve the polyp and adenoma detection rate by early colonoscopy screening, thereby lowering the possibility of mutating into CRC. Machine learning and bioinformatics analysis can help screen and identify more CRC biomarkers to provide the basis for non-invasive screening. The Convolutional neural networks can assist in reading histopathologic tissue images, reducing the experience difference among doctors. Various studies have shown that AI-based high-level auxiliary diagnostic systems can significantly improve the readability of medical images and help clinicians make more accurate diagnostic and therapeutic decisions. Moreover, Robotic surgery systems such as da Vinci have been more and more commonly used to treat CRC patients, according to their precise operating performance. The application of AI in neoadjuvant chemoradiotherapy has further improved the treatment and efficacy evaluation of CRC. In addition, AI represented by deep learning in gene sequencing research offers a new treatment option. All of these things have seen that AI has a promising prospect in the era of precision medicine.
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Affiliation(s)
- Zugang Yin
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Chenhui Yao
- Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Limin Zhang
- Department of Respiratory, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shaohua Qi
- Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences and Comparative Medicine Center, Peking Union Medical College, Beijing, China
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31
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Teramoto A, Hamada S, Ogino B, Yasuda I, Sano Y. Updates in narrow-band imaging for colorectal polyps: Narrow-band imaging generations, detection, diagnosis, and artificial intelligence. Dig Endosc 2022; 35:453-470. [PMID: 36480465 DOI: 10.1111/den.14489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 12/01/2022] [Indexed: 01/20/2023]
Abstract
Narrow-band imaging (NBI) is an optical digital enhancement method that allows the observation of vascular and surface structures of colorectal lesions. Its usefulness in the detection and diagnosis of colorectal polyps has been demonstrated in several clinical trials and the diagnostic algorithms have been simplified after the establishment of endoscopic classifications such as the Japan NBI Expert Team classification. However, there were issues including lack of brightness in the earlier models, poor visibility under insufficient bowel preparation, and the incompatibility of magnifying endoscopes in certain endoscopic platforms, which had impeded NBI from becoming standardized globally. Nonetheless, NBI continued its evolution and the newest endoscopic platform launched in 2020 offers significantly brighter and detailed images. Enhanced visualization is expected to improve the detection of polyps while universal compatibility across all scopes including magnifying endoscopy will promote the global standardization of magnifying diagnosis. Therefore, knowledge related to magnifying colonoscopy will become essential as magnification becomes standardly equipped in future models, although the advent of computer-aided diagnosis and detection may greatly assist endoscopists to ensure quality of practice. Given that most endoscopic departments will be using both old and new models, it is important to understand how each generation of endoscopic platforms differ from each other. We reviewed the advances in the endoscopic platforms, artificial intelligence, and evidence related to NBI essential for the next generation of endoscopic practice.
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Affiliation(s)
- Akira Teramoto
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Seiji Hamada
- Gastrointestinal Center, Urasoe General Hospital, Okinawa, Japan
| | - Banri Ogino
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Ichiro Yasuda
- Third Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
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Takamaru H, Stammers M, Yanagisawa F, Mizuguchi Y, Sekiguchi M, Yamada M, Sakamoto T, Matsuda T, Saito Y. Conditional inference tree models to perceive depth of invasion in T1 colorectal cancer. Surg Endosc 2022; 36:9234-9243. [PMID: 35915186 DOI: 10.1007/s00464-022-09414-4] [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: 10/18/2021] [Accepted: 06/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM Accurate diagnosis of invasion depth for T1 colorectal cancer is of critical importance as it decides optimal resection technique. Few reports have previously covered the effects of endoscopic morphology on depth assessment. We developed and validated a novel diagnostic algorithm that accurately predicts the depth of early colorectal cancer. METHODS We examined large pathological and endoscopic databases compiled between Jan 2015 and Dec 2018. Training and validation data cohorts were derived and real-world diagnostic performance of two conditional interference tree algorithms (Models 1 and 2) was evaluated against that of the Japan NBI-Expert Team (JNET) classification used by both expert and non-expert endoscopists. RESULTS Model 1 had higher sensitivity in deep submucosal invasion than that of JNET alone in both training (45.1% vs. 28.6%, p < 0.01) and validation sets (52.3% vs. 40.0%, p < 0.01). Model 2 demonstrated higher sensitivity than Model 1 (66.2% vs. 52.3%, p < 0.01) in excluding deeper invasion of suspected Tis/T1a lesions. CONCLUSION We discovered that machine-learning classifiers, including JNET and macroscopic features, provide the best non-invasive screen to exclude deeper invasion for suspected Tis/T1 lesions. Adding this algorithm improves depth diagnosis of T1 colorectal lesions for both expert and non-expert endoscopists.
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Affiliation(s)
- Hiroyuki Takamaru
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
| | - Matthew Stammers
- Department of Gastroenterology & Research Data Sciences Team (RDST), University Hospital Southampton, Southampton, UK
| | - Fumito Yanagisawa
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Tokyo, Japan
| | - Yasuhiko Mizuguchi
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan
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Sundaram S, Giri S, Jearth V, Vizhi N K, Yelsangikar A, Bhat N. Image-enhanced endoscopy and endoscopic resection practices in the colon among endoscopists in India. Endosc Int Open 2022; 10:E1181-E1187. [PMID: 36118641 PMCID: PMC9473856 DOI: 10.1055/a-1914-6197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background and study aims Clinical practice patterns for image-enhanced endoscopy (IEE) and colonic endoscopic resection practices vary among endoscopists. We conducted a survey to understand the differences in IEE and colonoscopic resection practices among endoscopists from India. Methods An online cross-sectional survey comprising 40 questions regarding quality control of colonoscopy, IEE, and colonic endoscopic resection practices was circulated through the registry of the Indian Society of Gastroenterology and Association of Colon and Rectal Surgeons of India. Participation was voluntary and response to all questions was compulsory. Results There were 205 respondents to the survey (93.2 % gastroenterologists, 90.2 % male, 54.6 % aged 30 to 40 years, 36.1 % working in academic institution, 36.1 % working in corporate hospitals). Of the endoscopists, 50.7 % had no training in IEE and 10.7 % performed endoscopy on systems without any IEE modalities. Endoscopists with more experience were more likely to use IEE modalities in practice routinely ( P = 0.007). Twenty percent never used IEE to classify polyps. Sixty percent of respondents did not use dye-chromoendoscopy. Less experienced endoscopists used viscous solutions as submucosal injectate ( P = 0.036) more often. Of the respondents, 44 % never tattooed the site of endoscopic resection. Ablation of edges post-endoscopic mucosal resection was not done by 25.5 % respondents. Most respondents used electronic chromoendoscopy (36.1 %) or random four-quadrant sampling (35.6 %) for surveillance in inflammatory bowel disease. Surveillance post-endoscopic resection was done arbitrarily by 24 % respondents at 6 months to 1 year. Conclusions There are several lacunae in the practice of IEE and colonic endoscopic resection among endoscopists, with need for programs for privileging, credentialing and proctoring these endoscopic skills.
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Affiliation(s)
- Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai
| | - Suprabhat Giri
- Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
| | - Kayal Vizhi N
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
| | - Amit Yelsangikar
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
| | - Naresh Bhat
- Department of Gastroenterology and Hepatology, Aster CMI Hospital, Bangalore
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Wagner A, Zandanell S, Ziachehabi A, Mitrakov A, Klieser E, Neureiter D, Kiesslich T, Mayr C, Berr F, Fedoruk M, Singhartinger F, Holzinger J. New method for real-time visualization and quantitative characterization of early colorectal cancer in endoscopy: a pilot study. Endosc Int Open 2022; 10:E1147-E1154. [PMID: 36082194 PMCID: PMC9445923 DOI: 10.1055/a-1847-2820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 05/09/2022] [Indexed: 10/26/2022] Open
Abstract
Background and study aims Endoscopic optical diagnosis is crucial to the therapeutic strategy for early gastrointestinal cancer. It accurately (> 85 %) predicts pT category based on microsurface (SP) and vascular patterns (VP). However, interobserver variability is a major problem. We have visualized and digitalized the graded irregularities based on bioinformatically enhanced quantitative endoscopic image analysis (BEE) of high-definition white-light images. Methods In a pilot study of 26 large colorectal lesions (LCLs, mean diameter 39 mm), we retrospectively compared BEE variables with corresponding histopathology of the resected LCLs. Results We included 10 adenomas with low-grade intraepithelial neoplasia (LGIN), nine with high-grade intraepithelial neoplasia (HGIN) and early adenocarcinoma (EAC), and seven deeply submucosal invasive carcinomas. Quantified density (d) and nonuniformity (C U ) of vascular and surface structures correlated with histology (r s d VP: -0.77, r s C U VP: 0.13, r s d SP: -0.76, and r s C U SP: 0.45, respectively). A computed BEE score showed a sensitivity and specificity of 90 % and 100 % in the group with LGINs, 89 % and 41 % in the group with HGINs and EACs, and 100 % and 95 % in the group with deeply invasive carcinoma, respectively. Conclusions In this pilot study, BEE showed promise as a tool for endoscopic characterization of LCLs during routine endoscopy. Prospective clinical studies are needed.
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Affiliation(s)
- Andrej Wagner
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Stephan Zandanell
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | | | - Alexander Mitrakov
- Endoscopy Division, Nizhniy Novgorod Cancer Hospital, Nizhniy Novgorod, Russian Federation
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University/Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Tobias Kiesslich
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria,Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | - Christian Mayr
- Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | - Frieder Berr
- Department of Internal Medicine I, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | | | - Franz Singhartinger
- Department of Surgery, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Josef Holzinger
- Department of Surgery, University Clinics Salzburg, Paracelsus Medical University, Salzburg, Austria
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Nomura H, Tsuji S, Utsunomiya M, Kawasaki A, Tsuji K, Yoshida N, Takemura K, Katayanagi K, Minato H, Doyama H. Resection depth and layer of underwater versus conventional endoscopic mucosal resection of intermediate-sized colorectal polyps: A pilot study. Endosc Int Open 2022; 10:E1037-E1044. [PMID: 35979030 PMCID: PMC9377830 DOI: 10.1055/a-1864-6452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 05/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Curability of colorectal tumors is associated with resection depth and layer in endoscopic resection. Underwater endoscopic mucosal resection (UEMR) has not undergone sufficient histopathological evaluation. We conducted a pilot study to compare the effectiveness, including resection depth and layer, of UEMR and conventional endoscopic mucosal resection (CEMR). Patients and methods This study was a single-center, retrospective study. Patients with colorectal lesions were treated by UEMR or CEMR between January 2018 and March 2020. Eligible patients were selected from included patients in a 1:1 ratio using propensity score matching. We compared the resection depth and layer and treatment results between the UEMR and CEMR groups. Results We evaluated 55 patients undergoing UEMR and 291 patients undergoing CEMR. Using propensity score matching, we analyzed 54 lesions in each group. The proportion of specimens containing submucosal tissue was 100 % in both groups. The median thickness of the submucosal tissue was significantly greater in the CEMR group than in the UEMR group [1235 µm (95 % confidence interval [CI], 1020-1530 µm) vs. 950 µm (95 % CI, 830-1090 µm), respectively]. However, vertical margins were negative in all lesions in both groups. Conclusions Our findings suggest that the median thickness of submucosal tissue in the UEMR group was about 1,000 μm. Even though the resection depth achieved with UEMR was more superficial than that achieved with CEMR, UEMR may be a treatment option, especially for colorectal lesions ≤ 20 mm in diameter without suspicious findings of submucosal deeply invasive cancer.
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Affiliation(s)
- Hiroki Nomura
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Shigetsugu Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Manami Utsunomiya
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Azusa Kawasaki
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kunihiro Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Naohiro Yoshida
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenichi Takemura
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kazuyoshi Katayanagi
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroshi Minato
- Department of Diagnostic Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Ikehara H, Kusano C, Gotoda T. Magnifying chromoendoscopy or image enhanced endoscopy with magnification? Dig Endosc 2022; 34:963-964. [PMID: 35466443 DOI: 10.1111/den.14306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Hisatomo Ikehara
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Saito Y, Takamaru H, Toyoshima N. Resection depth: a very important advantage for underwater EMR. Endosc Int Open 2022; 10:E729-E730. [PMID: 35692916 PMCID: PMC9187411 DOI: 10.1055/a-1795-7635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Takamaru H, Saito Y, Hammoud GM, Mizuguchi Y, Cho H, Sekiguchi M, Yamada M, Sakamoto T, Matsuda T. Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score-matched analysis. Gastrointest Endosc 2022; 95:982-989.e6. [PMID: 34971668 DOI: 10.1016/j.gie.2021.12.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Cold snare polypectomy (CSP), a safe procedure for removing colon polyps, has a low prevalence of postpolypectomy bleeding (PPB). Previous studies have failed to demonstrate differences in PPB rates between CSP and hot snare polypectomy (HSP), possibly because of their small sample sizes. This study analyzed PPB rates after CSP and HSP. METHODS This was a retrospective analysis of colorectal lesions (diameter <10 mm) treated using endoscopic resection at our institution between January 2015 and December 2019. Resections were performed using CSP or HSP, depending on the endoscopist's preference. Endoscopic and histologic findings were recorded in the endoscopic database at our institution. Propensity score (PS) matching was performed to match patient age, lesion size, macroscopic features, location of the lesions, clipping after resection, and antithrombotic agent use. The CSP and HSP groups were compared to determine the adverse event (PPB) rates. RESULTS The CSP and HSP groups included 12,928 and 2408 lesions (total of 5371 patients), respectively. Univariate analysis revealed that the overall prevalence of PPB after HSP was higher than that after CSP (odds ratio [OR], 5.39; 95% confidence interval [CI], 2.50-11.60). After PS matching (2135 lesions per group), the prevalence of PPB after HSP remained higher than that after CSP (OR, 6.0; 95% CI, 1.34-26.8). CONCLUSIONS For colorectal lesions <10 mm in diameter, the risk of PPB after CSP is significantly lower than that after HSP, after PS matching. CSP for lesions <10 mm could be safely performed compared with HSP.
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Affiliation(s)
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ghassan M Hammoud
- Division of Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Hourin Cho
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Screening Center, National Cancer Center Hospital, Tokyo, Japan
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Mezzapesa M, Losurdo G, Celiberto F, Rizzi S, d’Amati A, Piscitelli D, Ierardi E, Di Leo A. Serrated Colorectal Lesions: An Up-to-Date Review from Histological Pattern to Molecular Pathogenesis. Int J Mol Sci 2022; 23:4461. [PMID: 35457279 PMCID: PMC9032676 DOI: 10.3390/ijms23084461] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/16/2022] [Accepted: 04/17/2022] [Indexed: 12/10/2022] Open
Abstract
Until 2010, colorectal serrated lesions were generally considered as harmless lesions and reported as hyperplastic polyps (HPs) by pathologists and gastroenterologists. However, recent evidence showed that they may bear the potential to develop into colorectal carcinoma (CRC). Therefore, the World Health Organization (WHO) classification has identified four categories of serrated lesions: hyperplastic polyps (HPs), sessile serrated lesions (SSLs), traditional serrated adenoma (TSAs) and unclassified serrated adenomas. SSLs with dysplasia and TSAs are the most common precursors of CRC. CRCs arising from serrated lesions originate via two different molecular pathways, namely sporadic microsatellite instability (MSI) and the CpG island methylator phenotype (CIMP), the latter being considered as the major mechanism that drives the serrated pathway towards CRC. Unlike CRCs arising through the adenoma-carcinoma pathway, APC-inactivating mutations are rarely shown in the serrated neoplasia pathway.
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Affiliation(s)
- Martino Mezzapesa
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.M.); (G.L.); (F.C.); (S.R.); (A.D.L.)
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.M.); (G.L.); (F.C.); (S.R.); (A.D.L.)
- PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
| | - Francesca Celiberto
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.M.); (G.L.); (F.C.); (S.R.); (A.D.L.)
- PhD Course in Organs and Tissues Transplantation and Cellular Therapies, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy
| | - Salvatore Rizzi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.M.); (G.L.); (F.C.); (S.R.); (A.D.L.)
| | - Antonio d’Amati
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (A.d.); (D.P.)
| | - Domenico Piscitelli
- Section of Pathology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (A.d.); (D.P.)
| | - Enzo Ierardi
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.M.); (G.L.); (F.C.); (S.R.); (A.D.L.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy; (M.M.); (G.L.); (F.C.); (S.R.); (A.D.L.)
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Inoue K, Yoshida N, Kobayashi R, Tomita Y, Hashimoto H, Sugino S, Hirose R, Dohi O, Yasuda H, Yasuda R, Murakami T, Inada Y, Itoh Y. The Efficacy of Tumor Characterization for Colorectal Lesions with Blue Light Imaging of a Compact Light-Emitting Diode Endoscopic System Compared to a Laser Endoscopic System: A Pilot Study. Gastroenterol Res Pract 2022; 2022:9998280. [PMID: 35462983 PMCID: PMC9019446 DOI: 10.1155/2022/9998280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A compact and cost-effective light source-processor combined 3-color light-emitting diode (LED) endoscopic system (ELUXEO-Lite: EP-6000, Fujifilm Co., Tokyo) with a magnified colonoscope (EC-6600ZP, Fujifilm Co.) has been released. Aims: In this study, we analyzed the efficacy of this system for colorectal tumor characterization with magnified blue light imaging (BLI-LED) and image's subjective and objective evaluations, compared to a magnified blue laser imaging (BLI-LASER) using a standard LASER endoscopic system. Methods: We retrospectively reviewed 37 lesions observed with both BLI-LED and BLI-LASER systems from 2019 using the Japanese narrow band imaging classification. Two representative magnified images, one BLI-LED and one BLI-LASER, of the same area of a lesion were evaluated for diagnostic accuracy and visualization quality by three experts and three non-experts. Their color difference values (CDVs) and brightness values (BVs) were also calculated as objective indicators. Results: Among 37 lesions, mean tumor size was 18.9 ± 13.1 mm, and 21 lesions were nonpolypoid. Histopathology revealed 14 sessile serrated lesions, 7 adenomas, 12 high-grade dysplasias and T1a cancers, and 4 T1b cancers. The diagnostic accuracy rates of BLI-LED/BLI-LASER of experts and non-experts were 90.1% and 87.4% (p = 0.52) and 89.2% and 89.2% (p = 0.99). The percentages of instances where BLI-LED images were better, the two imaging types were equivalent, or BLI-LASER images were better were 16%/83%/1% for experts and 19%/58%/23% for non-experts (p < 0.001). CDVs and BVs between BLI-LED and BLI-LASER were not significantly different (CDVs: p = 0.653, BVs: p = 0.518). Conclusions: BLI-LED using the compact system was noninferior to BLI-LASER for colorectal tumor characterization and image quality.
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Affiliation(s)
- Ken Inoue
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Naohisa Yoshida
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Reo Kobayashi
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yuri Tomita
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Hikaru Hashimoto
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Satoshi Sugino
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Hiroaki Yasuda
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Ritsu Yasuda
- Department of Gastroenterology, Nara City Hospital, Nara, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Kyoto Daiichi Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Tamai N, Horiuchi H, Matsui H, Furuhashi H, Kamba S, Dobashi A, Sumiyama K. Visibility evaluation of colorectal lesion using texture and color enhancement imaging with video. DEN OPEN 2022; 2:e90. [PMID: 35310754 PMCID: PMC8828205 DOI: 10.1002/deo2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/09/2022]
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Naoto Tamai
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
| | - Hideka Horiuchi
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
| | - Hiroaki Matsui
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
| | - Hiroto Furuhashi
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
| | - Shunsuke Kamba
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
| | - Akira Dobashi
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
| | - Kazuki Sumiyama
- Department of Endoscopy The Jikei University School of Medicine Tokyo Japan
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Sekiguchi M, Igarashi A, Mizuguchi Y, Takamaru H, Yamada M, Sakamoto T, Maltzman H, Falkén Y, Esaki M, Matsuda T, Saito Y. Cost-effectiveness analysis of endoscopic resection for colorectal laterally spreading tumors: Endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection. Dig Endosc 2022; 34:553-568. [PMID: 34101915 DOI: 10.1111/den.14058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The cost-effectiveness of endoscopic submucosal dissection (ESD) and piecemeal endoscopic mucosal resection (pEMR) for colorectal laterally spreading tumors (LSTs) remains unclear. We examined the cost-effectiveness of these procedures for cases of colon/rectal LST-non-granular-type ≥2 cm and LST-granular-mixed-type ≥3 cm. METHODS We performed a simulation model analysis using parameters based on clinical data from the National Cancer Center Hospital, Tokyo, and previous literature. The number of recurrences and surgeries and the required costs for 5 years following ESD and pEMR were assessed. Japanese cost data were used in the base-case analysis, and probabilistic sensitivity analysis (PSA) was performed. The Swedish cost data were used in the scenario analysis. RESULTS Endoscopic submucosal dissection yielded a considerably lower number of recurrences and surgeries but required a higher cost than pEMR. The recurrence rates following ESD and pEMR were 0.9-1.3% and 21.1-25.9%, respectively. The incremental cost-effectiveness ratios for an avoided recurrence and surgery for ESD against pEMR were 376,796-476,496 JPY (3575-4521 USD) and 7,335,436-8,187,476 JPY (69,604-77,689 USD), respectively. PSA demonstrated that the probability of ESD being chosen as a more cost-effective option than pEMR was >50% at willingness-to-pay values of ≥400,000-500,000 JPY (3795-4744 USD) for avoiding a recurrence and ≥9,500,000-10,500,000 JPY (90,143-99,631 USD) for avoiding a surgery. In the scenario analysis, the required cost was also lower for ESD. CONCLUSIONS Our findings suggest potentially favorable cost-effectiveness of ESD, depending on cost settings and the willingness-to-pay value for avoiding recurrence/surgery.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.,Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | | | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Henrik Maltzman
- Division of Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Falkén
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Minoru Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Toyoshima O, Nishizawa T, Yoshida S, Yamada T, Odawara N, Matsuno T, Obata M, Kurokawa K, Uekura C, Fujishiro M. Texture and color enhancement imaging in magnifying endoscopic evaluation of colorectal adenomas. World J Gastrointest Endosc 2022; 14:96-105. [PMID: 35316981 PMCID: PMC8908327 DOI: 10.4253/wjge.v14.i2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/18/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Olympus Corporation has developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. AIM To investigate the effectiveness of TXI in identifying colorectal adenomas using magnifying observation. METHODS Colorectal adenomas were observed by magnified endoscopy using white light imaging (WLI), TXI, narrow band imaging (NBI), and chromoendoscopy (CE). This study adopted mode 1 of TXI. Adenomas were confirmed by histological examination. TXI visibility was compared with the visibility of WLI, NBI, and CE for tumor margin, and vessel and surface patterns of the Japan NBI expert team (JNET) classification. Three expert endoscopists and three non-expert endoscopists evaluated the visibility scores, which were classified as 1, 2, 3, and 4. RESULTS Sixty-one consecutive adenomas were evaluated. The visibility score for tumor margin of TXI (3.47 ± 0.79) was significantly higher than that of WLI (2.86 ± 1.02, P < 0.001), but lower than that of NBI (3.76 ± 0.52, P < 0.001), regardless of the endoscopist's expertise. TXI (3.05 ± 0.79) had a higher visibility score for the vessel pattern of JNET classification than WLI (2.17 ± 0.90, P < 0.001) and CE (2.47 ± 0.87, P < 0.001), but lower visibility score than NBI (3.79 ± 0.47, P < 0.001), regardless of the experience of endoscopists. For the visibility score for the surface pattern of JNET classification, TXI (2.89 ± 0.85) was superior to WLI (1.95 ± 0.79, P < 0.01) and CE (2.75 ± 0.90, P = 0.002), but inferior to NBI (3.67 ± 0.55, P < 0.001). CONCLUSION TXI provided higher visibility than WLI, lower than NBI, and comparable to or higher than CE in the magnified observation of colorectal adenomas.
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Affiliation(s)
- Osamu Toyoshima
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Toshihiro Nishizawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Chiba, Japan
| | - Shuntaro Yoshida
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Tomoharu Yamada
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Nariaki Odawara
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tatsuya Matsuno
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Miho Obata
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Ken Kurokawa
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Chie Uekura
- Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Brule C, Pioche M, Albouys J, Rivory J, Geyl S, Legros R, Rostain F, Dahan M, Lepetit H, Sautereau D, Ponchon T, Auditeau E, Jacques J. The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment classification for identification of large laterally spreading lesions lacking submucosal carcinomas: A prospective study of 663 lesions. United European Gastroenterol J 2022; 10:80-92. [PMID: 35089651 PMCID: PMC8830277 DOI: 10.1002/ueg2.12194] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/11/2021] [Indexed: 12/27/2022] Open
Abstract
Introduction Optical diagnosis is necessary when selecting the resection modality for large superficial colorectal lesions. The COlorectal NEoplasia Endoscopic Classification to Choose the Treatment (CONECCT) encompasses overt (irregular pit or vascular pattern) and covert (macroscopic features) signs of carcinoma in an all‐in‐one classification using validated criteria. The CONECCT IIC subtype corresponds to adenomas with a high risk of superficial carcinoma that should be resected en bloc with free margins. Methods This prospective multicentre study investigated the diagnostic accuracy of the CONECCT classification for predicting submucosal invasion in colorectal lesions >20 mm. Optical diagnosis before en bloc resection by endoscopic submucosal dissection (ESD) was compared with the final histological diagnosis. Diagnostic accuracy for the CONECCT IIC subtype was compared with literature‐validated features of concern considered to be risk factors for submucosal invasion (non‐granular large spreading tumour [NG LST], macronodule >1 cm, SANO IIIA area, and Paris 0‐IIC area). Results Six hundred 63 lesions removed by ESD were assessed. The en bloc, R0, and curative resection rates were respectively 96%, 85%, and 81%. The CONECCT classification had a sensitivity (Se) of 100%, specificity (Sp) of 26.2%, positive predictive value of 11.6%, and negative predictive value (NPV) of 100% for predicting at least submucosal adenocarcinoma. The sensitivity of CONECCT IIC (100%) to predict submucosal cancer was superior to all other criteria evaluated. COlorectal NEoplasia Endoscopic Classification to Choose the Treatment IIC lesions constituted 11.5% of all submucosal carcinomas. Conclusion The CONECCT classification, which combines covert and overt signs of carcinoma, identifies with very perfect sensitivity (Se 100%, NPV 100%) the 30% of low‐risk adenomas in large laterally spreading lesions treatable by piecemeal endoscopic mucosal resection or ESD according to expertise without undertreatment. However, the low specificity of CONECCT leads to a large number of potentially not indicated ESDs for suspected high‐risk lesions.
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Affiliation(s)
- Clementine Brule
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jeremie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jerome Rivory
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sophie Geyl
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Martin Dahan
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Hugo Lepetit
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Denis Sautereau
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Emilie Auditeau
- Department of Epidemiology, Dupuytren University Hospital, Limoges, France
| | - Jeremie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
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Bonniaud P, Jacques J, Lambin T, Gonzalez JM, Dray X, Coron E, Leblanc S, Chevaux JB, Léger-Nguyen F, Hamel B, Lienhart I, Rivory J, Ponchon T, Saurin JC, Monzy F, Legros R, Lépilliez V, Subtil F, Barret M, Pioche M. Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification. Endosc Int Open 2022; 10:E145-E153. [PMID: 35047345 PMCID: PMC8759940 DOI: 10.1055/a-1613-5328] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/10/2021] [Indexed: 10/26/2022] Open
Abstract
Background and study aims The aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table. Patients and methods For this multicenter comparative study an expert endoscopist created an image library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohen's Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology. Results Eleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alpha = 0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95 % CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95 % CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different ( P < 0.001): the highest sensitivities were for NICE 2 (84.2 %) and CONECCT IIC (78.9 %), and the lowest for Kudo Vi (31.6 %). Conclusions The CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma.
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Affiliation(s)
- Paul Bonniaud
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University hospital, Limoges, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thomas Lambin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Gonzalez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Marseille university North Hospital, Marseille, France
| | - Xavier Dray
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Digestive Diseases, Sorbonne University & APHP, Saint-Antoine Hospital, Paris, France
| | - Emmanuel Coron
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nantes University Hospital, Nantes, France
| | - Sarah Leblanc
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Jean-Baptiste Chevaux
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Nancy University Hospital, Nancy, France
| | | | - Benjamin Hamel
- Department of Gastroenterology, North-Ouest Hospital, Villefranche-Sur-Saône, France
| | | | - Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Frédéric Monzy
- Department of Gastroenterology, Clinique Claude Bernard, Albi, France
| | - Romain Legros
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Vincent Lépilliez
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Mermoz Hospital, Lyon, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France
| | - Maximilien Barret
- Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Department of Endoscopy and Gastroenterology, Hôpital Cochin, Lyon, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France,Research and Development Committee of the French Society of Digestive Endoscopy (SFED), Paris, France,Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France,Inserm U1032 LabTau, Lyon, France
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46
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Saito Y, Kodashima S, Matsuda T, Matsuda K, Fujishiro M, Tanaka K, Kobayashi K, Katada C, Horimatsu T, Muto M, Ohtsuka K, Oda I, Kato M, Kida M, Hoteya S, Yamamoto H, Ryozawa S, Iwakiri R, Kutsumi H, Kato M, Haruma K, Fujimoto K, Iishi H, Ogata H, Uemura N, Kaminishi M, Tajiri H, Inoue H. Current status of diagnostic and therapeutic colonoscopy in Japan: The Japan Endoscopic Database Project. Dig Endosc 2022; 34:144-152. [PMID: 33774877 DOI: 10.1111/den.13980] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/23/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The Japan Endoscopy Database Project was initiated to develop the world's largest endoscopy data repository. This study describes the first phase of the colonoscopy project in Japan. METHODS Data were aggregated offline by integrating information from the endoscopy database software from January 2015 through March 2017. The study population included all patients who underwent colonoscopy at eight centers. RESULTS A total of 31,395 patients who underwent 38,497 colonoscopy procedures were registered. The majority of procedures were performed for screening (n = 14,156), followed by fecal immunochemical test positivity (n = 3960), abdominal symptoms (n = 3864), post-colorectal surgery surveillance (n = 3431), post-endoscopic treatment surveillance (n = 3757), thorough pre-treatment examination (n = 2822), and therapeutic purposes (n = 6507). In the screening group, advanced cancers, early cancers, and adenomas were diagnosed endoscopically in 2.1%, 1.3%, and 28.7% of cases, respectively, while in the fecal immunochemical test-positive group, they were diagnosed in 2.5%, 1.9%, and 41.6% of cases, respectively. The incidence of complications was 0.177% and 0.152% in the screening and fecal immunochemical test-positive groups, respectively. The therapeutic procedures included 1446 cold forceps polypectomy procedures, 4770 cold snare polypectomy procedures, 368 hot biopsies, 2998 hot snare polypectomy procedures, 9775 endoscopic or piecemeal endoscopic mucosal resections, and 1660 endoscopic submucosal dissections. A total of 173 procedure-related complications (0.82%) occurred in 21,017 therapeutic procedures performed in 15,744 patients. CONCLUSIONS The first phase of the Japan Endoscopy Database Project established the proportions of the diagnostic and therapeutic colonoscopy procedures, and complication rates in real-world settings.
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Affiliation(s)
- Yutaka Saito
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shinya Kodashima
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takahisa Matsuda
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Koji Matsuda
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kiyohito Tanaka
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kiyonori Kobayashi
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Chikatoshi Katada
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takahiro Horimatsu
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Manabu Muto
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kazuo Ohtsuka
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Ichiro Oda
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Masayuki Kato
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Mitsuhiro Kida
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shu Hoteya
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hironori Yamamoto
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shomei Ryozawa
- MSED-J (Minimal Standard Endoscopic Database) Creation Subcommittee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Ryuichi Iwakiri
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hiromu Kutsumi
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Mototsugu Kato
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Ken Haruma
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Kazuma Fujimoto
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hiroyasu Iishi
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Haruhiko Ogata
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naomi Uemura
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Michio Kaminishi
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hisao Tajiri
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Haruhiro Inoue
- JED (Japan Endoscopy Database) Project Committee, Japan Gastroenterological Endoscopy Society, Tokyo, Japan
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Messmann H, Probst A, Ebigbo A. Endoscopic Characterization of Colorectal Lesions and Resection Strategy. GASTROINTESTINAL AND PANCREATICO-BILIARY DISEASES: ADVANCED DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2022:311-327. [DOI: 10.1007/978-3-030-56993-8_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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48
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Ikematsu H, Murano T, Shinmura K. Depth diagnosis of early colorectal cancer: Magnifying chromoendoscopy or image enhanced endoscopy with magnification? Dig Endosc 2022; 34:265-273. [PMID: 34289171 DOI: 10.1111/den.14087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
Depth diagnosis is extremely crucial in making a treatment choice between endoscopic resection and surgery in the early stages of cancers. Among several imaging modalities, we use magnifying endoscopy to diagnose lesions by close observation of the findings at mucosal surface layer. In combination with topical staining, magnifying endoscopy enables us to assess the definite pit structure, which referred to as magnifying chromoendoscopy (MCE). The pit pattern classification by MCE was proposed and is now widely accepted as the standard diagnostic criteria for colorectal lesions. Meanwhile, image enhanced endoscopy (IEE) represented by narrow-band imaging was developed to improve the visibility of surface and vascular findings without dyeing. Recent collaborative work performed by endoscopic experts in Japan yielded the unified diagnostic criteria, the Japan NBI Expert Team (JNET) classification, based on the findings of IEE with magnification. In this review, focusing on MCE and IEE with magnification, we aimed to give an outline of the pit pattern classification and the JNET classification, and further discuss their accuracy rate of depth diagnosis of early colorectal lesions by performing a review of the related literature. Both modalities have a high accuracy rate of nearly 90% for depth diagnosis. IEE with magnification is an ideal modality because it helps observe lesions without dye spraying; however, lesions with JNET type 2B have an inadequate diagnostic ability, which should be complemented by MCE. We conclude that accurate diagnosis is possible by examining lesions using both modalities properly to overcome the limitations of each modality.
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Affiliation(s)
- Hiroaki Ikematsu
- Division of Science and Technology for Endoscopy, Exploratory Oncology Research & Clinical Trial Center, National Cancer Center, Chiba, Japan.,Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
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49
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Mizuguchi Y, Tanaka Y, Cho H, Sekiguchi M, Takamaru H, Yamada M, Sakamoto T, Matsuda T, Hashimoto T, Sekine S, Saito Y. Endoscopic features of isolated and traditional serrated adenoma-associated superficially serrated adenomas of the colorectum. Dig Endosc 2022; 34:153-162. [PMID: 33871900 DOI: 10.1111/den.13992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Superficially serrated adenoma (SuSA) is a recently proposed subtype of colorectal serrated lesions. It is characterized by distinct clinicopathological and molecular features, including mixed serrated and adenomatous histology and frequent genetic alterations involving KRAS and RSPO. This study aimed to characterize the endoscopic features of isolated and traditional serrated adenoma (TSA)-associated SuSAs. METHODS We retrospectively evaluated the endoscopic findings of 25 isolated SuSAs and 21 TSA-associated SuSAs that were histologically and molecularly characterized. RESULTS SuSAs appeared as a sessile polyp or slightly elevated lesion located mostly in the sigmoid colon and rectum (88%). The size was between 3 and 20 mm (median, 6 mm). Most of them exhibited KRAS mutations (96%) and RSPO fusions/overexpression (92%). Endoscopically, many lesions had a whitish color (84%), a distinct border (96%), an irregular border (76%), and a lobulated surface (72%). However, diminutive lesions exhibited overlapping features with hyperplastic polyps. On narrow-band imaging, vessel patterns were invisible or appeared as lacy microvessels in most lesions (80%). Chromoendoscopy invariably showed stellar or elongated/branched stellar pits, indicating a serrated microarchitecture. Most TSA-associated SuSAs typically presented as polyps with a two-tier raised appearance, consisting of whitish lower and reddish higher components corresponding to a SuSA and a TSA, respectively. CONCLUSIONS SuSAs exhibit several characteristic endoscopic features on white-light and image-enhanced endoscopy. Diminutive lesions exhibit endoscopic features overlapping with hyperplastic polyps. Nonetheless, the endoscopic diagnosis of larger and TSA-associated SuSAs may be feasible.
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Affiliation(s)
- Yasuhiko Mizuguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusaku Tanaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Gastroenterology, Keiyu Hospital, Kanagawa, Japan
| | - Hourin Cho
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Taiki Hashimoto
- Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan.,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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50
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Okamoto Y, Yoshida S, Izakura S, Katayama D, Michida R, Koide T, Tamaki T, Kamigaichi Y, Tamari H, Shimohara Y, Nishimura T, Inagaki K, Tanaka H, Yamashita K, Sumimoto K, Oka S, Tanaka S. Development of multi-class computer-aided diagnostic systems using the NICE/JNET classifications for colorectal lesions. J Gastroenterol Hepatol 2022; 37:104-110. [PMID: 34478167 DOI: 10.1111/jgh.15682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/22/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Diagnostic support using artificial intelligence may contribute to the equalization of endoscopic diagnosis of colorectal lesions. We developed computer-aided diagnosis (CADx) support system for diagnosing colorectal lesions using the NBI International Colorectal Endoscopic (NICE) classification and the Japan NBI Expert Team (JNET) classification. METHODS Using Residual Network as the classifier and NBI images as training images, we developed a CADx based on the NICE classification (CADx-N) and a CADx based on the JNET classification (CADx-J). For validation, 480 non-magnifying and magnifying NBI images were used for the CADx-N and 320 magnifying NBI images were used for the CADx-J. The diagnostic performance of the CADx-N was evaluated using the magnification rate. RESULTS The accuracy of the CADx-N for Types 1, 2, and 3 was 97.5%, 91.2%, and 93.8%, respectively. The diagnostic performance for each magnification level was good (no statistically significant difference). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CADx-J were 100%, 96.3%, 82.8%, 100%, and 96.9% for Type 1; 80.3%, 93.7%, 94.1%, 79.2%, and 86.3% for Type 2A; 80.4%, 84.7%, 46.8%, 96.3%, and 84.1% for Type 2B; and 62.5%, 99.6%, 96.8%, 93.8%, and 94.1% for Type 3, respectively. CONCLUSIONS The multi-class CADx systems had good diagnostic performance with both the NICE and JNET classifications and may aid in educating non-expert endoscopists and assist in diagnosing colorectal lesions.
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Affiliation(s)
- Yuki Okamoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shigeto Yoshida
- Department of Gastroenterology, JR Hiroshima Hospital, Hiroshima, Japan
| | - Seiji Izakura
- Research Institute for Nanodevice and Bio Systems, Hiroshima University, Hiroshima, Japan
| | - Daisuke Katayama
- Research Institute for Nanodevice and Bio Systems, Hiroshima University, Hiroshima, Japan
| | - Ryuichi Michida
- Research Institute for Nanodevice and Bio Systems, Hiroshima University, Hiroshima, Japan
| | - Tetsushi Koide
- Research Institute for Nanodevice and Bio Systems, Hiroshima University, Hiroshima, Japan
| | - Toru Tamaki
- Department of Computer Science, Nagoya Institute of Technology, Nagoya, Japan
| | - Yuki Kamigaichi
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirosato Tamari
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasutsugu Shimohara
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Nishimura
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsuaki Inagaki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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