ABSTRACT
BACKGROUND: Computed tomography (CT) radiomics combined with deep transfer learning was used to identify cholesterol and adenomatous gallbladder polyps that have not been well evaluated before surgery. PURPOSE: To investigate the potential of various machine learning models, incorporating radiomics and deep transfer learning, in predicting the nature of cholesterol and adenomatous gallbladder polyps. MATERIAL AND METHODS: A retrospective analysis was conducted on clinical and imaging data from 100 patients with cholesterol or adenomatous polyps confirmed by surgery and pathology at our hospital between September 2015 and February 2023. Preoperative contrast-enhanced CT radiomics combined with deep learning features were utilized, and t-tests and least absolute shrinkage and selection operator (LASSO) cross-validation were employed for feature selection. Subsequently, 11 machine learning algorithms were utilized to construct prediction models, and the area under the ROC curve (AUC), accuracy, and F1 measure were used to assess model performance, which was validated in a validation group. RESULTS: The Logistic algorithm demonstrated the most effective prediction in identifying polyp properties based on 10 radiomics combined with deep learning features, achieving the highest AUC (0.85 in the validation group, 95% confidence interval = 0.68-1.0). In addition, the accuracy (0.83 in the validation group) and F1 measure (0.76 in the validation group) also indicated strong performance. CONCLUSION: The machine learning radiomics combined with deep learning model based on enhanced CT proves valuable in predicting the characteristics of cholesterol and adenomatous gallbladder polyps. This approach provides a more reliable basis for preoperative diagnosis and treatment of these conditions.
Subject(s)
Deep Learning , Tomography, X-Ray Computed , Humans , Female , Male , Retrospective Studies , Middle Aged , Tomography, X-Ray Computed/methods , Aged , Gallbladder/diagnostic imaging , Gallbladder Neoplasms/diagnostic imaging , Adult , Polyps/diagnostic imaging , Cholesterol , Gallbladder Diseases/diagnostic imaging , Predictive Value of Tests , Adenomatous Polyps/diagnostic imaging , Machine Learning , Contrast Media , RadiomicsABSTRACT
BACKGROUND AND AIM: Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm. We assessed the value of ultrasound scoring system based on independent predictive parameters in distinguishing adenomatous polyps from cholesterol polyps with the maximum size of 1.0 to 1.5 cm. MATERIALS AND METHODS: We enrolled 163 patients with gallbladder polyps (1.0 to 1.5 cm) who underwent ultrasonography and cholecystectomy. Ultrasound image characteristics were compared between cholesterol polyps and adenomatous polyps in the training cohort from April 2018 to January 2020. An ultrasound scoring system was constructed in the training cohort, and its diagnostic performance was evaluated in the validation cohort from February 2020 to February 2021. RESULTS: Maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot were significantly different between cholesterol polyps and adenomatous polyps in the training cohort ( P <0.05). The independent predictive parameters for adenomatous polyps were lower height/width ratio, presence of vascularity and absence of hyperechoic spot. The total score was as follows: (height/width ratio, <0.9=4, ≥0.9=0) + (vascularity, present=3, absent=0) + (hyperechoic spot, absent=2, present=0). The sensitivity, specificity and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33%, 80.49%, and 78.57%, respectively. CONCLUSIONS: The ultrasound scoring system aids in distinguishing adenomatous polyps from cholesterol polyps, and effectively decreasing unnecessary cholecystectomy.
Subject(s)
Adenomatous Polyps , Gallbladder Diseases , Gallbladder Neoplasms , Polyps , Adenomatous Polyps/diagnostic imaging , Cholesterol , Diagnosis, Differential , Humans , Polyps/diagnostic imaging , Retrospective Studies , Sewage , Ultrasonography/methodsABSTRACT
OBJECTIVES: This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS). METHODS: Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors. RESULTS: There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P < .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P < .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%. CONCLUSIONS: The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.
Subject(s)
Adenomatous Polyps , Gallbladder Neoplasms , Polyps , Adenomatous Polyps/diagnostic imaging , Cholesterol , Contrast Media , Diagnosis, Differential , Gallbladder Neoplasms/diagnosis , Humans , Polyps/diagnostic imaging , UltrasonographyABSTRACT
BACKGROUND AND AIM: Recently, the BLI Adenoma Serrated International Classification (BASIC) system was developed by European experts to differentiate colorectal polyps. Our aim was to validate the BASIC classification system among the US-based endoscopy experts. METHODS: Participants utilized a web-based interactive learning system where the group was asked to characterize polyps using the BASIC criteria: polyp surface (presence of mucus, regular/irregular and [pseudo]depressed), pit appearance (featureless, round/non-round with/without dark spots; homogeneous/heterogeneous distribution with/without focal loss), and vessels (present/absent, lacy, peri-cryptal, irregular). The final testing consisted of reviewing BLI images/videos to determine whether the criteria accurately predicted the histology results. Confidence in adenoma identification (rated "1" to "5") and agreement in polyp (adenoma vs non-adenoma) identification and characterization per BASIC criteria were derived. Strength of interobserver agreement with kappa (k) value was reported for adenoma identification. RESULTS: Ten endoscopy experts from the United States identified conventional adenoma (vs non-adenoma) with 94.4% accuracy, 95.0% sensitivity, 93.8% specificity, 93.8% positive predictive value, and 94.9% negative predictive value using BASIC criteria. Overall strength of interobserver agreement was high: kappa 0.89 (0.82-0.96). Agreement for the individual criteria was as follows: surface mucus (93.8%), regularity (65.6%), type of pit (40.6%), pit visibility (66.9%), pit distribution (57%), vessel visibility (73%), and being lacy (46%) and peri-cryptal (61%). The confidence in diagnosis was rated at high ≥4 in 67% of the cases. CONCLUSIONS: A group of US-based endoscopy experts have validated a simple and easily reproducible BLI classification system to characterize colorectal polyps with >90% accuracy and a high level of interobserver agreement.
Subject(s)
Adenoma , Colonic Polyps , Colonoscopy , Colorectal Neoplasms , Optical Imaging , Precancerous Conditions , Adenoma/classification , Adenoma/diagnostic imaging , Adenoma/pathology , Adenomatous Polyps/classification , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/pathology , Colonic Polyps/classification , Colonic Polyps/diagnostic imaging , Colonic Polyps/pathology , Colonoscopy/standards , Color , Colorectal Neoplasms/diagnostic imaging , Humans , Light , Observer Variation , Optical Imaging/standards , Precancerous Conditions/classification , Precancerous Conditions/diagnostic imaging , Precancerous Conditions/pathology , Sensitivity and Specificity , United StatesABSTRACT
BACKGROUND: Adequate bowel preparation is crucial for effective screening colonoscopy. However, it is unclear whether higher bowel preparation scores correspond to beneficial effects on the adenoma and polyp detection rate (ADR and PDR) in the adequate bowel preparation group. AIMS: This study aimed to evaluate the effects of bowel preparation, according to the Boston Bowel Preparation Scale (BBPS), and colonoscopy withdrawal time (CWT) on ADR and PDR in the adequate bowel preparation group. METHODS: Healthy examinees between 50 and 75 years old who underwent colonoscopy between September 2015 and August 2016 were included. BBPS scores, CWT, ADR, and PDR were reviewed retrospectively. Predictors of ADR and PDR were analyzed with a generalized linear mixed model. RESULTS: A total of 5073 cases with adequate bowel preparation (BBPS ≥ 6) were analyzed. Examinees with good (BBPS = 6, 7) and excellent (BBPS = 8, 9) bowel preparation were 1898 (37.4%) and 3175 (62.6%), respectively. Both ADR and PDR were higher in the good bowel preparation group than in the excellent bowel preparation group (ADR 47.3% vs. 45.0%, P = 0.035; PDR 73.7% vs. 69.5%, P = 0.004, respectively). In the multivariate analysis, CWT, rather than BBPS, was significantly associated with both ADR (OR 1.04; 95% CI 1.02-1.06; P < 0.001) and PDR (OR 1.05; 95% CI 1.02-1.07; P = 0.002). CONCLUSIONS: Both ADR and PDR were lower when bowel preparation was excellent rather than good. However, CWT, not BBPS, was significantly associated with ADR and PDR in the adequate bowel preparation group. Therefore, meticulous inspection is important for high-quality colonoscopy regardless of the BBPS score in examinees with adequate bowel preparation.
Subject(s)
Adenomatous Polyps/diagnostic imaging , Cathartics/administration & dosage , Colon/diagnostic imaging , Colonoscopy/methods , Early Detection of Cancer/methods , Adenomatous Polyps/surgery , Aged , Colon/surgery , Colonic Neoplasms/diagnostic imaging , Colonic Neoplasms/surgery , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/surgery , Female , Humans , Male , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
BACKGROUND: Dual-energy computed tomography (DE-CT) scans were acquired to identify cholesterol and adenomatous gallbladder (GB) polyps, which have not been well evaluated before surgery. PURPOSE: To evaluate the DE-CT findings of GB polyps 1.0-2.0 cm in size and differentiate between cholesterol and adenomatous polyps. MATERIAL AND METHODS: Forty-six patients with GB polyps were surgically treated from December 2017 to December 2019 and divided into two groups according to their postoperative pathologic results: a cholesterol group with 26 patients and an adenomatous group with 20 patients. All of these patients underwent DE-CT imaging with tube voltages of 80 kVp and 140 kVp within two weeks before surgery. Mean attenuation values were measured for every GB polyp at 80/140 kVp and at 40/140 keV. The mean attenuation value changes between 140 kVp and 80 kVp (MAVC140-80 kVp) and mean attenuation value changes between 100 keV and 40 keV (MAVC100-40 keV) were calculated. RESULTS: The CT image parameters of all 46 patients with GB polyps were analyzed. There were significant differences in MAVC140-80 kVp and MAVC100-40 keV between cholesterol and adenomatous polyps (P <0.05); these values were positive for cholesterol polyps and negative for adenomatous polyps. CONCLUSION: The unique energy spectrum information provided by DE-CT scans is helpful in differentiating between cholesterol and adenomatous polyps 1.0-2.0 cm in size.
Subject(s)
Adenomatous Polyps/diagnostic imaging , Gallbladder Neoplasms/diagnostic imaging , Polyps/diagnostic imaging , Radiography, Dual-Energy Scanned Projection/methods , Tomography, X-Ray Computed/methods , Adenomatous Polyps/surgery , Adult , Aged , Cholecystectomy , Cholesterol , Diagnosis, Differential , Female , Gallbladder/diagnostic imaging , Gallbladder/surgery , Gallbladder Neoplasms/surgery , Humans , Male , Middle Aged , Polyps/surgery , Radiographic Image Interpretation, Computer-Assisted/methods , Reproducibility of Results , Retrospective Studies , Young AdultABSTRACT
BACKGROUND AND STUDY AIMS: Small polyps are occasionally missed during colonoscopy. This study was conducted to validate the diagnostic performance of a polyp-detection algorithm to alert endoscopists to unrecognized lesions. METHODS: A computer-aided detection (CADe) algorithm was developed based on convolutional neural networks using training data from 1991 still colonoscopy images from 283 subjects with adenomatous polyps. The CADe algorithm was evaluated on a validation dataset including 50 short videos with 1-2 polyps (3.5 ± 1.5 mm, range 2-8 mm) and 50 videos without polyps. Two expert colonoscopists and two physicians in training separately read the same videos, blinded to the presence of polyps. The CADe algorithm was also evaluated using eight full videos with polyps and seven full videos without a polyp. RESULTS: The per-video sensitivity of CADe for polyp detection was 88% and the per-frame false-positive rate was 2.8%, with a confidence level of ≥30%. The per-video sensitivity of both experts was 88%, and the sensitivities of the two physicians in training were 84% and 76%. For each reader, the frames with missed polyps appearing on short videos were significantly less than the frames with detected polyps, but no trends were observed regarding polyp size, morphology or color. For full video readings, per-polyp sensitivity was 100% with a per-frame false-positive rate of 1.7%, and per-frame specificity of 98.3%. CONCLUSIONS: The sensitivity of CADe to detect small polyps was almost equivalent to experts and superior to physicians in training. A clinical trial using CADe is warranted.
Subject(s)
Adenomatous Polyps , Colonic Polyps , Deep Learning , Adenomatous Polyps/diagnostic imaging , Algorithms , Colonic Polyps/diagnostic imaging , Colonoscopy , HumansABSTRACT
BACKGROUND: The BASIC classification for predicting in vivo colorectal polyp histology incorporates both surface and pit/vessel descriptor domains. This study aimed to define new BASIC classes for adenomatous and hyperplastic polyps. METHODS: A video library (102 still images/videos of <â10-mm polyps using white-light [WLI] and blue-light imaging [BLI]) was reviewed by seven expert endoscopists. Polyps were rated according to the individual descriptors of the three BASIC domains (surface/pit/vessel). A model to predict polyp histology (adenomatous or hyperplastic) was developed using multivariable logistic regression and subsequent "leave-one-out" cross-validation. New BASIC rules were then defined by Delphi agreement. The overall accuracy of these rules when used by experts was evaluated according to the level of confidence and light type. RESULTS: The strength of prediction for adenomatous histology from 2175 observations assessed by area under the curve (AUC; 95â% confidence interval) was poor-to-fair for the surface descriptors (0.50 [0.33â-â0.69] for mucus; 0.68 [0.57â-â0.79] for irregular surface), but stronger for pits (0.87 [0.80â-â0.96] for featureless/round/not round) and vessels (0.80 [0.65â-â0.87] for not present/lacy/pericryptal). By combining the domains, a good-to-excellent prediction was shown (AUC 0.89 [0.81â-â0.96]). After the definition of new BASIC rules for adenomatous and hyperplastic polyps, accuracy for high confidence BLI predictions was 90.3â% (86.3â%â-â93.2â%), which was superior to high confidence WLI (83.7â% [77.3â%â-â87.7â%]) and low confidence BLI predictions (77.7â% [61.1â%â-â88.6â%]). CONCLUSIONS: Based on the strength of prediction, the new BASIC classes for adenomatous and hyperplastic histology show favorable results for accuracy and confidence levels.
Subject(s)
Adenomatous Polyps , Colonic Polyps , Colorectal Neoplasms , Adenomatous Polyps/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colonoscopy , Colorectal Neoplasms/diagnostic imaging , Humans , Narrow Band Imaging , Sensitivity and Specificity , SoftwareABSTRACT
BACKGROUND: Helicobacter pylori infection and hyperplastic polyp are known to have strong connections, but there are not enough randomized controlled trial data. AIMS: To evaluate the effect of H. pylori eradication on gastric hyperplastic polyp. METHOD: This is an open-labeled, single-center, randomized controlled trial. Patients with hyperplastic polyp and current infection of H. pylori were randomly assigned to eradication or non-eradication groups. All participants underwent follow-up endoscopy to investigate the regression of gastric polyps. Gastric polyp regression was defined as the disappearance of polyps or a reduction of more than 50% in size. RESULTS: Thirty-two patients were randomized to eradication (n = 17) and non-eradication groups (n = 15). Final included patients were 14 in eradication group and 13 in non-eradication group. All patients showed polyp regression in eradication group, whereas no regression was observed in non-eradication group (P < 0.001). Disappearance of polyp (n = 7) and decrease in size (n = 7) were observed in eradication group. In non-eradication group, no change (n = 5), increase of size (n = 5), and increase of number (n = 3) were observed. Mean regression time was 6.8 months, and disappearance time was 9.8 months. In non-eradication group, hyperglycemia was noted in 50% of progression group but not noted in no change group (P = 0.057). CONCLUSIONS: H. pylori eradication induced regression of hyperplastic polyp, and persistent H. pylori infection was related to progression of gastric polyp. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT03065868.
Subject(s)
Adenomatous Polyps , Amoxicillin/administration & dosage , Clarithromycin/administration & dosage , Helicobacter Infections , Helicobacter pylori , Lansoprazole/administration & dosage , Stomach Neoplasms , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/microbiology , Adenomatous Polyps/therapy , Anti-Bacterial Agents/administration & dosage , Breath Tests/methods , Drug Monitoring/methods , Endoscopy, Digestive System/methods , Female , Helicobacter Infections/diagnosis , Helicobacter Infections/drug therapy , Helicobacter Infections/physiopathology , Helicobacter pylori/drug effects , Helicobacter pylori/isolation & purification , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Proton Pump Inhibitors/administration & dosage , Stomach Neoplasms/diagnostic imaging , Stomach Neoplasms/microbiology , Stomach Neoplasms/therapyABSTRACT
BACKGROUND & AIMS: Recommendations for surveillance after curative surgery for colorectal cancer (CRC) include a 1-year post-resection abdominal-pelvic computed tomography (CT) scan and optical colonoscopy (OC). CT colonography (CTC), when used in CRC screening, effectively identifies colorectal polyps ≥10 mm and cancers. We performed a prospective study to determine whether CTC, concurrent with CT, could substitute for OC in CRC surveillance. METHODS: Our study enrolled 231 patients with resected stage 0-III CRC, identified at 5 tertiary care academic centers. Approximately 1 year after surgery, participants underwent outpatient CTC plus CT, followed by same-day OC. CTC results were revealed after endoscopic visualization of sequential colonic segments, which were re-examined for discordant findings. The primary outcome was performance of CTC in the detection of colorectal adenomas and cancers using endoscopy as the reference standard. RESULTS: Of the 231 participants, 116 (50.2%) had polyps of any size or histology identified by OC, and 15.6% had conventional adenomas and/or serrated polyps ≥6 mm. No intra-luminal cancers were detected. CTC detected patients with polyps of ≥6 mm with 44.0% sensitivity (95% CI, 30.2-57.8) and 93.4% specificity (95% CI, 89.7-97.0). CTC detected polyps ≥10 mm with 76.9% sensitivity (95% CI, 54.0-99.8) and 89.0% specificity (95% CI, 84.8-93.1). Similar values were found when only adenomatous polyps were considered. The negative predictive value of CTC for adenomas ≥6 mm was 90.7% (95% CI, 86.7-94.5) and for adenomas ≥10 mm the negative predictive value was 98.6% (95% CI, 97.0-100). CONCLUSIONS: In a CRC surveillance population 1 year following resection, CTC was inferior to OC for detecting patients with polyps ≥6 mm. Clinical Trials.gov Registration Number: NCT02143115.
Subject(s)
Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/pathology , Colonic Polyps/diagnostic imaging , Colonic Polyps/pathology , Colonography, Computed Tomographic , Colonoscopy , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/pathology , Adenomatous Polyps/surgery , Adult , Aged , Aged, 80 and over , Colectomy , Colonic Polyps/surgery , Colorectal Neoplasms/surgery , Female , Humans , Male , Middle Aged , Postoperative Care , Predictive Value of Tests , Prospective Studies , Reproducibility of Results , Tertiary Care Centers , Time Factors , Treatment Outcome , Tumor Burden , United StatesABSTRACT
OBJECTIVES: Accurate, real-time, endoscopic risk stratification of colorectal polyps would improve decision-making and optimize clinical efficiency. Technologies to manipulate endoscopic optical outputs can be used to predict polyp histology in vivo; however, it remains unclear how accuracy has progressed and whether it is sufficient for routine clinical implementation. METHODS: A meta-analysis was conducted by searching MEDLINE, Embase, and the Cochrane Library. Studies were included if they prospectively deployed an endoscopic optical technology for real-time in vivo prediction of adenomatous colorectal polyps. Polyposis and inflammatory bowel diseases were excluded. Bayesian bivariate meta-analysis was performed, presenting 95% confidence intervals (CI). RESULTS: One hundred two studies using optical technologies on 33,123 colorectal polyps were included. Digital chromoendoscopy differentiated neoplasia (adenoma and adenocarcinoma) from benign polyps with sensitivity of 92.2% (90.6%-93.9% CI) and specificity of 84.0% (81.5%-86.3% CI), with no difference between constituent technologies (narrow-band imaging, Fuji intelligent Chromo Endoscopy, iSCAN) or with only diminutive polyps. Dye chromoendoscopy had sensitivity of 92.7% (90.1%-94.9% CI) and specificity of 86.6% (82.9%-89.9% CI), similarly unchanged for diminutive polyps. Spectral analysis of autofluorescence had sensitivity of 94.4% (84.0%-99.1% CI) and specificity of 50.9% (13.2%-88.8% CI). Endomicroscopy had sensitivity of 93.6% (85.3%-98.3% CI) and specificity of 92.5% (81.8%-98.1% CI). Computer-aided diagnosis had sensitivity of 88.9% (74.2%-96.7% CI) and specificity of 80.4% (52.6%-95.7% CI). Prediction confidence and endoscopist experience alone did not significantly improve any technology. The only subgroup to demonstrate a negative predictive value for adenoma above 90% was digital chromoendoscopy, making high confidence predictions of diminutive recto-sigmoid polyps. Chronologic meta-analyses show a falling negative predictive value over time. A significant publication bias exists. DISCUSSION: This novel approach to meta-analysis demonstrates that existing optical technologies are increasingly unlikely to allow safe "resect and discard" strategies and that step-change innovation may be required. A "diagnose and leave" strategy may be supported for diminutive recto-sigmoid polyps diagnosed with high confidence; however, limitations exist in the evidence base for this cohort.
Subject(s)
Adenocarcinoma/diagnostic imaging , Adenomatous Polyps/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colorectal Neoplasms/diagnostic imaging , Adenocarcinoma/pathology , Adenoma/diagnostic imaging , Adenoma/pathology , Adenomatous Polyps/pathology , Colonic Polyps/pathology , Colonoscopy , Colorectal Neoplasms/pathology , Diagnosis, Computer-Assisted , Humans , Microscopy , Narrow Band Imaging , Optical Imaging , Sensitivity and SpecificityABSTRACT
BACKGROUND: Yield of Endocuff-assisted colonoscopy (EAC) compared with standard colonoscopy is conflicting in terms of adenoma detection rate (ADR). A meta-analysis of randomized controlled trials (RCTs) appears necessary. METHODS: PubMed and Google Scholar were searched in December 2017.âAbstracts from Digestive Disease Week and United European Gastroenterology Week meetings were also searched to 2017.âAll RCTs comparing EAC with standard colonoscopy were included. Analysis was conducted by using the Mantel-Haenszel models. Heterogeneity was quantified using the I2 test. RESULTS: Of the 265 articles reviewed, 12 RCTs were included, with a total of 8376 patients (EAC group 4225; standard colonoscopy group 4151). In the meta-analysis, ADR was significantly increased in the EAC group vs. the standard colonoscopy group (41.3â% vs. 34.2â%; risk ratio [RR]â=â1.20, 95â% confidence interval [CI] 1.06 to 1.36; Pâ=â0.003; I2â=â79â%), especially for operators with low-to-moderate ADRs (<â35â%): RRâ=â1.51, 95â%CI 1.35 to 1.69; Pâ<â0.001; I2â=â43â%). In contrast, this benefit was not reached for operators with high ADRs (>â45â%): RRâ=â1.01, 95â%CI 0.93 to 1.09; Pâ=â0.87; I2â=â0.0â%). The mean number of adenomas per patient tended to be higher with EAC (mean differenceâ=â0.11 adenomas/patient, 95â%CIâ-â0.17 to 0.38). Similar results were shown for polyp detection rates (61.6â% vs. 51.4â%; RRâ=â1.20, 95â%CI 1.06 to 1.36; Pâ=â0.004). Use of the Endocuff did not impact the cecal intubation rate (95.1â% vs. 95.7â%; Pâ=â0.08), or the procedure time compared with standard colonoscopy. Adverse events related to Endocuff were rare and exclusively mild mucosal erosion (4.0â%; 95â%CI 2.0â% to 8.0â%). CONCLUSION: With moderate-quality evidence, this study showed an improvement in ADR with EAC without major adverse events, especially for operators with low-to-moderate ADRs.
Subject(s)
Adenoma , Adenomatous Polyps , Colonoscopy , Colorectal Neoplasms , Adenoma/diagnostic imaging , Adenoma/pathology , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/pathology , Colonoscopy/adverse effects , Colonoscopy/instrumentation , Colonoscopy/methods , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/pathology , Humans , Randomized Controlled Trials as Topic , Reproducibility of ResultsABSTRACT
BACKGROUND AND STUDY AIM: Advanced endoscopic imaging has revolutionized the characterization of lesions during colonoscopy. The aim of this study was to create a new classification for differentiating subcentimetric hyperplastic and adenomatous polyps, and deeply invasive malignant lesions using blue-light imaging (BLI) with high definition, with and without optical magnification, as well as to assess its interobserver concordance. METHODS: A video library consisting of 48 videos/still images (with/without optical magnification) from 24 histologically verified polyps/cancer with BLI was prospectively created. In the first step, seven endoscopists with experience in electronic chromoendoscopy reviewed 12 BLI videos/still images with/without magnification representative of the different histotypes, and individually identified possible descriptors. In the second step, these descriptors were categorized and summarized with a modified Delphi methodology. In the third step, the seven endoscopists independently reviewed the remaining 36 videos/still images with/without optical magnification, and the interobserver agreement for the new descriptors was assessed. The interobserver agreement between endoscopists was assessed using Gwet's AC1. RESULTS: By reviewing the initial 12 videos/still images, 43 descriptors were proposed. By a modified Delphi process, the endoscopists eventually agreed on summarizing 12 descriptors into three main domains. The main domains identified were: polyp surface (mucus, yes/no; regular/irregular; [pseudo]depressed, yes/no), pit appearance (featureless, yes/no; round/nonround with/without dark spots; homogeneous/heterogeneous distribution with/without focal loss), and vessels (present/absent, lacy, pericryptal, irregular). Interobserver agreement for the polyp surface domain appeared to be almost perfect for mucus (AC1 0.92 with and 0.88 without optical magnification), substantial for the regular/irregular surface (AC1 0.67 with and 0.66 without optical magnification). For the pit appearance domain, interobserver agreement was good for featureless (AC1 0.9 with and 0.8 without optical magnification), and round/nonround (AC1 0.77 with and 0.69 without optical magnification) descriptors, but less consistent for the homogeneity of distribution (AC1 with/without optical magnification 0.58). Agreement was almost perfect for the vessel domain (AC1 0.81â-â0.85). CONCLUSIONS: The new BASIC classification takes into account both morphological features of the polyp, as well as crypt and vessel characteristics. A high concordance among the observers was shown for most of the summarized descriptors. Optical magnification had a beneficial effect in terms of interobserver agreement for most of the descriptors.
Subject(s)
Adenomatous Polyps , Colonic Polyps , Colonoscopy/methods , Colorectal Neoplasms , Intestinal Mucosa/pathology , Narrow Band Imaging/methods , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/pathology , Classification , Colonic Polyps/classification , Colonic Polyps/diagnostic imaging , Colonic Polyps/pathology , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/pathology , Humans , Hyperplasia , Library Collection Development , Neoplasm Invasiveness , Observer Variation , Precancerous Conditions/diagnostic imaging , Precancerous Conditions/pathology , Reproducibility of Results , Video RecordingABSTRACT
BACKGROUND: The optimal method for teaching NBI International Colorectal Endoscopic (NICE) criteria to medical trainees is unknown. METHODS: Trainees (medical students, residents, and gastroenterology fellows) were randomized to 2 groups (in-classroom vs. self-directed training). Teaching phase: A standardized presentation was developed about narrow band imaging (NBI) and NICE criteria. The in-class teaching group attended a single live-teaching session (with NBI expert). The self-directed training group was provided with the same educational tool with recorded audio. Testing phase: All participants provided their predicted histology and their level of confidence. After completing initial 10 clips, the in-class teaching group received live feedback (NBI expert), whereas the self-teaching group received automated audio feedback. All participants then reviewed the next 30 NBI videos. The diagnostic performance of NBI in predicting histology was compared between the 2 groups. RESULTS: Twenty medical trainees (8 students, 8 residents, and 4 gastroenterology fellows) participated in the study. The overall accuracy, sensitivity, specificity, and negative predictive value in using NBI to predict histology were: 79.0% [95% confidence interval (CI), 76.2-81.8], 69.5% (95% CI, 65.0-74.0), 88.5% (95% CI, 85.3-91.6), and 74.4% (95% CI, 70.4-78.3). There were no significant differences in the performance characteristics between the in-classroom and self-directed groups for all responses including those answered with high confidence. CONCLUSIONS: Using a standardized educational tool, the accuracy of distinguishing adenomatous versus hyperplastic colon polyps using NBI between the in-class teaching and self-directed learning were similar. This suggests that both training methods can be utilized for the education of medical trainees in the use of NICE criteria.
Subject(s)
Adenomatous Polyps/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colonoscopy/education , Education, Medical/methods , Adenomatous Polyps/pathology , Clinical Competence , Colonic Polyps/pathology , Colonoscopy/methods , Fellowships and Scholarships , Gastroenterology/education , Humans , Internship and Residency , Narrow Band Imaging/methods , Predictive Value of Tests , Sensitivity and Specificity , Students, MedicalABSTRACT
BACKGROUND: Polyp detection rate (PDR) during lower gastrointestinal endoscopy (LGIE) is of clinical importance. Detecting adenomatous polyps early in the adenoma-carcinoma sequence can halt disease progression, enabling treatment at a favourable stage. High definition colonoscopy (HDC) has been used in our hospital alongside standard definition equipment since 2011. We aim to determine what affect the use of HDC has on PDR. METHODS: Post-hoc analysis of a prospectively maintained database on all patients undergoing LGIE was performed (01/01/2012-31/12/2015), n = 15,448. Analysis tested the primary outcome of HD's effect on PDR across LGIE and secondary outcome stratified this by endoscopist group (Physician (PE), Surgeon (SE) and Nurse Endoscopist (NE)). RESULTS: Of 15,448 patients, 1353 underwent HDC. Unmatched analysis showed PDR increased by 5.3% in this group (p < 0.001). Matched analysis considered 2288 patients from the total cohort (1144 HDC) and showed an increase of 1% in PDR with HDC (p = 0.578). Further unmatched analysis stratified by endoscopist groups showed a PDR increase of 1.8% (p = 0.375), 5.4% (p = 0.008) and 4.6% (p = 0.021) by PE, SE and NE respectively. Matched analysis demonstrated an increase of 1% (p = 0.734) and 1.5% (p = 0.701) amongst PE and NE, with a decrease of 0.6% (p = 0.883) by SE. CONCLUSION: The introduction of HDC increased PDR across all LGIE in our hospital, though this was not clinically significant. This marginal benefit was present across all endoscopist groups with no group benefiting over another in matched analysis.
Subject(s)
Adenomatous Polyps/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colonoscopy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Propensity Score , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: This study aims to investigate the value of oral contrast ultrasonography (OCUS) in the diagnosis of gastric cancer in elderly patients. METHODS: OCUS data obtained from patients ≥ 60 years old were retrospectively analyzed and compared with gastroscopy results. RESULTS: Among the 12,716 subjects examined by OCUS, 5021 subjects were ≥ 60 years old, which accounted for 39.48% (5021/12,716). Gastritis, gastric polyp, benign ulcer, and gastric cancer were detected by OCUS in 1099 patients. Among them, 196 patients underwent gastroscopy. Furthermore, ulcerative lesions were detected in 32 patients by OCUS and in 51 patients by gastroscopy, and the coincidence rate was 62.74%. Among these patients, gastric cancer was diagnosed in 18 patients by OCUS with a detection rate of 1.64% (18/1099) and detected in 19 patients by gastroscopy with a diagnostic coincidence rate of 94.73% (18/19). Furthermore, benign ulcer was detected in 14 patients by OCUS and in 32 patients by gastroscopy, and the diagnostic coincidence rate was 43.75% (14/32). CONCLUSION: OCUS helps to timely detect senile gastric cancer and can be used as a suitable technique for the detection of gastric diseases.
Subject(s)
Contrast Media/administration & dosage , Early Detection of Cancer/methods , Stomach Neoplasms/diagnostic imaging , Ultrasonography/methods , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/epidemiology , Age Factors , Aged , Aged, 80 and over , Comorbidity , Feasibility Studies , Female , Gastritis/diagnostic imaging , Gastritis/epidemiology , Gastroscopy , Humans , Incidence , Male , Middle Aged , Predictive Value of Tests , Prognosis , Retrospective Studies , Stomach Neoplasms/epidemiology , Stomach Ulcer/diagnostic imaging , Stomach Ulcer/epidemiologyABSTRACT
BACKGROUNDS AND AIMS: The Japan NBI Expert Team (JNET) classification is the first universal narrow-band imaging magnifying endoscopic classification of colorectal tumors. Considering each type in this classification, the diagnostic ability of Type 2B is the weakest. Generally, clinical behavior is believed to be different in each gross type of colorectal tumor. We evaluated the differences in the diagnostic performance of JNET classification for each gross type (polypoid and superficial) and examined whether the diagnostic performance of Type 2B could be improved by subtyping. METHODS: We analyzed 2933 consecutive cases of colorectal lesions, including 136 hyperplastic polyps/sessile serrated polyps, 1926 low-grade dysplasias (LGDs), 571 high-grade dysplasias (HGDs), and 300 submucosal (SM) carcinomas. We classified lesions as polypoid and superficial type and compared the diagnostic performance of the classification system in each type. Additionally, we subtyped Type 2B into 2B-low and 2B-high based on the level of irregularity in surface and vessel patterns, and we evaluated the relationship between the subtypes and histology, as analyzed separately for polypoid and superficial types. We also estimated interobserver and intraobserver variability. RESULTS: The diagnostic performance of JNET classification did not differ significantly between polypoid and superficial lesions. Ninety-nine percent of Type 2B-low lesions were LGDs, HGDs, or superficial submucosal invasive (SM-s) carcinomas. In contrast, 60% of Type 2B-high lesions were deep submucosal invasive (SM-d) carcinomas. The results were not different between each gross type. Interobserver and intraobserver agreements for Type 2B subtyping were good, with kappa values of .743 and .786, respectively. CONCLUSIONS: Type 2B subtyping may be useful for identifying lesions that are appropriate for endoscopic resection. JNET classification and Type 2B sub classification are useful criteria, regardless of gross type.
Subject(s)
Adenomatous Polyps/diagnostic imaging , Carcinoma/diagnostic imaging , Colonic Polyps/diagnostic imaging , Colorectal Neoplasms/diagnostic imaging , Adenoma/classification , Adenoma/diagnostic imaging , Adenoma/pathology , Adenomatous Polyps/classification , Adenomatous Polyps/pathology , Carcinoma/classification , Carcinoma/pathology , Colonic Polyps/classification , Colonic Polyps/pathology , Colonoscopy , Colorectal Neoplasms/classification , Colorectal Neoplasms/pathology , Humans , Intestinal Mucosa/pathology , Japan , Narrow Band Imaging , Neoplasm InvasivenessABSTRACT
Background and study aims Cold snare polypectomy (CSP) is considered to be safe for the removal of subcentimeter colorectal polyps. This study aimed to determine the rate of incomplete CSP resection for subcentimeter neoplastic polyps at our center. Patients and methods Patients with small or diminutive adenomas (diameter 1â-â9âmm) were recruited to undergo CSP until no polyp was visible. After CSP, a 1â-â3âmm margin around the resection site was removed using endoscopic mucosal resection. The polyps and resection site marginal specimens were microscopically evaluated. Incomplete resection was defined as the presence of neoplastic tissue in the marginal specimen. We also calculated the frequency at which the polyp lateral margins could be assessed for completeness of resection. Results A total of 307 subcentimeter neoplastic polyps were removed from 120 patients. The incomplete resection rate was 3.9â% (95â% confidence interval [CI] 1.7â%â-â6.1â%); incomplete resection was not associated with polyp size, location, morphology, or operator experience. The polyp lateral margins could not be assessed adequately for 206 polyps (67.1â%). Interobserver agreement between incomplete resection and lateral polyp margins that were inadequate for assessment was poor (κâ=â0.029, 95â%CI 0â-â0.04). Female sex was an independent risk factor for incomplete resection (odds ratio 4.41, 95â%CI 1.26â-â15.48; P â=â0.02). Conclusions At our center, CSP resection was associated with a moderate rate of incomplete resection, which was not associated with polyp characteristics. However, adequate evaluation of resection may not be routinely possible using the lateral margin from subcentimeter polyps that were removed using CSP.Trial registered at University Hospital Medical Information Network (UMIN 000010879).
Subject(s)
Adenomatous Polyps/surgery , Colonoscopy/methods , Colorectal Neoplasms/surgery , Endoscopic Mucosal Resection/methods , Intestinal Polyps/surgery , Adenomatous Polyps/diagnostic imaging , Adult , Aged , Aged, 80 and over , Colorectal Neoplasms/diagnostic imaging , Female , Humans , Intestinal Polyps/diagnostic imaging , Logistic Models , Male , Middle Aged , Narrow Band Imaging , Observer Variation , Prospective Studies , Treatment OutcomeABSTRACT
1 ESGE recommends cold snare polypectomy (CSP) as the preferred technique for removal of diminutive polyps (sizeâ≤â5âmm). This technique has high rates of complete resection, adequate tissue sampling for histology, and low complication rates. (High quality evidence, strong recommendation.) 2 ESGE suggests CSP for sessile polyps 6â-â9âmm in size because of its superior safety profile, although evidence comparing efficacy with hot snare polypectomy (HSP) is lacking. (Moderate quality evidence, weak recommendation.) 3 ESGE suggests HSP (with or without submucosal injection) for removal of sessile polyps 10â-â19âmm in size. In most cases deep thermal injury is a potential risk and thus submucosal injection prior to HSP should be considered. (Low quality evidence, strong recommendation.) 4 ESGE recommends HSP for pedunculated polyps. To prevent bleeding in pedunculated colorectal polyps with headâ≥â20âmm or a stalkâ≥â10âmm in diameter, ESGE recommends pretreatment of the stalk with injection of dilute adrenaline and/or mechanical hemostasis. (Moderate quality evidence, strong recommendation.) 5 ESGE recommends that the goals of endoscopic mucosal resection (EMR) are to achieve a completely snare-resected lesion in the safest minimum number of pieces, with adequate margins and without need for adjunctive ablative techniques. (Low quality evidence; strong recommendation.) 6 ESGE recommends careful lesion assessment prior to EMR to identify features suggestive of poor outcome. Features associated with incomplete resection or recurrence include lesion size > 40 mm, ileocecal valve location, prior failed attempts at resection, and size, morphology, site, and access (SMSA) level 4. (Moderate quality evidence; strong recommendation.) 7 For intraprocedural bleeding, ESGE recommends endoscopic coagulation (snare-tip soft coagulation or coagulating forceps) or mechanical therapy, with or without the combined use of dilute adrenaline injection. (Low quality evidence, strong recommendation.)An algorithm of polypectomy recommendations according to shape and size of polyps is given (Fig.â1).
Subject(s)
Colon/surgery , Colonoscopy/methods , Endoscopic Mucosal Resection/methods , Intestinal Polyps/surgery , Rectum/surgery , Adenomatous Polyps/diagnostic imaging , Adenomatous Polyps/pathology , Adenomatous Polyps/surgery , Algorithms , Colon/diagnostic imaging , Colon/pathology , Colonoscopy/instrumentation , Colonoscopy/standards , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/pathology , Colorectal Neoplasms/surgery , Endoscopic Mucosal Resection/instrumentation , Endoscopic Mucosal Resection/standards , Humans , Intestinal Polyps/diagnostic imaging , Intestinal Polyps/pathology , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Rectum/diagnostic imaging , Rectum/pathologyABSTRACT
BACKGROUND: Double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) is a method broadly used for gastric cancer screening in Japan. Gastric polyp is one of the most frequent findings detected by UGI-XR, but how to handle it remains controversial. METHODS: Gastric polyps of the 17,264 generally healthy subjects in Japan who underwent UGI-XR or upper gastrointestinal endoscopy (UGI-ES) in 2010 were analyzed. RESULTS: Of the 6,433 UGI-XR examinees (3,405 men and 3,028 women, 47.4 ± 9.0 years old), gastric polyps were detected in 464 men (13.6 %) and 733 women (24.2 %) and were predominantly developed on the non-atrophic gastric mucosa (p < 0.0001). Multiple logistic regression analysis showed that the presence of gastric polyps has significant association with lower value of serum anti-Helicobacter pylori IgG titer, female gender, lighter smoking habit, older age, and normal range of body mass index (≥18.5 and <25), but not with drinking or serum pepsinogen I/II ratio. During the 3-year follow-up, gastric cancer occurred in 7 subjects (0.11 %), but none of them had gastric polyps at the beginning of the follow-up period. Of the 2,722 subjects with gastric polyps among the 10,831 UGI-ES examinees in the same period, 2,446 (89.9 %) had fundic, 267 (9.8 %) had hyperplastic, and 9 (0.3 %) had adenomatous/cancerous polyps. CONCLUSIONS: Gastric polyps diagnosed by UGI-XR predominantly arise on the Helicobacter pylori-negative gastric mucosa with a low risk of gastric cancer in Japan. In the prospective observation, none of the UGI-XR examinees with gastric polyps developed gastric cancer for at least 3 years subsequently.