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Browsing by Author "Anderson, Joseph C."
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Item Association of small versus diminutive adenomas and the risk for metachronous advanced adenomas: data from the New Hampshire Colonoscopy Registry(Elsevier, 2019) Anderson, Joseph C.; Rex, Douglas K.; Robinson, Christina; Butterly, Lynn F.; Medicine, School of MedicineBackground and Aims Limited data are available to investigate the impact of index adenoma size on the risk of metachronous advanced adenomas. Our goal was to examine the impact of having small (5-9 mm) versus diminutive (<5 mm) adenomas on the future risk of advanced adenomas within the categories for polyps <1 cm currently used in the United States: 1 to 2 and 3 or more tubular adenomas. Methods We included data from individuals participating in the statewide, population-based New Hampshire Colonoscopy Registry (NHCR). Groups were based on index findings: (1) 1 to 2 adenomas <5 mm (both diminutive), (2) 1 to 2 adenomas <1 cm (one or both small), (3) 3 to 10 adenomas <5 mm (all diminutive), (4) 3 to 10 adenomas <1 cm (one or more small), and (5) advanced adenomas (AA). AAs were defined as adenomas ≥1cm or those with villous elements or high-grade dysplasia or colorectal cancer (CRC). Outcomes were the absolute and adjusted risk of metachronous AAs. Covariates included age, sex, body mass index, family history of CRC, lifestyle factors, presence of serrated polyps, and time since the index examination. Results After adjusting for the covariates, we observed that having 1 to 2 adenomas with at least one 5 to 9 mm adenoma (adjusted odds ratio [AOR], 1.54; 95% confidence interval [CI], 1.12-2.11), 3 to 10 diminutive adenomas (AOR, 1.75; 95% CI, 1.03-2.95), 3 to 10 adenomas <1 cm (1 or more small) (AOR, 2.14; 95% CI, 1.39-3.29) or AAs (AOR, 2.77; 95% CI, 2.05-3.74) were associated with an increased risk for metachronous AA compared with having 1 to 2 diminutive adenomas. A further stratification of group 2 showed that those with exactly 2 small adenomas had an absolute risk of future AA of 7.6% (11/144) (95% CI, 4.3%-13.2%), higher than the absolute risk in the 1 to 2 diminutive polyp group, and similar to the risk for 3 to 10 adenomas of 8.2% (95% CI, 5.4-11.9). Conclusions For individuals with 1 to 2 adenomas <1 cm, having at least 1 small adenoma increased the metachronous risk of AA compared with having only diminutive adenomas. Furthermore, the subset with 2 small adenomas had a risk of future AA similar to the risk for 3 to 10 adenomas. These data suggest that individuals with at least 1 small adenoma may be at higher risk for future AAs and thus require closer follow-up than those with only diminutive adenomas. These data may be valuable to guideline committees for the creation of future surveillance recommendations.Item Cold versus hot snare resection with or without submucosal injection of 6-15 mm colorectal polyps: a randomized controlled trial(ScienceDirect, 2022) Rex, Douglas K.; Anderson, Joseph C.; Pohl, Heiko; Lahr, Rachel E.; Judd, Stephanie; Antaki, Fadi; Lilley, Kirthi; Castelluccio., Peter F.; Vemulapalli, Krishna C.; Medicine, School of MedicineBackground and aims Cold snare resection of colorectal lesions has been found safe and effective for an expanding set of colorectal lesions. In this study, we sought to understand the efficacy of simple cold snare resection and cold endoscopic mucosal resection (EMR), versus hot snare resection and hot EMR for colorectal lesions 6-15 mm in size. Methods At three U.S. centers, 235 patients with 286 colorectal lesions 6-15 mm in size were randomized to cold snaring, cold EMR, hot snaring, or hot EMR for non-pedunculated colorectal lesions 6-15 mm in size. The primary outcome was complete resection determined by 4 biopsies from the defect margin and 1 biopsy from the center of the resection defect. Results The overall incomplete resection rate was 2.4% (95% CI 0.8-7.5%). All 7 incompletely removed polyps were 10-15 mm in size and removed by hot EMR (n = 4, 6.2%), hot snare (n = 2, 2.2%), or cold EMR (n = 1, 1.8%). Cold snaring had no incomplete resections, required less procedural time than the other methods, and was not associated with serious adverse events. Conclusion Cold snaring is a dominant resection technique for non-pedunculated colorectal lesions 6-15 mm in size.Item Comparing adenoma and polyp miss rates for total underwater colonoscopy versus standard CO2: a randomized controlled trial using a tandem colonoscopy approach(Elsevier, 2018) Anderson, Joseph C.; Kahi, Charles J.; Sullivan, Andrew; MacPhail, Margaret; Garcia, Jonathan; Rex, Douglas K.; Medicine, School of MedicineBackground and Aims Although water exchange may improve adenoma detection when compared to CO2, it is unclear whether water is a better medium to fill the lumen during withdrawal and visualize the mucosa. Total underwater (TUC) involves the use of water exchange with the air valve off during insertion followed by the inspection of the mucosa under water. Our goal was to use a tandem colonoscopy design to compare miss rates for TUC to standard CO2 for polyps and adenomas. Methods We randomized participants (NCT03231917; clinicaltrials.gov) to undergo tandem colonoscopies using TUC or CO2 first. In TUC, water exchange was performed during insertion and withdrawal was performed under water. For the CO2 colonoscopy both insertion and withdrawal were performed with CO2. The main outcomes were miss rates for polyps and adenomas for the first examination calculated as the number of additional polyps/adenomas detected during the second examination divided by the total number of polyps/adenomas detected for both examinations. Inspection times were calculated by subtracting time for polypectomy and care was given to keep the times equal for both examinations. Results A total of 121 participants were randomized with 61 having CO2 first. The overall miss rate for polyps was higher for the TUC first group (81/237; 34%) as compared to the CO2 first cohort (57/264; 22%)(p=0.002). In addition, the overall miss rate for all adenomas was higher for the TUC first group (52/146; 36%) as compared with the CO2 group (37/159; 23%) (p=0.025). However, 1 of the 3 endoscopists had higher polyp/adenoma miss rates for CO2 but these were not statistically significant differences. The insertion time was longer for TUC than CO2. After adjusting for times, participant characteristics and bowel preparation, the miss rate for polyps was higher for TUC than CO2. Conclusions We found that TUC had an overall higher polyp and adenoma miss rate than colonoscopy performed with CO2, and TUC took longer to perform. However, TUC may benefit some endoscopists, an issue that requires further study.Item Endoscopist Adenoma Per Colonoscopy Detection Rates and Risk for Post Colonoscopy Colorectal Cancer: Data From New Hampshire Colonoscopy Registry(Elsevier, 2023-11-21) Anderson, Joseph C.; Rex, Douglas K.; Mackenzie, Todd A.; Hisey, William; Robinson, Christina M.; Butterly, Lynn F.; Medicine, School of MedicineBackground and Aims Adenomas per colonoscopy (APC) may be a better measure of colonoscopy quality than adenoma detection rate (ADR) since it credits endoscopists for each detected adenoma. There are few data examining the association between APC and post colonoscopy colorectal cancer (PCCRC) incidence. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine APC and PCCRC risk. Methods We included NHCR patients with an index exam and at least one follow up event, either a colonoscopy or a CRC diagnosis. Our outcome was PCCRC defined as any CRC diagnosed > 6 months after an index exam. The exposure variable was endoscopist specific APC quintiles of 0.25, 0.40, 50 and 0.70. Cox regression was used to model the hazard of PCCRC on APC, controlling for age, sex, year of index exam, index findings, bowel preparation and having more than 1 surveillance exam. Results In 32,535 patients, a lower hazard for PCCRC (n=178) was observed for higher APCs as compared to APCs <0.25 (Reference) (0.25-<0.40:HR=0.35, 95% CI: 0.22-0.56;0.40-<0.50: HR=0.31, 95% CI: 0.20-0.49; 0.50-<0.70: HR=0.20, 95% CI: 0.11-0.36; and ≥0.70: HR=0.19, 95% CI: 0.09-0.37). When examining endoscopists with an ADR of at least 25%, an APC < 0.50 was associated with a significantly higher hazard than an APC > 0.50 (HR=1.65; 95% CI: 1.06-2.56). A large proportion of endoscopists, 1/5th (32/152; 21.1%), had an ADR >25 but an APC <0.50. Discussion Our novel data demonstrating lower PCCRC risk in exams performed by endoscopists with higher APCs suggest that APC could be a useful quality measure. Quality improvement programs may identify important deficiencies in endoscopist detection performance by measuring APC for endoscopists with ADR > 25%.Item Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer(Elsevier, 2020-03) Gupta, Samir; Lieberman, David; Anderson, Joseph C.; Burke, Carol A.; Dominitz, Jason A.; Kaltenbach, Tonya; Robertson, Douglas J.; Shaukat, Aasma; Syngal, Sapna; Rex, Douglas K.; Medicine, School of MedicineItem Spotlight: US Multi-Society Task Force on Colorectal Cancer Recommendations for Follow-up After Colonoscopy and Polypectomy(Elsevier, 2020-03) Gupta, Samir; Lieberman, David; Anderson, Joseph C.; Burke, Carol A.; Dominitz, Jason A.; Kaltenbach, Tonya; Robertson, Douglas J.; Shaukat, Aasma; Syngal, Sapna; Rex, Douglas K.; Medicine, School of Medicine