Browsing by Author "Lee, Christopher J."

Now showing 1 - 4 of 4
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    Colorectal EMR outcomes in octogenarians versus younger patients referred for removal of large (≥20 mm) nonpedunculated polyps
    (Elsevier, 2021-03) Lee, Christopher J.; Vemulapalli, Krishna C.; Rex, Douglas K.; Medicine, School of Medicine
    Background and Aims Data are limited on safety and outcomes of colorectal EMR in octogenarians (≥80 years old). We sought to review outcome data for patients aged ≥80 in a prospectively collected database of patients referred for large polyp removal. Methods We retrospectively evaluated a database of patients referred for large (≥20 mm) nonpedunculated polyp removal. From 2000 to 2019, we compared the rates of follow-up, recurrence, adverse events, and synchronous neoplasia detection between younger patients and patients aged ≥80. Results There were 167 patients aged ≥80 years and 1686 <80 years. Patients in the elderly group returned for surveillance less often (67.1% vs 75.1%, P = .024), had greater first follow-up recurrence rates (27.5% vs 13.8%, P < .001), but had similar adverse event rates (1.8% vs 2.8%, P = .619) compared with younger patients. Rates of synchronous neoplasia were similar and high in both groups. Conclusions EMR is safe and well tolerated for large polyp removal in patients over 80 years old. Patients aged ≥80 years are less likely to present for follow-up after EMR. They had a higher recurrence rate and a similarly high prevalence of synchronous precancerous lesions. Follow-up after EMR should be encouraged in the elderly, and an attempt to clear the colon of synchronous disease at the time of the initial EMR may be warranted.
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    Impact of changing diagnostic criteria on the diagnosis of serrated polyposis syndrome
    (Thieme, 2023-01-04) McWhinney, Connor D.; Lahr, Rachel E.; Lee, Christopher J.; El-Rahyel, Ahmed; Rex, Douglas K.; Medicine, School of Medicine
    Background and study aims: The World Health Organization criteria for serrated polyposis syndrome (SPS) were established in 2010 and modified in 2019. Neither set of criteria have been validated against genetic markers or proven to be the optimal criteria for defining colorectal cancer risk in patients with serrated colorectal lesions. In this study, we sought to gain insight into how frequently the change in SPS criteria in 2019 impacted the diagnosis of SPS. Patients and methods: We reviewed 279 patients with SPS diagnosed between 2010 and 2019 using the 2010 criteria (n = 163) or since 2019 using the 2019 criteria (n = 116). We reviewed whether patients in each group met the diagnosis of SPS by the alternative criteria. Results: Of those diagnosed using 2010 criteria, 5.5 % did not meet 2019 criteria. Of those diagnosed by 2019 criteria, 10.3 % did not meet 2010 criteria. Conclusions: Most patients with SPS in our database met the diagnosis of SPS by both 2010 and 2019 criteria, with only 5 % to 10 % of patients in each cohort not meeting the alternative diagnostic criteria.
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    Metastatic Cancer of Apparent Colon Origin With No Intraluminal Cancer After Resection of Colorectal Lateral Spreading Lesions
    (Wolters Kluwer, 2021-12-28) Lee, Christopher J.; Vemulapalli, Krishna C.; Lin, Jingmei; Rex, Douglas K.; Medicine, School of Medicine
    We report a case of metastatic adenocarcinoma to the liver that presented 5 months after piecemeal endoscopic mucosal resection of 3 benign lateral spreading adenomas in the cecum. The pathologic features of the metastatic cancer indicated a probable colonic origin. However, when the cancer was identified, there was no endoscopic evidence of recurrent polyp or another primary lesion in the colon.
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    Yield of a second right colon examination during colonoscopy after a first examination using a mucosal exposure device
    (Elsevier, 2022-01) Vemulapalli., Krishna C.; Lahr, Rachel E.; Lee, Christopher J.; Abdullah, Noor; Rex, Douglas K.; Medicine, School of Medicine
    Background and Aims Double right colon examination during colonoscopy has been advocated to reduce the risk of interval cancer in the right colon. Whether 2 examinations are necessary when the first examination is performed with a mucosal exposure device is uncertain. We documented the rates of missed adenomas, sessile serrated lesions, and hyperplastic polyps after an initial right colon examination by a high-level detector using a mucosal exposure device. Methods At a single tertiary hospital outpatient practice, we prospectively collected data on the yield of a second examination of the right colon after an initial examination by a single high-detecting colonoscopist using a mucosal exposure device. Results During the study period, 1331 eligible consecutive patients underwent colonoscopy. Right colon adenoma, sessile serrated lesion, and hyperplastic polyp miss rates were 15.8%, 14.1%, and 16.7%, respectively. Four percent of patients had adenomas detected in the right colon only with a second examination. Conclusions A second examination of the right colon is warranted, even when using a distal mucosal exposure device to perform colonoscopy.