Browsing by Subject "colonoscopy"
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Item Acceptance of a Risk Estimation Tool for Colorectal Cancer Screening(Office of the Vice Chancellor for Research, 2016-04-08) Luckhurst, Cherie; Imperiale, Tom; Matthias, Marianne S.Abstract: While colonoscopy is the most prevalent screening test for colorectal cancer (CRC), it is often too expensive, too uncomfortable, or too time-consuming for patients. Non-compliance is common. Recently, fecal immunochemical testing (FIT) has become a guideline-recommended alternative. The FIT is a non-invasive, inexpensive method that requires no uncomfortable preparation by patients. The decision to recommend the colonoscopy or the FIT is based on the patient’s estimated risk for CRC. Several countries have created risk prediction tools to help identify patients at high risk for advanced colorectal neoplasia (the combination of CRC and advanced, precancerous polyps). A U.S.-based prediction tool was recently published1 that uses five easily and reliably measured factors (age, sex, a first degree relative with CRC, waist circumference, and cigarette smoking history) to quantify risk. We aimed to learn the impressions of clinicians and patients to this risk estimation tool. In the first phase of this study, we used a semi-structured format to interview clinicians at a VA medical center and a non-VA hospital. Using a paper prototype of the risk estimation tool, we asked about its usefulness to estimate risk and to aid their selection of a CRC screening tool. Using a grounded theory approach, we analyzed the interview transcripts and identified major themes. We found that clinicians thought the tool was clear and easy to use. However, they are unlikely to use it as a decision aid until FIT is more widely-endorsed as an acceptable alternative screening test. In phase two of the study, we will interview patients to assess their responses to the tool.Item Achieving cecal intubation in the difficult colon (with videos)(Elsevier, 2021) Rex, Douglas K.; Medicine, School of MedicineItem Adenoma Detection Rate in Asymptomatic Patients with Positive Fecal Immunochemical Tests(Springer, 2018-05) Kligman, Eugene; Li, Wenfang; Eckert, George J.; Kahi, Charles; Medicine, School of MedicineBackground and Aims The adenoma detection rate (ADR) is a powerful measure of screening colonoscopy quality. Patients who undergo colonoscopy for the evaluation of a positive fecal immunochemical test (FIT) have increased prevalence of colorectal neoplasia, but it is not known whether separate quality benchmarks are required. The aim of this study was to compare the conventional ADR to the ADR of colonoscopies performed for the evaluation of positive FIT, in asymptomatic average-risk patients. Methods Patients ≥ 50 years old who underwent colonoscopy for the evaluation of a positive FIT between January 1, 2013, and July 31, 2014, at a tertiary Veterans Affairs Medical Center were identified. FIT performed for any indication other than average-risk screening was excluded. The comparison group included average-risk patients ≥ 50 years old undergoing screening colonoscopy during the same time frame. The two groups were compared for ADR, advanced neoplasm [adenoma ≥ 10 mm, tubulovillous, high-grade dysplasia, CRC, sessile serrated polyp (SSP) ≥ 10 mm], CRC, and SSP detection after propensity score adjustment using a logistic regression model adjusted for endoscopist. Results There were 207 patients in the FIT group and 601 in the screening colonoscopy comparison group. After propensity score adjustment, ADR (72.9 vs. 50.0%, p = 0.003), number of adenomas per colonoscopy (3.3 ± 3.6 vs. 1.4 ± 2.3, p = 0.033), and advanced neoplasm detection rate (32.4 vs. 11.0%, p < 0.0001) were significantly higher in the FIT group. There were no significant differences in the number of CRC and the SSP detection rate. Conclusions In this cohort of average-risk Veterans, the ADR of colonoscopies performed for the evaluation of a positive FIT was higher than the ADR of screening colonoscopies. Patients with a positive FIT also had significantly more adenomas per colonoscopy and advanced neoplasms. These findings suggest that the quality of colonoscopies performed for a positive FIT is insufficiently assessed by the conventional ADR and requires additional quality metrics.Item Adjusting Detection Measures for Colonoscopy: How Far Should We Go?(Elsevier, 2021-09) Rex, Douglas K.; Medicine, School of MedicineItem Advanced Colonoscopy Techniques and Technologies(Elsevier, 2015-10) Gromski, Mark A.; Kahi, Charles J.; Department of Medicine, IU School of MedicineColonoscopy is the most frequently performed endoscopic procedure in the United States. It is the mainstay of diagnostic and therapeutic options for the practicing gastroenterologist. It plays a fundamental role in colorectal cancer (CRC) prevention, with a dominant position among the screening options for CRC and precancerous lesions. Over the past decade, there have been significant advances in the field of CRC and colonoscopy, including a better understanding of the importance of right-sided lesions, the sessile serrated pathway, and recognition of the significance of operator dependence in colonoscopy. This has been paralleled by an array of technological and technical advances that has transformed the field of colonoscopy and improved patient care. This article addresses the diverse and expanding field of advanced colonoscopy techniques and technologies. It is intended to be a primer on recent and effective developments in advanced technologies for screening or imaging, mucosal resection techniques, and endoscopic management of CRC.Item Advances in CRC prevention: screening and surveillance(Elsevier, 2018) Dekker, Evelien; Rex, Douglas K.; Medicine, School of MedicineColorectal cancer (CRC) is amongst the most commonly diagnosed cancers and causes of death from cancer across the world. CRC can, however, be detected in asymptomatic patients at a curable stage, and several studies have shown lower mortality among patients who undergo screening compared to those who do not. Using colonoscopy in CRC screening also results in the detection of precancerous polyps that can be directly removed during the procedure, thereby reducing the incidence of cancer. In the past decade, convincing evidence has appeared that the effectiveness of colonoscopy as CRC prevention tool is associated with the quality of the procedure. This review aims to provide an up-to-date overview of recent efforts to improve colonoscopy effectiveness of by enhancing detection and improving the completeness and safety of resection of colorectal lesions.Item Artificial Intelligence Improves Detection at Colonoscopy: Why aren’t we all already using it?(ScienceDirect, 2022) Rex, Douglas K.; Berzin, Tyler M.; Mori, Yuichi; Medicine, School of MedicineItem Can we do resect and discard with artificial intelligence-assisted colon polyp “optical biopsy?”(Elsevier, 2019) Rex, Douglas K.; Medicine, School of MedicineResect and discard refers to a paradigm for the management of colorectal adenomas 1-5 mm in size. In this paradigm, histology of colorectal polyps is predicted endoscopically based on surface features. Lesions that are ≤5 mm in size and predicted to be adenomas are resected endoscopically and discarded rather than submitted to pathology. Adenomas in this size range have an extremely low risk of cancer, and the cost savings of the resect and discard paradigm would be substantial. Artificial intelligence programs can improve the overall prediction for histology based on endoscopic imaging, and reduce operator dependence in endoscopic predictions. Although meta-analyses have concluded that the accuracy of endoscopic prediction is sufficiently high to institute the resect and discard paradigm in clinical practice, actual implementation has faced several obstacles. These include lack of financial incentives for endoscopists, perceived increased medical-legal risk compared with the current management paradigm of submitting all polyps to pathology, and local rules for tissue handling.Item Characterization of endoscopic features and histology of a distinct mucosal transition zone on the ileocecal valve (with video)(Elsevier, 2023-09) Rex, Douglas K.; Lahr, Rachel E.; Guardiola, John J.; Dewitt, John M.; Zhang, Dongwei; Medicine, School of MedicineBackground and Aims We have endoscopically encountered a zone of transitional mucosa between the colonic and ileal mucosa located in a 3- to 10-mm-wide ring around the ileocecal valve (ICV) orifice. We aimed to describe the features of the ICV transitional zone mucosa. Methods We used videos and photographs from normal ICVs and biopsy samples from normal colonic mucosa, transitional zone mucosa, and normal ileal mucosa to characterize the endoscopic and histologic features of the ICV transitional zone mucosa. Results The ICV transitional zone is identifiable on every ICV without a circumferential adenoma or inflammation that obliterates the zone. The zone is characterized endoscopically by an absence of villi, which distinguishes it from the ileal mucosa, but the pits are more tubular and with more prominent blood vessels compared with normal colonic mucosa. Histologically, the villi of the transitional zone are blunted, and the amount of lymphoid tissue is intermediate between the colonic mucosa and ileal mucosa. Conclusions This is the first description of the normal transitional zone of mucosa on the ICV. This zone has unique endoscopic features that should be recognized by colonoscopists and that can potentially create difficulty in identifying the margins of adenomas located on the ICV.Item The colonoscopist's guide to the vocabulary of colorectal neoplasia: histology, morphology, and management(Elsevier, 2017) Rex, Douglas K.; Hassan, Cesare; Bourke, Michael J.; Department of Medicine, IU School of MedicinePrevention of colorectal cancer by colonoscopy requires effective and safe insertion technique, high level detection of precancerous lesions, and skillful use of curative endoscopic resection techniques. Lesion detection, characterization, use of appropriate resection methods, prediction of cancer at colonoscopy, and management of malignant polyps, all depend on an accurate and complete understanding of an extensive vocabulary describing the histology and morphology of neoplastic colorectal lesions. Incomplete understanding of vocabulary terms can lead to management errors. We provide a colonoscopist’s perspective on the vocabulary of colorectal neoplasia, and discuss the interaction of specific terms with management decisions.