Browsing by Subject "colorectal polyp"

Now showing 1 - 3 of 3
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    Can we do resect and discard with artificial intelligence-assisted colon polyp “optical biopsy?”
    (Elsevier, 2019) Rex, Douglas K.; Medicine, School of Medicine
    Resect 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.
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    Colonoscopy: the current king of the hill in the United States
    (Springer, 2015-03) Rex, Douglas K.; Department of Medicine, IU School of Medicine
    Colonoscopy is the dominant colorectal cancer screening strategy in the USA. There are no randomized controlled trials completed of screening colonoscopy, but multiple lines of evidence establish that colonoscopy reduces colorectal cancer incidence in both the proximal and distal colon. Colonoscopy is highly operator dependent, but systematic efforts to measure and improve quality are impacting performance. Colonoscopy holds a substantial advantage over other strategies for detection of serrated lesions, and a recent case–control study suggests that once-only colonoscopy or colonoscopy at 20-year intervals, by a high-level detector, could ensure lifetime protection from colorectal cancer for many patients.
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    Endocuff Vision Reduces Inspection Time Without Decreasing Lesion Detection in a Randomized Colonoscopy Trial
    (Elsevier, 2019) Rex, Douglas K.; Slaven, James E.; Garcia, Jonathan; Lahr, Rachel; Searight, Meghan; Gross, Seth A.; Medicine, School of Medicine
    Background & Aims Mucosal exposure devices improve detection of lesions during colonoscopy and have reduced examination times in uncontrolled studies. We performed a randomized trial of Endocuff Vision vs standard colonoscopy to compare differences in withdrawal time (the primary end point). We proposed that Endocuff Vision would allow complete mucosal inspection in a shorter time without impairing lesion detection. Methods Adults older than 40 years undergoing screening or surveillance colonoscopies were randomly assigned to the Endocuff group (n=101, 43.6% women) or the standard colonoscopy group (n=99; 57.6% women). One of 2 experienced endoscopists performed the colonoscopies, aiming for a thorough evaluation of the proximal sides of all haustral folds, flexures, and valves in the shortest time possible. Inspection time was measured with a stopwatch and calculated by subtracting washing, suctioning, polypectomy and biopsy times from total withdrawal time. Results There were significantly fewer women in the Endocuff arm (P = .0475) but there were no other demographic differences between groups. Mean insertion time with Endocuff was 4.0 min vs 4.4 min for standard colonoscopy (P = .14). Mean inspection time with Endocuff was 6.5 min vs 8.4 min for standard colonoscopy (P < .0001). Numbers of adenomas detected per colonoscopy (1.43 vs 1.07; P = .07), adenoma detection rate (61.4% vs 52%; P = .21), number of sessile serrated polyps per colonoscopy (0.27 vs 0.21; P = .12), and sessile serrated polyp detection rate (19.8% vs 11.1%; P = .09) were all higher with Endocuff Vision. Results did not differ significantly when we controlled for age, sex, or race. Conclusion In a randomized trial, we found inclusion of Endocuff in screening or surveillance colonoscopies to decrease examination time without reducing lesion detection.