Accuracy in optical diagnosis for polyps between 5 and 15 mm and its implications on surveillance. A prospective, multicenter study. (POPS study)

Author(s):  
Eduardo Redondo-Cerezo ◽  
Clara Heredia-Carrasco ◽  
Carlos Alegría-Motte ◽  
Antonio Caballero-Mateos ◽  
Francisco Vadillo-Calles ◽  
...  
Endoscopy ◽  
2018 ◽  
Vol 51 (03) ◽  
pp. 244-252 ◽  
Author(s):  
Jasper Vleugels ◽  
Yark Hazewinkel ◽  
Marcel Dijkgraaf ◽  
Lianne Koens ◽  
Paul Fockens ◽  
...  

Abstract Background: Optical diagnosis can replace histopathology of diminutive (1 – 5 mm) polyps if surveillance intervals based on optical diagnosis of polyps have ≥ 90 % agreement with intervals based on polyp histology and if the negative predictive value (NPV) for predicting neoplastic histology in the rectosigmoid is ≥ 90 %. This study aims to assess whether small (6 – 9 mm) polyps can be included in optical diagnosis strategies. Method: This is a post-hoc analysis of a prospective multicenter study in which 27 endoscopists, all performing endoscopies for the Dutch screening program, were trained in optical diagnosis. For 1 year, endoscopists recorded the predicted histology for all lesions detected using narrow-band imaging during 3144 consecutive colonoscopies after a positive fecal immunochemical test, along with confidence levels. Surveillance interval agreement and NPV were calculated for high confidence predictions for polyps of 1 – 9 mm and compared with histopathology. Surveillance interval agreement was calculated using the European Society of Gastrointestinal Endoscopy surveillance guideline. Results: Surveillance interval agreement was 95.4 % (confidence interval [CI] 94.2 % – 96.4 %), and NPV for predicting neoplastic histology in the rectosigmoid 90.0 % (CI 87.3 % – 92.2 %). The reduction in histology (45.9 % vs. 30.5 %) and the proportion of patients who could have received direct surveillance advice (15.6 % vs. 7.3 %) was higher when small polyps were included (P < 0.001). T1 cancer was found in seven small polyps (0.33 %), five of which would have been discarded without histopathology. Conclusion: Including small polyps in the optical diagnosis strategy improves its efficacy while maintaining performance thresholds. However, there is a small risk of missing T1 cancers when small polyps are included in the optical diagnosis strategy.


2019 ◽  
Author(s):  
M Maida ◽  
G Morreale ◽  
E Sinagra ◽  
M Manganaro ◽  
D Schillaci ◽  
...  

2013 ◽  
Vol 154 (21) ◽  
pp. 825-833
Author(s):  
Zoltán Döbrönte ◽  
Mária Szenes ◽  
Beáta Gasztonyi ◽  
Lajos Csermely ◽  
Márta Kovács ◽  
...  

Introduction: Recent guidelines recommend routine pulse oximetric monitoring during endoscopy, however, this has not been the common practice yet in the majority of the local endoscopic units. Aims: To draw attention to the importance of the routine use of pulse oximetric recording during endoscopy. Method: A prospective multicenter study was performed with the participation of 11 gastrointestinal endoscopic units. Data of pulse oximetric monitoring of 1249 endoscopic investigations were evaluated, of which 1183 were carried out with and 66 without sedation. Results: Oxygen saturation less than 90% was observed in 239 cases corresponding to 19.1% of all cases. It occurred most often during endoscopic retrograde cholangiopancreatography (31.2%) and proximal enteroscopy (20%). Procedure-related risk factors proved to be the long duration of the investigation, premedication with pethidine (31.3%), and combined sedoanalgesia with pethidine and midazolam (34.38%). The age over 60 years, obesity, consumption of hypnotics or sedatives, severe cardiopulmonary state, and risk factor scores III and IV of the American Society of Anestwere found as patient-related risk factors. Conclusion: To increase the safety of patients undergoing endoscopic investigation, pulse oximeter and oxygen supplementation should be the standard requirement in all of the endoscopic investigation rooms. Pulse oximetric monitoring is advised routinely during endoscopy with special regard to the risk factors of hypoxemia. Orv. Hetil., 2013, 154, 825–833.


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