scholarly journals Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification

2022 ◽  
Vol 10 (01) ◽  
pp. E145-E153
Author(s):  
Paul Bonniaud ◽  
Jérémie Jacques ◽  
Thomas Lambin ◽  
Jean-Michel Gonzalez ◽  
Xavier Dray ◽  
...  
Keyword(s):  
Comparative Study ◽  
Colorectal Neoplasia ◽  
Observer Agreement ◽  
Serrated Adenoma ◽  
Web Based ◽  
Serrated Polyps ◽  
Image Library ◽  
Endoscopic Classification

Abstract Background and study aims The aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table. Patients and methods For this multicenter comparative study an expert endoscopist created an image library (n = 206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohen’s Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology. Results Eleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alpha = 0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95 % CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95 % CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different (P < 0.001): the highest sensitivities were for NICE 2 (84.2 %) and CONECCT IIC (78.9 %), and the lowest for Kudo Vi (31.6 %). Conclusions The CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma.

scholarly journals Coexistent adenoma and serrated polyps on index colonoscopy and the risk of metachronous advanced colorectal neoplasia

2019 ◽  
Vol 07 (12) ◽  
pp. E1748-E1754 ◽  
Author(s):  
Soo-Kyung Park ◽  
Hak-Soo Kim ◽  
Hyo-Joon Yang ◽  
Yoon Suk Jung ◽  
Jung Ho Park ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
Colorectal Neoplasia ◽  
Advanced Adenoma ◽  
Serrated Adenoma ◽  
Serrated Polyps ◽  
Advanced Colorectal Neoplasia ◽  
Significant Difference ◽  
The Family ◽  
Risk Patients

Abstract Background and aims The family of serrated polyps (SP) includes hyperplastic polyps (HP), sessile serrated adenomas/polyps, and traditional serrated adenoma. We investigated whether SP synchronous with adenoma at index colonoscopy is associated with metachronous advanced colorectal neoplasia (CRN). Methods Patients with ≥ 1 adenoma on index colonoscopy and who had undergone a follow-up colonoscopy were included. The patients were divided into four groups according to the presence of SP and advanced adenoma (AA) on index colonoscopy (non-AA, non-AA + SP, AA, AA + SP). The cumulative incidence of metachronous advanced CRN at surveillance colonoscopy was compared between groups. Results Among a total of 2209 patients, the numbers of patients in the non-AA, non-AA + SP, AA, and AA + SP groups were 922, 441, 625, and 221, respectively. The cumulative incidence of metachronous advanced CRN was higher in patients in the AA + SP group than that in the AA group (P<0.001), and there was no significant difference between the non-AA + SP group and the non-AA group (P = 0.06). The cumulative incidence of metachronous advanced CRN at 3 years was 17.9 % [95 % confidence interval (CI) 8.0–27.6], 10.7 % [95 %CI 7.7–3.6], 3.5 % [95 %CI 1.3–5.6], and 3.4 % [95 %CI 2.0–4.7] in the AA + SP, AA, non-AA + SP, and non-AA group, respectively. In a multivariate analysis, overall SP [hazard ratio (HR) 2.24; 95 %CI 1.38–3.64, P = 0.001], proximal SP (HR 2.31; 95 %CI 1.32–4.08), and HP (HR 2.19; 95 %CI 1.35–3.57) were risk factors for metachronous advanced CRN in patients with AA on index colonoscopy. Conclusions Coexistent AA and SP on index colonoscopy significantly increased the risk of metachronous advanced CRN compared with AA alone. Further large prospective studies are needed to confirm whether more intensive follow-up improves outcomes in these high risk patients.

The Orientation of Gastric Biopsy Samples Improves the Interobserver Agreement of the OLGA Staging System

2017 ◽  
Vol 26 (4) ◽  
pp. 351-356 ◽  
Author(s):  
Bogdan Cotruta ◽  
Cristian Gheorghe ◽  
Razvan Iacob ◽  
Mona Dumbrava ◽  
Cristina Radu ◽  
...  
Keyword(s):  
Intestinal Metaplasia ◽  
Lamina Propria ◽  
Case Series ◽  
Gastric Biopsy ◽  
Gastric Atrophy ◽  
Observer Agreement ◽  
Gastric Body ◽  
Kappa Index ◽  
Gastric Biopsies

Background & Aims: Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed.Methods: A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples was completed using nitrocellulose filters (Endokit®, BioOptica, Milan, Italy). The samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. The quality of histopathology specimens taking into account the identification of lamina propria was analyzed in oriented vs. unoriented samples. The samples with detectable lamina propria mucosae were defined as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically significant.Results: A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). The kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275).Conclusion: The orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy.Key words:  –  –  – .Abbreviations: H. pylori: Helicobacter pylori; OLGA: operative link for gastritis assessment; OLGIM: operative link on intestinal metaplasia assessment.

Physicochemical and bacteriological characterization of hospital effluents and their impact on the environment

2019 ◽  
Author(s):  
Chem Int
Keyword(s):  
Human Health ◽  
Fecal Coliforms ◽  
Chemical Pollution ◽  
Hospital Effluents ◽  
Biological Contaminants ◽  
Almost All ◽  
Direct Discharge ◽  
Significant Chemical

Liquid effluents discharged by hospitals may contain chemical and biological contaminants whose main source is the different substances used for the treatment of patients. This type of rejection can present a sanitary potentially dangerous risk for human health and can provoke a strong degradation of diverse environmental compartments mainly water and soils. The present study focuses on the quality of the liquid effluents of Hassani Abdelkader’s hospital of Sidi Bel-Abbes (West of Algeria). The results reveal a significant chemical pollution (COD: 879 mgO2/L, BOD5: 850 mgO2/L, NH4+ : 47.9 mg/l, NO2- : 4.2 mg/l, NO3- : 56.8 mg/l with respect to WHO standard of 90 mgO2/L, 30 mgO2/L, 0.5 mg/l, 1 mg/l and 1 mg/l respectively). However, these effluents are biodegradable since the ratio COD/BOD5 do not exceeded the value of 2 in almost all samples. The presence of pathogen germs is put into evidence such as pseudomonas, the clostridium, the staphylococcus, the fecal coliforms and fecal streptococcus. These results show that the direct discharge of these effluents constitutes a major threat to human health and the environment.

Telehealth During COVID-19 for Remote Vision Rehabilitation of a Patient with mTBI

2020 ◽  
pp. 191-198
Keyword(s):  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Home Setting ◽  
Therapeutic Goals ◽  
Vision Rehabilitation ◽  
Novel Coronavirus ◽  
Performance Challenges ◽  
Perception Of Performance

Background: Binocular and accommodative vision problems are common after mild traumatic brain injury (mTBI). Traditionally, the management of visual dysfunctions following mTBI included in-office vision rehabilitation with a trained eye care provider. The concept of providing telehealth for remote vision rehabilitation in mTBI patients is a relatively novel practice that has not been widely utilized until the recent outbreak of the 2019 novel coronavirus (COVID-19) pandemic. Case Report: We describe the implementation of telehealth for remote vision rehabilitation during COVID-19 within the Veterans’ Health Administration (VHA) system in an adult patient with multiple confirmed histories of mTBI. Conclusion: Our telehealth remote vision rehabilitation was successfully implemented utilizing established VHA’s web-based videoconferencing tools. Therapeutic goals identified prior to COVID 19 were addressed without any challenges. The delivery of vision rehabilitation intervention via telehealth allowed for the continuance of services within the home setting that led to improvements in functional vision, decreased perception of performance challenges, and improved quality of life.

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