SP10.1.6 Benefit of Two week colorectal cancer referrals of patients who had colonic imaging within the last 5 years: do they improve the colorectal cancer outcome?

Abstract Purpose There has been a significant rise in the number of colorectal rapid access referrals. These referral results in additional demand for hospital services as well as delays assessment and management of other patients. We analyzed the outcome of colorectal fast tract clinic re- referrals on bowel cancer outcome in patients with recent colonic imaging. Methods We retrospectively analyzed 1000 consecutive colorectal rapid access pathway referrals in 2019.Patients with complete colonic imaging within the preceding 5 years were included. We assessed their clinical outcome and colonic imaging when performed. Results In total, 82 (8.2%) patients out of 1000 met the selection criteria. Among these 12 patients (14%) did not need any further colonic investigations. A further 12 patients (14%) were already on the colorectal surveillance program, including a patient with recently diagnosed rectal cancer. Hence 24 patients (29.2%) referral was not indicated. 58 patients had further colonic imaging in the form of colonoscopy or virtual colonoscopy following clinic consultation. 32 (55.17%) of them had normal colonic imaging. 14 patients (24.1%) were identified with colorectal polyps with only one identified as tubular adenoma. The remaining 12 patients had non neoplastic pathology. Conclusion No new significant colorectal pathology was identified in this group of patients. We suggest that symptomatic patients who had complete colonic imaging within 5 years be referred to routine colorectal clinic in order to make the colorectal rapid access referral pathway more effective especially during these unprecedented times.

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Feasibility and Potential of MR-Colonography for Evaluating Colorectal Cancer

Swiss Surgery ◽

10.1024/1023-9332.8.1.21 ◽

2002 ◽

Vol 8 (1) ◽

pp. 21-24 ◽

Cited By ~ 11

Author(s):

Meier ◽

Wildermuth

Keyword(s):

Colorectal Cancer ◽

Bowel Preparation ◽

Virtual Colonoscopy ◽

Colorectal Polyps ◽

Data Sets ◽

Diagnostic Modality ◽

Technical Problems ◽

Mr Colonography ◽

Synchronous Carcinoma ◽

3D Data

Background: MR-Colonography (MRC) based on MR-imaging is a relatively new diagnostic modality for diagnosing colorectal polyps. The aim of this experimental study was to evaluate its performance in detecting and staging colorectal cancer..Method: 23 patients with proven colorectal cancer underwent MR-Colonography one day prior to operation after standard bowel preparation. The colon was filled with a diluted gadolinium enema. Coronal sections were acquired in prone and supine. Virtual colonoscopy (VC) was processed from the acquired 3D data sets and MRC was interactively analysed together with VC. The findings were correlated with colonoscopic and pathology results..Results: A complete MRC was achieved in 21 patients (92%), two patients (8%) could not be conclusively evaluated due to insufficient bowel preparation or technical problems. No complications were observed. Compared to colonoscopy all 23 carcinomas were detected. No lesion >= 8mm was missed. In one patient a synchronous carcinoma was newly diagnosed. This lesion was missed by colonoscopy since the distal tumour was endoscopically unpassable. In total eight (33%) colonoscopies were incomplete..Conclusion: MRC offers a new and promising diagnostic tool for colorectal cancer. It is particularly valuable when colonoscopy is incomplete. It improves preoperative planning and it holds the potential as an all-in-one investigation including local and liver staging in combination with conventional MRI.

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EP.TU.465Role of CT scan as initial investigation in colorectal rapid access patients

British Journal of Surgery ◽

10.1093/bjs/znab311.060 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

T Athisayaraj ◽

A Bavikatte ◽

J Olugbemi ◽

B Sebastian ◽

A Mishra

Keyword(s):

Weight Loss ◽

Virtual Colonoscopy ◽

Abdominal Mass ◽

Test Protocol ◽

Initial Investigation ◽

Rapid Access ◽

Form Part ◽

Risk Patients ◽

Electronic Data Base ◽

Access Pathway

Abstract Background We looked into CT colonoscopies and CT abdomen and pelvis which were booked as initial investigation in patients referred via the colorectal rapid access pathway. These tests were directly booked following the referral after a nurse led triage. As per our colorectal straight to test protocol (STT) any patients over the age of 75 or unfit individuals will have a CT colonoscopy (virtual colonoscopy) instead of colonoscopy. CT trunk was used during COVID pandemic as the initial investigation when the aerosol generating procedures were stopped. CT trunks are also the initial investigation as per the STT protocol when patients are referred with suspected abdominal mass, weight loss or abdominal pain. Methods Retrospective analysis of prospective electronic data base of colorectal STT referrals from Feb 2020 to end of October 2020. Results Conclusion CT colonoscopies and CT trunks form part of initial diagnostic tool in the colorectal rapid access patients. They are particularly useful in high risk patients who cannot tolerate colonoscopy. These investigations complement the lower GI endoscopy. These scans also identify non-colorectal malignancies and retroperitoneal pathology such as AAA.CT trunks were useful tools during COVID 19 Pandemic.

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Surveillance Colonoscopy following Resection of Colorectal Polyps and Cancer

Canadian Journal of Gastroenterology ◽

10.1155/2001/751657 ◽

2001 ◽

Vol 15 (1) ◽

pp. 57-59 ◽

Cited By ~ 3

Author(s):

Douglas K Rex

Keyword(s):

Colorectal Cancer ◽

Barium Enema ◽

Colorectal Polyps ◽

Average Risk ◽

Tubular Adenoma ◽

Surveillance Colonoscopy ◽

Risk Patients ◽

One Year

Patients undergoing clearing colonoscopy with resection of adenomas should generally have their next examination at three years. Exceptions include large sessile adenomas removed piecemeal (re-examine at two to six months until no evidence of recurrent polyp, then at one year), average risk patients with a single tubular adenoma (next examination at five years) and patients with 'numerous' adenomas (next examination at one or two years). Patients with surgically resected colorectal cancer should have a clearing colonoscopy preoperatively or within two to three months of surgery in obstructed patients, even if the preoperative barium enema is negative for proximal lesions. After the clearing colonoscopy, subsequent examinations can be performed based on the associated adenoma findings.

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A121 UNDERWATER EMR FOR NON-LIFTING SESSILE COLORECTAL LESIONS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.119 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 102-103

Author(s):

C Galts ◽

R Barclay ◽

D Percy

Keyword(s):

Surgical Resection ◽

De Novo ◽

Lesion Size ◽

Colorectal Polyps ◽

Invasive Cancer ◽

Previous Attempt ◽

Tubular Adenoma ◽

En Bloc ◽

Clinical Role ◽

Submucosal Injection

Abstract Background Sessile colorectal lesions which do not elevate with submucosal injection — “non-lifting” lesions — are considered poor candidates for EMR due to concerns of possible invasive cancer and increased procedural risk. However, a non-lifting sign is an unreliable predictor of malignancy, relegating many benign lesions to surgical resection. Underwater EMR (UEMR), which obviates submucosal injection, is effective for sessile colorectal polyps but has not been evaluated specifically for non-lifting lesions. Aims The aim of this study was to assess the efficacy of UEMR for “non-lifting” large sessile colorectal lesions with the hypothesis that UEMR may have a clinical role in managing complex lesions. Methods We reviewed our database from 2016 to 2019 for patients referred for large (≥ 20 mm) non-lifting colorectal lesions without overt signs of invasive cancer, who subsequently underwent UEMR. Results Thirty-two cases were successfully treated with single session UEMR. 18 (56%) were de novo lesions whereas the remainder had undergone previous attempt(s) at conventional EMR. The mean lesion size was 37 ± 17 mm. 4 cases (13%) were resected en bloc; the remainder piecemeal. Final pathology was T1 adenocarcinoma, N=3 (9%); tubulovillous adenoma, N=15 (47%); tubular adenoma, N=8 (25%); sessile serrated, N=6 (19%); high-grade dysplasia, N=2 (6%). One patient with cancer underwent surgical resection (T1N0); the remainder had endoscopic follow-up over 8 ± 3 months with benign recurrent/residual lesions in 8%, all amenable to UEMR. There were no procedural complications. Conclusions In this series of large sessile non-lifting colorectal lesions, UEMR was effective for both de novo and previously treated lesions, obviating surgery in the majority of cases. Funding Agencies None

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82 RISK OF COLORECTAL CANCER IN FIRST-DEGREE RELATIVES OF PATIENTS WITH COLORECTAL POLYPS: A NATIONWIDE CASE-CONTROL STUDY IN SWEDEN

Gastroenterology ◽

10.1016/s0016-5085(21)00797-6 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-20

Author(s):

Mingyang Song ◽

Louise Emilsson ◽

Bjorn Roelstraete ◽

Jonas F. Ludvigsson

Keyword(s):

Colorectal Cancer ◽

Case Control Study ◽

Case Control ◽

Colorectal Polyps ◽

First Degree Relatives ◽

Control Study

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Convolutional Neural Networks in Computer-Aided Diagnosis of Colorectal Polyps and Cancer: A Review

10.20944/preprints202110.0135.v1 ◽

2021 ◽

Author(s):

Kamyab Keshtkar

Keyword(s):

Colorectal Cancer ◽

Neural Networks ◽

Deep Learning ◽

Computer Aided Diagnosis ◽

Colorectal Polyps ◽

Support Vector ◽

Training Process ◽

Computer Aided ◽

Conventional Models ◽

Aided Diagnosis

As a relatively high percentage of adenoma polyps are missed, a computer-aided diagnosis (CAD) tool based on deep learning can aid the endoscopist in diagnosing colorectal polyps or colorectal cancer in order to decrease polyps missing rate and prevent colorectal cancer mortality. Convolutional Neural Network (CNN) is a deep learning method and has achieved better results in detecting and segmenting specific objects in images in the last decade than conventional models such as regression, support vector machines or artificial neural networks. In recent years, based on the studies in medical imaging criteria, CNN models have acquired promising results in detecting masses and lesions in various body organs, including colorectal polyps. In this review, the structure and architecture of CNN models and how colonoscopy images are processed as input and converted to the output are explained in detail. In most primary studies conducted in the colorectal polyp detection and classification field, the CNN model has been regarded as a black box since the calculations performed at different layers in the model training process have not been clarified precisely. Furthermore, I discuss the differences between the CNN and conventional models, inspect how to train the CNN model for diagnosing colorectal polyps or cancer, and evaluate model performance after the training process.

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Intake of dietary fibre and lifetime non-steroidal anti-inflammatory drug (NSAID) use and the incidence of colorectal polyps in a population screened for colorectal cancer

Journal of Epidemiology & Community Health ◽

10.1136/jech-2016-208606 ◽

2017 ◽

Vol 71 (10) ◽

pp. 961-969 ◽

Cited By ~ 5

Author(s):

Eileen Shaw ◽

Matthew T Warkentin ◽

S Elizabeth McGregor ◽

Susanna Town ◽

Robert J Hilsden ◽

...

Keyword(s):

Colorectal Cancer ◽

Dietary Fibre ◽

Cross Sectional Study ◽

Colorectal Polyps ◽

Cross Sectional ◽

Fibre Intake ◽

Screening Population ◽

Lifestyle Questionnaire ◽

Dietary Fibre Intake ◽

Anti Inflammatory

BackgroundThere is suggestive evidence that increased intake of dietary fibre and the use of non-steroidal anti-inflammatory drugs (NSAIDs) are generally associated with decreased colorectal cancer risk. However, the effects on precursors of colorectal cancer, such as adenomatous polyps, are mixed. We present the associations between dietary fibre intake and NSAID use on the presence and type of colorectal polyps in a screening population.MethodsA cross-sectional study of 2548 individuals undergoing colonoscopy at the Forzani & MacPhail Colon Cancer Screening Centre (Calgary, Canada) was conducted. Dietary fibre intake and NSAID use were assessed using the Diet History Questionnaire I or II and the Health and Lifestyle Questionnaire. Colorectal outcomes were documented as a polyp or high-risk adenomatous polyp (HRAP; villous histology, high-grade dysplasia, ≥10 mm or ≥3 adenomas). Crude and ORs and 95% CIs were estimated using unconditional logistic regression.ResultsThere were 1450 negative colonoscopies and 1098 patients with polyps, of which 189 patients had HRAPs. Total dietary fibre intake was associated with a decreased presence of HRAPs (OR=0.50, 95% CI: 0.29 to 0.86) when comparing the highest to lowest quartiles and was observed with both soluble (OR=0.51, 95% CI: 0.30 to 0.88) and insoluble (OR=0.51, 95% CI: 0.30 to 0.86) fibres. Ever use of NSAIDs was also inversely associated with HRAPs (OR=0.65, 95% CI: 0.47 to 0.89), observed with monthly (OR=0.60, 95% CI: 0.37 to 0.95) and daily (OR=0.53, 95% CI: 0.32 to 0.86) use.ConclusionsDietary fibre intake and NSAID use were associated with a decreased risk of having a HRAP at screening.

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Performance of computed tomographic colonography for the screening of colorectal polyp in acromegalic patients: a prospective study

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032009000200003 ◽

2009 ◽

Vol 46 (2) ◽

pp. 90-96 ◽

Cited By ~ 5

Author(s):

Odery Ramos Jr. ◽

César Luiz Boguszewski ◽

Sandra Teixeira ◽

Ricardo De Bem ◽

Benito Parolim ◽

...

Keyword(s):

Prospective Study ◽

Virtual Colonoscopy ◽

Colorectal Polyp ◽

Colorectal Polyps ◽

High Risk Group ◽

Conventional Colonoscopy ◽

Intestinal Loop ◽

Computed Tomographic Colonography ◽

Computed Tomographic ◽

A Prospective Study

CONTEXT: Acromegalic patients have better chances to develop colorectal polyps and cancer and, considered a high-risk group, need to undergo frequent screening examinations. Moreover, in acromegalia, the increased bowel length and the intestinal loop complexity can lead to higher levels of technical difficulties and increase the risks of complications at conventional colonoscopy. Computed tomographic colonography, also known as virtual colonoscopy, is an innovative and secure technology which is revolutionizing the diagnosis of colon and rectum neoplasias. OBJECTIVE: To analyze computed tomographic colonography performance for the screening of colorectal polyps in acromegalic patients. METHODS: A prospective study of 21 asymptomatic acromegalic patients, 12 male and 9 female, average age 49, who underwent computed tomographic colonography and conventional colonoscopy. Computed tomographic colonography was performed with a GE Helical Multislice Computed Tomography Apparatus. Conventional colonoscopy was performed in the same day, without previous knowledge of the computed tomographic colonography diagnostics. The study evaluated the capacity of computed tomographic colonography to detect patients with colorectal polyps and identify each colorectal lesion described by the colonoscopy. RESULTS: In two patients (2/21), conventional colonoscopy was incomplete. However, in all patients computed tomographic colonography was complete. In Phase I ("per patient"), computed tomographic colonography diagnosed eight of the nine patients with colorectal polyps and showed 88% sensitivity, 75% specificity and 81% accuracy. In Phase II ("per polyp"), out of the 21 acromegalic patients included in this study, 12 presented normal findings at conventional colonoscopy. A total of 19 polyps were identified in 9 patients. Ten of the 19 polyps were smaller than 10 mm, and 9 were equal to or larger than 10 mm. Computed tomographic colonography identified 7 of the 9 polyps >10 mm described by conventional colonoscopy and only 6 of the 10 small polyps identified at conventional colonoscopy were detected by computed tomographic colonography. The histological analysis of resected lesions revealed 12 tubular adenomas, 6 hyperplastic polyps and 1 colonic tubulo-villous adenoma with an adenocarcinoma focus. CONCLUSION: The authors present the first reports of computed tomographic colonography in the screening of colorectal polyps in acromegalic patients. In this study, computed tomographic colonography was performed without complications and a complete and safe colorectal evaluation was possible in all acromegalic patients. Moreover, computed tomographic colonography presented good sensitivity, specificity and accuracy for the identification of acromegalic patients with polyps of any size and better results in the diagnosis of large polyps, when they were compared to small polypoid lesions.

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