Medical needs related to the endoscopic technology and colonoscopy for colorectal cancer diagnosis

Abstract Background The high incidence and mortality rate of colorectal cancer require new technologies to improve its early diagnosis. This study aims at extracting the medical needs related to the endoscopic technology and the colonoscopy procedure currently used for colorectal cancer diagnosis, essential for designing these demanded technologies. Methods Semi-structured interviews and an online survey were used. Results Six endoscopists were interviewed and 103 were surveyed, obtaining the demanded needs that can be divided into: a) clinical needs, for better polyp detection and classification (especially flat polyps), location, size, margins and penetration depth; b) computer-aided diagnosis (CAD) system needs, for additional visual information supporting polyp characterization and diagnosis; and c) operational/physical needs, related to limitations of image quality, colon lighting, flexibility of the endoscope tip, and even poor bowel preparation. Conclusions This study shows some undertaken initiatives to meet the detected medical needs and challenges to be solved. The great potential of advanced optical technologies suggests their use for a better polyp detection and classification since they provide additional functional and structural information than the currently used image enhancement technologies. The inspection of remaining tissue of diminutive polyps (< 5 mm) should be addressed to reduce recurrence rates. Few progresses have been made in estimating the infiltration depth. Detection and classification methods should be combined into one CAD system, providing visual aids over polyps for detection and displaying a Kudo-based diagnosis suggestion to assist the endoscopist on real-time decision making. Estimated size and location of polyps should also be provided. Endoscopes with 360° vision are still a challenge not met by the mechanical and optical systems developed to improve the colon inspection. Patients and healthcare providers should be trained to improve the patient’s bowel preparation.

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The importance of colonoscopy bowel preparation for the detection of colorectal lesions and colorectal cancer prevention

Endoscopy International Open ◽

10.1055/a-1127-3144 ◽

2020 ◽

Vol 08 (05) ◽

pp. E673-E683 ◽

Cited By ~ 1

Author(s):

Prateek Sharma ◽

Carol A. Burke ◽

David A. Johnson ◽

Brooks D. Cash

Keyword(s):

Colorectal Cancer ◽

Bowel Preparation ◽

Clinical Importance ◽

High Volume ◽

High Quality ◽

Crc Screening ◽

Incidence And Mortality ◽

Low Volume ◽

Split Dosing ◽

Bowel Preparations

Abstract Background and study aims Colonoscopy for colorectal cancer (CRC) screening has reduced CRC incidence and mortality and improved prognosis. Optimal bowel preparation and high-quality endoscopic technique facilitate early CRC detection.This review provides a narrative on the clinical importance of bowel preparation for colonoscopy and highlights available bowel preparations. Methods A PubMed search was conducted through June 2019 to identify studies evaluating clinical outcomes, efficacy, safety, and tolerability associated with bowel preparation for CRC screening-related colonoscopy. Results Selecting the optimal bowel preparation regimen is based on considerations of efficacy, safety, and tolerability, in conjunction with individual patient characteristics and preferences. Available bowel preparations include high-volume (4 L) and low-volume (2 L and 1 L), polyethylene glycol (PEG) solutions, sodium sulfate, sodium picosulfate/magnesium oxide plus anhydrous citric acid, sodium phosphate tablets, and the over-the-counter preparations magnesium citrate and PEG-3350. These preparations may be administered as a single dose on the same day or evening before, or as two doses administered the same day or evening before/morning of colonoscopy. Ingesting at least half the bowel preparation on the day of colonoscopy (split-dosing) is associated with higher adequate bowel preparation quality versus evening-before dosing (odds ratio [OR], 2.5; 95 % confidence interval [CI], 1.9−3.4). Conclusions High-quality bowel preparation is integral for optimal CRC screening/surveillance by colonoscopy. Over the last 30 years, patients and providers have gained more options for bowel preparation, including low-volume agents with enhanced tolerability and cleansing quality that are equivalent to 4 L preparations. Split-dosing is preferred for achieving a high-quality preparation.

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Evolving management of colorectal polyps

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/26317745211047010 ◽

2021 ◽

Vol 14 ◽

pp. 263177452110470

Author(s):

Yervant Ichkhanian ◽

Tobias Zuchelli ◽

Andrew Watson ◽

Cyrus Piraka

Keyword(s):

Colorectal Cancer ◽

Endoscopic Resection ◽

Colorectal Polyps ◽

Complete Resection ◽

Incomplete Resection ◽

Polyp Detection ◽

Crc Screening ◽

Incidence And Mortality

Advances in endoscopic technology have led to increased success in colorectal cancer (CRC) screening and polyp management, with reduction of CRC incidence and mortality. Despite these advances, CRC is still one of the leading causes of cancer deaths, and half of all CRC develops from lesions that were missed during colonoscopy while one-fifth of CRC arise from prior incomplete resection. Techniques to improve polyp detection are needed, along with optimization of complete resection of any abnormal lesions that are found. This article will review the currently available endoscopic resection techniques and will discuss where they fit in the management of polyps of different sizes and types, such as pedunculated versus nonpedunculated, and those with or without suspected invasion.

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CT- and MR Colonography

Scandinavian Journal of Surgery ◽

10.1177/145749690209100402 ◽

2002 ◽

Vol 91 (4) ◽

pp. 322-327 ◽

Cited By ~ 5

Author(s):

M. P. Achiam ◽

S. Bülow ◽

J. Rosenberg

Keyword(s):

Colorectal Cancer ◽

Bowel Preparation ◽

High Sensitivity ◽

Diagnostic Methods ◽

Diagnostic Colonoscopy ◽

Mr Colonography ◽

Non Invasive ◽

Processing Power ◽

Major Disadvantage ◽

Incidence And Mortality

Background: Colorectal cancer is the second most frequent cancer and adenomas are widely accepted as precursors to colorectal cancer. Diagnosis and removal of adenomas are recommended to reduce cancer incidence and mortality. The current diagnostic methods include sigmoidoscopy and colonoscopy. Lately, CT- and MR colonography have emerged as non-invasive methods for colon imaging. Methods: At present, CTC and MRC require bowel preparation. However, preliminary studies have been carried out without colon preparation. After the colon has been filled with air or contrast, the patient is scanned in the supine and prone positions. Data are then downloaded to a workstation for post processing and image-analysis. Results: Results have shown a high sensitivity and specificity for polyps ≥ 10 mm, comparable to the sensitivity of conventional colonoscopy and superior to double contrast barium enema. Conclusions: With the exponential development in computer processing power, CT- and MR colonography holds the promise for future colon examination with the advantages of non-invasiveness, no need for sedation, and probably no bowel preparation. major disadvantage, however, is the radiation dose during CT colonography. Future developments with the use of “intelligent” computers, better resolution and faster examinations will make CT and/or MR colonography realistic options to replace conventional diagnostic colonoscopy.

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Trends of Screening Utilization, Bowel Preparation and Polyp Detection and its Effect on Colorectal Cancer Incidence in Major Ethnic Groups in Israel

10.1055/s-0041-1724741 ◽

2021 ◽

Author(s):

F Abu Baker ◽

Y Kopelman

Keyword(s):

Colorectal Cancer ◽

Ethnic Groups ◽

Cancer Incidence ◽

Bowel Preparation ◽

Polyp Detection ◽

Colorectal Cancer Incidence

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Distinct trajectories of positive and negative affect after colorectal cancer diagnosis.

Health Psychology ◽

10.1037/hea0000485 ◽

2017 ◽

Vol 36 (6) ◽

pp. 521-528 ◽

Cited By ~ 4

Author(s):

Yvette Ciere ◽

Moniek Janse ◽

Josué Almansa ◽

Annemieke Visser ◽

Robbert Sanderman ◽

...

Keyword(s):

Colorectal Cancer ◽

Negative Affect ◽

Cancer Diagnosis ◽

Positive And Negative Affect

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Opportunistic Colorectal Cancer Screening using Colonoscopy. Comparative Results between two Historical Cohorts in Bucharest, Romania

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.242.buch ◽

2015 ◽

Vol 24 (2) ◽

pp. 171-176 ◽

Cited By ~ 1

Author(s):

Elena Mirela Ionescu ◽

Tudor Nicolaie ◽

Serban Ion Gologan ◽

Ana Mocanu ◽

Cristina Ditescu ◽

...

Keyword(s):

Colorectal Cancer ◽

Screening Program ◽

Advanced Adenoma ◽

Detection Rates ◽

Incidence And Mortality ◽

Organized Screening Program ◽

History Of ◽

Comparative Results ◽

Asymptomatic Individuals ◽

Second Period

Background & Aims: Even though Romania has one of the highest incidence and mortality in colorectal cancer (CRC) in Europe, there is currently no organized screening program. We aimed to assess the results of our opportunistic CRC screening using colonoscopy.Methods: A single center retrospective study to include all opportunistic screening colonoscopies performed in two 18 month periods (2007-2008 and 2012-2013) was designed. All asymptomatic individuals without a personal or family history of adenoma or CRC and with complete colonoscopy performed in these two time periods were included.Results: We included 1,807 individuals, 882 in the first period, 925 in the second period. There were 389 individuals aged below 50, 1,351 between 50 and 75 and 67 older than 75 years. There were 956 women (52.9%), with a mean age of 58.5 (median 59, range 23-97). The detection rates were 12.6% for adenomas (6.1% for advanced adenoma) and 3.4% for adenocarcinoma. Adenoma incidence (4.9% in subjects under 50, 14.7% in those aged 50 to 75, and 16.4% in those older than 75, p<0.0001) and size (6.3mm in subjects younger than 50, 9.2mm in those 50 to 75 and 10.8mm in those older than 75, p=0.015) significantly increased with age. Adenoma incidence increased in the second period (14.8% vs. 10.3%, p=0.005), while adenoma size decreased in the second period (8.4mm vs. 10mm, p=0.006). There were no procedure related complications.Conclusions: The neoplasia detection rate was 16% (12.6% adenoma, 3.4% adenocarcinoma). Adenoma incidence and size increased with age in both cohorts. In the second screening period significantly more and smaller adenomas were detected.

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Patient Tolerability of Bowel Preparation is Associated with Polyp Detection Rate During Colonoscopy

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.ewh1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 135-140 ◽

Cited By ~ 5

Author(s):

Edward W. Holt ◽

Kidist K. Yimam ◽

Hanley Ma ◽

Richard E. Shaw ◽

Richard A. Sundberg ◽

...

Keyword(s):

Bowel Preparation ◽

Primary Outcome ◽

Secondary Outcome ◽

Polyp Detection ◽

Cross Sectional ◽

Quality Outcomes ◽

Negative Experience ◽

Polyp Detection Rate ◽

Patient Reported ◽

Bowel Prep

Background & Aims: A number of factors have been identified that influence the yield of screeningcolonoscopy. The perceived tolerability of bowel preparation has not been studied as a predictor of quality outcomes in colonoscopy. We aimed to characterize the association between patient-perceived tolerability of bowel preparation and polyp detection during colonoscopy.Methods: We performed a cross-sectional cohort study of 413 consecutive adult patients presenting foroutpatient colonoscopy at two outpatient endoscopy centers at our institution. We developed a standardized questionnaire to assess the patient's experience with bowel preparation. Bowel preparation quality was measured using the validated Ottawa scale and colonoscopic findings were recorded for each patient. The primary outcome was polyp detection and the secondary outcome was the quality of bowel preparation.Results: Patient-reported clarity of effluent during bowel preparation correlated poorly with Ottawa score during colonoscopy, k=0.15. Female gender was an independent risk factor for a poorly tolerated bowel prep (OR 3.93, 95% CI 2.30 - 6.72, p<0.001). Report of a poorly tolerated bowel prep was independently associated with the primary outcome, polyp detection (OR 0.39, 95% CI 0.18 - 0.84, p=0.02) and also with the secondary outcome, lower quality bowel preparation (OR 2.39, 95% CI 1.17 - 4.9, p=0.02).Conclusions: A patient-perceived negative experience with bowel preparation independently predicted both a lower quality bowel preparation and a lower rate of polyp of detection. Assessment of the tolerability of bowel preparation before colonoscopy may be a clinically useful predictor of quality outcomes during colonoscopy.

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