Safety Of ColoRectal Assessment and Tumor Evaluation by Colon Capsule Endoscopy
Conditions: Colorectal Cancer; Colorectal Polyp Intervention: Device: Colon capsule endoscopy Sponsor: Odense University Hospital Not yet recruiting
Colonoscopic removal of adenomatous polyps has a preventive effect for colorectal cancer. Cold snare polypectomy is an effective method of polyp removal for small polyps (5 mm to 10 mm). Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is used for larger polyps (>10 mm). Submucosal injection during EMR or ESD is helpful to prevent complications. However, the effect of submucosal injection in cold snare polypectomy for small polyps is not clear. The aim of this study is to evaluate the risks of bleeding in cold snare polypectomy for small polyps and to investigate the effect of submucosal injection.
Postpolypectomy bleeding and incomplete polyp removal are important complication and quality concerns of colonoscopy for colon cancer prevention. Endoscopic mucosal stripping (EMS) is a modified extension of traditional cold snare polypectomy to avoid submucosal injury during removal of non-pedunculated colon polyps. We previously demonstrated EMS could potentially eliminate postpolypectomy bleeding, especially for advanced colon polyps, and facilitate complete polyp removal based on polypectomy site biopsy and short-term follow-up colonoscopy (1,2).
We reported retrospective data that compared with CO2 insufflation, water exchange (WE) colonoscopy significantly reduced rAMR (17.5% vs. 33.8%, P=0.034) (BMC Gastroenterol 2019;19:143). We performed a prospective randomized controlled trial (RCT) of WE and CO2 insufflation to determine whether WE with near-complete removal of infused water during insertion could reduce rAMR and rAMR combined with right colon hyperplastic polyp miss rate (rHPMR).
A net-work meta-analysis (GIE. 2018;88:589) showed water exchange (WE) provided the highest adenoma detection rate (ADR). The impact on sessile serrated polyp detection rate (SSPDR) was not addressed. SSP have increased malignant potential (Curr Treat Options Gastroenterol. 2015;13:156). They have subtle appearance (AJG. 2012;107:1315). They cluster in the proximal colon (61%) (Arch Pathol Lab Med. 2015;139:388) co-localizing with interval cancers (64% to 68%) (Gastro. 2014;146:950; Cancer. 2012;118:3044).
Most colorectal cancers originate from colon polyps that develop from normal tissue after an initial set of molecular events ends controlled mucosal regeneration. The molecular events that initiate polyp development depend on inherited and life style factors, age of the patient as well as random chance effect. Therefore, the distribution of polyp number per patient may adhere to a probability distribution.
The incidence of colon and rectal cancer (CRC) is rising in the US in individuals younger than 50 years. The American Cancer Society published a qualified recommendation to begin CRC screening at age 45. Bowel preparation is a recognized barrier to screening or diagnostic colonoscopy. Outcomes of bowel preparation have not been widely studied in individuals
Endoscopic submucosal dissection (ESD) allows en bloc removal of colon polyps and early colon cancer. Multiple studies have demonstrated the advantages of ESD versus endoscopic mucosal resection (EMR). However, ESD is technically difficult, labor-intensive and time-consuming. We performed a single center, retrospective observational study to evaluate safety and effectiveness of a new endoluminal double balloon interventional platform (Lumendi LLC, Westport, CT) for colonic polyp resection.
Colonoscopy is considered to be the preferred modality for colo-rectal cancer (CRC) screening because it has both diagnostic and therapeutic capabilities. Current consensus dictates that colonoscopy be performed with rapid passage of the instrument through the loops and bends of the colon to the cecum. The time taken for this is called cecal intubation time (CIT). This is then followed by thorough evaluation for and removal of all polyps during a slow deliberate withdrawal, the time taken for which is called withdrawal time.
Endosc Int Open 2020; 08: E775-E782 DOI: 10.1055/a-1136-9971 Background and study aims Adenoma detection rate (ADR) is an important quality indicator in colonoscopy, and improved ADR decreases the incidence of colorectal cancer. We investigated differences in polyp detection according to the endoscopist’s ADR. Patients and methods We performed a propensity-score matching study using baseline patient characteristics of age, sex, body mass index, family history of colorectal cancer, smoking, drinking, indication for colonoscopy, bowel preparation, and colonoscope type. We compared polyp detection and co...
This article reviews alternative colorectal cancer (CRC) screening tests, including flexible sigmoidoscopy (FS), computed tomography (CT) colonography, and colon capsule endoscopy. FS has abundant and convincing evidence supporting its use for CRC screening and is a commonly used CRC test worldwide. CT colonography has demonstrated convincing results for CRC screening, but concerns regarding cost, accuracy for flat or sessile neoplasia, reproducibility, extracolonic findings, and lack of coverage have limited its use and development. Colon capsule endoscopy has demonstrated encouraging results for polyp detection in averag...