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Colonoscopic yield of colorectal neoplasia in daily clinical practice

World Journal of Gastroenterology 2009年第9期15卷 1085-1092页

作者： jochim s terhaar sive droste Mike E Craanen Rene WM van der Hulst Joep F Bartelsman Dick P Bezemer Kim R Cappendijk Gerrit A Meijer Linde M Morsink Pleun snel Hans ARE Tuynman Roy LJ van Wanrooy Eric IC Wesdorp Chris JJ Mulder Department of Gastroenterology and Hepatology VU University Medical CentrePO Box 70571007 MBAmsterdamThe Netherlands Gastroenterology and Hepatology Kennemer Gasthuis2000 AKHaarlemThe Netherlands Gastroenterology and Hepatology Academic Medical Centre1100 DDAmsterdamThe Netherlands Epidemiology and Biostatistics VU University Medical Centre1007 MBAmsterdamThe Netherlands Pathology VU University Medical Centre1007 MBAmsterdamThe Netherlands Gastroenterology and Hepatology Slotervaart Hospital1006 BKAmsterdamThe Netherlands Gastroenterology and Hepatology Medical Centre Alkmaar1800 AMAlkmaarThe Netherlands Gastroenterology and Hepatology Sint Lucas Andreas Hospital1061 AEAmsterdamThe Netherlands

AIM:To assess the prevalence and location of ad-vanced neoplasia in patients undergoing colonoscopy,and to compare the yield per ***:In a multicenter colonoscopy survey (n = 18 hospitals) in the Amsterdam area (Northern Holland),data of all colonoscopies performed during a three month period in 2005 were analyzed. The location and the histological features of all colonic neoplasia were recorded. The prevalence and the distribution ofadvanced colorectal neoplasia and differences in yield between indication clusters were evaluated. Advanced neoplasm was defi ned as adenoma > 10 mm in size,with > 25% villous features or with high-grade dyspla-sia or ***:A total of 4623 eligible patients underwent a total colonoscopy. The prevalence of advanced neo-plasia was 13%,with 281 (6%) adenocarcinomas and 342 (7%) advanced adenomas. sixty-seven percent and 33% of advanced neoplasia were located in the distal and proximal colon,respectively. Of all patients with right-sided advanced neoplasia (n = 228),51% had a normal distal colon,whereas 27% had a syn-chronous distal adenoma. Ten percent of all colono-scopies were performed in asymptomatic patients,7% of whom had advanced neoplasia. In the respective procedure indication clusters,the prevalence of right-sided advanced neoplasia ranged from 11%-57%. CONCLUsION:One out of every 7-8 colonoscopies yielded an advanced colorectal neoplasm. Colonoscopy is warranted for the evaluation of both symptomatic and asymptomatic patients.

关键词： Colorectal cancer screening Advanced neoplasia Colonoscopy Adenoma

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引用

World Journal of Gastroenterology 2012年第38期18卷 5397-5403页

作者： sietze T van Turenhout Leo GM van Rossum Frank A Oort Robert JF Laheij Anne F van Rijn jochim s terhaar sive droste Paul Fockens René WM van der Hulst Anneke A Bouman Jan BMJ Jansen Gerrit A Meijer Evelien Dekker Chris JJ Mulder Department of Gastroenterology and Hepatology VU University Medical Center1081 HV Amsterdam The Netherlands Department of Epidemiology Biostatistics and HTA Radboud University Nijmegen Medical Center6500 HB Nijmegen The Netherlands Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Center6500 HB Nijmegen The Netherlands Department of Gastroenterology and Hepatology Academic Medical Center1105 AZ Amsterdam The Netherlands Department of Gastroenterology and Hepatology Kennemer Gasthuis 2035 RC Haarlem The Netherlands Clinical Chemistry VU University Medical Center 1081 HV Amsterdam The Netherlands Department of Gastroenterology and Hepatology Radboud University Nijmegen Medical Center 6500 HB Nijmegen The Netherlands Department of Pathology VU University Medical Center 1081 HV Amsterdam The Netherlands Department of Gastroenterology and Hepatology Academic Medical Center 1105 AZ Amsterdam The Netherlands Department of Gastroenterology and Hepatology VU University Medical Center 1081 HV Amsterdam The Netherlands

AIM: To improve the interpretation of fecal immunochemical test (FIT) results in colorectal cancer (CRC) cases from screening and referral cohorts. METHODs: In this comparative observational study, two prospective cohorts of CRC cases were compared. The first cohort was obtained from 10 322 average risk subjects invited for CRC screening with FIT, of which, only subjects with a positive FIT were referred for colonoscopy. The second cohort was obtained from 3637 subjects scheduled for elective colonoscopy with a positive FIT result. The same FIT and positivity threshold (OC sensor; ≥ 50 ng/mL) was used in both cohorts. Colonoscopy was performed in all referral subjects and in FIT positive screening subjects. All CRC cases were selected from both cohorts. Outcome measurements were mean FIT results and FIT scores per tissue tumor stage (T stage). REsULTs: One hundred and eighteen patients with CRC were included in the present study: 28 cases obtained from the screening cohort (64% male; mean age 65 years, sD 6.5) and 90 cases obtained from the referral cohort (58% male; mean age 69 years, sD 9.8). The mean FIT results found were higher in the referral cohort (829 ± 302 ng/mLvs 613 ± 368 ng/mL,P = 0.02). Tissue tumor stage (T stage) distribution was dif-ferent between both populations [screening population: 13 (46%) T1, eight (29%) T2, six (21%) T3, one (4%) T4 carcinoma; referral population: 12 (13%) T1, 22 (24%) T2, 52 (58%) T3, four (4%) T4 carcinoma], and higher T stage was significantly associated with higher FIT results (P stage, no significant difference in mean FIT results was observed (screening vs referral: T1 498 ± 382 ng/mL vs 725 ± 374 ng/mL, P = 0.22; T2 787 ± 303 ng/mL vs 794 ± 341 ng/mL, P = 0.79; T3 563 ± 368 ng/mLvs 870 ± 258 ng/mL,P = 0.13; T4 not available). After correction for T stage in logistic regression analysis, no significant differences in mean FIT results were observed between both types of cohorts (P = 0.10). CONCLUsION

关键词： screening population Referral cohort Fecal immunochemical test Tumor stage distribution Colorectal cancer

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Digestive oncologist in the gastroenterology training curriculum

引用

World Journal of Gastroenterology 2011年第9期17卷 1109-1115页

作者： Chris Jacob Johan Mulder Marc Peeters Annemieke Cats Anna Dahele jochim terhaar sive droste Department of Gastroenterology and Hepatology VU University Medical Center Department of Oncology Antwerp University Hospital Antwerp Department of Gastroenterology and Hepatology Netherlands Cancer Institute

Until the late 1980s, gastroenterology (GE) was considered a subspecialty of Internal Medicine. Today, GE also incorporates Hepatology. However, Digestive Oncology training is poorly defined in the Hepatogastroenterology (HGE)-curriculum. Therefore, a Digestive Oncology curriculum should be developed and this document might be a starting point for such a curriculum. HGE-specialists are increasingly resisting the paradigm in which they play only a diagnostic and technical role in the management of digestive tumors. We suggest minimum endpoints in the standard HGE-curriculum for oncology, and recommend a focus year in the Netherlands for Digestive Oncology in the HGE-curriculum. To produce welltrained digestive oncologists, an advanced Digestive Oncology training program with specific qualifications in Digestive Oncology (2 years) has been developed. The schedule in Belgium includes a period of at least 6 mo to be spent in a medical oncology department. The goal ofthese programs remains the production of well-trained digestive oncologists. HGE specialists are part of the multidisciplinary oncological teams, and some have been administering chemotherapy in their countries for years. In this article, we provide a road map for the organization of a proper training in Digestive Oncology. We hope that the World Gastroenterology Organisation and other (inter)national societies will support the necessary certifications for this specific training in the HGE-curriculum.

关键词： Gastroenterology Training Digestive oncologist Curriculum Chemotherapy Immunotherapy Oncology Targeted therapy

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