Accuracy Of Colonoscopy Research Articles

Application of artificial intelligence in colorectal cancer screening by colonoscopy: Future prospects (Review).

Colorectal cancer (CRC) has become a severe global health concern, with the third‑high incidence and second‑high mortality rate of all cancers. The burden of CRC is expected to surge to 60% by 2030. Fortunately, effective early evidence‑based screening could significantly reduce the incidence and mortality of CRC. Colonoscopy is the core screening method for CRC with high popularity and accuracy. Yet, the accuracy of colonoscopy in CRC screening is related to the experience and state of operating physicians. It is challenging to maintain the high CRC diagnostic rate of colonoscopy. Artificial intelligence (AI)‑assisted colonoscopy will compensate for the above shortcomings and improve the accuracy, efficiency, and quality of colonoscopy screening. The unique advantages of AI, such as the continuous advancement of high‑performance computing capabilities and innovative deep‑learning architectures, which hugely impact the control of colorectal cancer morbidity and mortality expectancy, highlight its role in colonoscopy screening.

Recent Advances in Diagnostic Colonoscopy for Colorectal Cancer Screening: An Update for Radiologists.

Colonoscopy accuracy in detecting colorectal neoplasia is critical for colorectal cancer prevention but has been shown to be operator- and technology-dependent. This article will discuss several recent improvements in the technique and technology of colonoscopy. More rigorous training and retraining programs, active monitoring of endoscopist technique and outcomes, and exclusion of poorly performing endoscopists are urgently needed to improve the ultimate efficacy of colorectal cancer screening programs.

PTH-024 The Role of Preassessment in Bowel Preparation

Introduction Inadequate bowel preparation reduces the diagnostic accuracy of colonoscopy. This has a significant impact on patients’ safety and the endoscopy units waiting lists. 90% adequate bowel preparation is a quality and safety indicator for endoscopy according to the Joint Advisory Group (JAG). The aim of this study is to determine the effect of patient pre-assessment on the quality of bowel preparation. The role of the cleansing agent was also assessed. Methods This is a retrospective observational study on consecutive patients undergoing elective colonoscopy in our centre from October 2014 until September 2015. Adults undergoing routine diagnostic colonoscopy, bowel cancer screening colonoscopy and chromoendoscopy were included. Sodium picosulphate (PIC) was used as cleansing agent in the first two groups whereas pegylated ethylene glycol with senna (PEG) was used in the latter. According to duration pre-assessment was either limited (LIM, 15 mins) or prolonged (PRO, 45 mins). Quality of bowel preparation was rated as inadequate, adequate and excellent. Results 2900 procedures were evaluated. 60% of the patients were male and the mean age was 58.8 +/- 15.68 years. 1670 (57.58%) were pre-assessed, of which 1329 received LIM/PIC, 280 PRO/PIC and 65 LIM/PEG. 1230 (42, 42%) were not preassessed and had PIC (NO/PIC). Inadequate bowel preparation was reported in 13.31% (n = 386) of the whole cohort. The rate of inadequate bowel preparation in each group was: NO/PIC (17.8%), LIM/PIC (11.51%), LIM/PEG (10.77%), PRO/PIC (2.53%). Pre-assessment showed significant association with bowel preparation outcome (p Further multiple regression analysis showed that patients who had no pre-assessment were more likely to present with inadequate bowel preparation (OR 15.46, CI [7.15–33.4]) compared to patients who underwent prolonged preassessment. Patients undergoing limited preassessment were more likely to present with inadequate bowel preparation (OR 8.16, CI [3.76–17.70]) compared to patients who underwent prolonged pre-assessment. Conclusion This study identifies a prognostic role of preassessment in bowel preparation for colonoscopy. The cleansing agent seems to have no effect but only a small number of patients receiving preparation with PEG were included in this study. Further analysis of more categorical independent variables is required to formulate a predictive model for inadequate bowel preparation. Reference 1 R. Valori. BSG Quality and Safety Indicators for Endoscopy, March 2007 Joint Advisory Group. Disclosure of Interest None Declared

560 Risk of Early Post-Procedure Bleeding With Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Patients Using Clopidogrel

560 Risk of Early Post-Procedure Bleeding With Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Patients Using Clopidogrel

A study on the accuracy of colonoscopy in detecting colorectal cancer

Justification and objective: colorectal cancer (CRC) is the third most common malignant neoplasm and the second major cause of cancer-related death. Colonoscopy is the most accurate technique for diagnosing structural lesions in the colon. The aim of this study was to calculate the diagnostic agreement rate (Kappa) of colonoscopy in cases of suspected colorectal cancer and histopathological examination (gold standard) in symptomatic patients examined between 2007-2010. Patients and methods: 233 cases were assessed in this observational prospective study. Results: changes upon colonoscopy suggestive of colorectal cancer were present in 24 (6.87%) patients submitted to colonoscopy and diagnosis was confirmed by histopathology in 21 cases. Most affected by CRC were the colon (62.5%) and rectum (37.5%), and no lesions were found in the anus or anal canal. The left colon was the most affected (75%), with 58.33% of the lesions in the sigmoid region; and 25% of lesions were found in the right colon. Conclusion: The Kappa index of diagnostic agreement for this sample in the detection of colorectal cancer was 0.88 with CI 0.78 and 0.98, considered substantial.

Accuracy of colonoscopy in localizing colorectal cancer - A quality issue?

Accuracy of colonoscopy in localizing colorectal cancer - A quality issue?

Light-Scattering Technologies for Field Carcinogenesis Detection: A Modality for Endoscopic Prescreening

Colonoscopy has revolutionized colorectal cancer (CRC) screening resulting in a decrease in both CRC mortality and incidence. Despite this, CRC still ranks as the second leading cause of cancer deaths among Americans, underscoring the need to both increase availability and accuracy of colonoscopy. The latter considerations provide the impetus for much of the current research into adjunctive imaging technologies. Recent advances in improving detection of dysplasia that have translated into clinical practice include high-definition scopes, narrow-band imaging, and chromoendoscopy.

A novel device for rapid cleaning of poorly prepared colons

Adequate colon preparation is essential for the quality and accuracy of colonoscopy and has a significant influence on related costs. The aim of this study was to assess the efficacy and safety of a novel attachable colon-cleaning device used during colonoscopies in porcine colon. The ClearPath device consists of a multilumen extruded tube with channels for water irrigation and evacuation designed to allow the break up and removal of stool remnants during colonoscopy. Seven female domestic swine underwent several series of experiments in which partial bowel preparation followed by a sedated colonoscopy using the new device was performed. Between February 2008 and October 2008, a total of 57 colonoscopic procedures were conducted. The device enabled rapid cleaning of the partially prepared porcine colon with no immediate or delayed adverse consequences. Use of the ClearPath device was found to be a simple, reliable, and safe method for intraprocedural cleaning of partly prepared porcine colon. These experiments support a potential role for ClearPath in cleaning the colon in unprepared or poorly prepared human patients.

How to choose the best preparation for colonoscopy

The success and accuracy of colonoscopy is largely dependent on appropriate cleansing of the colon. The ideal bowel preparation should be safe, well-tolerated and effective. Although colonoscopy preparations are vastly better than the earliest barium enemas used in X-ray regimens, none of the currently available formulations sufficiently fulfills the above criteria. Currently used techniques of colon cleansing include dietary and cathartic methods, gut lavage and the administration of phosphates. All of these methods are efficacious, particularly when administered in a split dose (one the evening before and one just before the planned colonoscopy). Gut lavage methods are the safest method; however, dietary and cathartic methods are also reasonably safe. Low-dose phosphate preparations are well tolerated, but safety concerns have led to the withdrawal of some phosphate products from the US market. A new oral sulfate product that achieves a desirable balance of safety, tolerability in patients and efficacy will shortly be introduced. Physicians should be aware of the range of colonoscopy preparations available and their limitations, so that the best preparation can be chosen for an individual patient.

Diagnostic Accuracy of Sigmoidoscopy Compared with Histology for Ischemic Colitis after Aortic Aneurysm Repair

Clinically relevant rates of ischemic colitis (IC) causing diarrhea, systemic involvement, colon necrosis, and, ultimately, death by multiple organ failure affect only a small proportion of patients after aortic reconstructions, with reported incidences of 2.7 to 3.3%. The key to treating and saving patients with this complication remains early detection and consequent treatment. The aim of this retrospective analysis of prospectively collected data was to compare the diagnostic accuracy of colonoscopy for detecting postoperative IC compared with histology and to evaluate the interobserver difference of two experienced surgeons. One hundred patients with infrarenal aortic aneurysms, operated on electively from March 2001 to December 2003, who had on postoperative days 3 to 6 a sigmoidoscopy by two independent surgeons and a histologic sample of the sigmoid mucosa, were included in the study. Patients with previous colon resection or inflammatory bowel disease were excluded from the study. All patients gave written informed consent. The study was approved by the Institutional Review Board. Histologic examination of the sigmoid mucosa revealed IC in 13 patients. The combined sensitivity of both investigators for detecting IC by sigmoidoscopy compared with histology was 84%, the specificity was 92.0%, the positive predictive value was 61.1%, the negative predictive value was 97.6%, and the diagnostic accuracy was 91.0%. There was no statistically significant difference between investigator 1 and investigator 2 (p=1.0) and between both investigators and histology (p=.380). Histology remains the gold standard for detecting IC after aortic surgery. Sigmoidoscopy, however, is a valid diagnostic tool allowing immediate clinical decision making with a negative predictive value of more than 94% and a diagnostic accuracy of 92%.

Rates of New or Missed Colorectal Cancers After Colonoscopy and Their Risk Factors: A Population-Based Analysis

The rate of new or missed colorectal cancer (CRC) after colonoscopy and their risk factors in usual practice are unknown. Our objective was to evaluate the rate and risk factors in a population-based study. We analyzed data from the Canadian Institute for Health Information, the Ontario Health Insurance Program, and Ontario Cancer Registry for all patients (> or =20 years of age) with a new diagnosis of right-sided, transverse, splenic flexure/descending, rectal or sigmoid CRC in Ontario from April 1, 1997 to March 31, 2002, who had a colonoscopy within the 3 years before their diagnosis. Patients with new or missed cancers were those whose most recent colonoscopy was 6 to 36 months before diagnosis. We examined characteristics that might be risk factors for new or missed CRC. We identified a diagnosis of CRC in 3288 (right sided), 777 (transverse), 710 (splenic flexure/descending), and 7712 (rectal or sigmoid) patients. The rates of new or missed cancers were 5.9%, 5.5%, 2.1%, and 2.3%, respectively. Independent risk factors for these cancers in men and women were older age; diverticular disease; right-sided or transverse CRC; colonoscopy by an internist or family physician; and colonoscopy in an office. Because having an office colonoscopy and certain patient, procedure, and physician characteristics are independent risk factors for new or missed CRC, physicians must inform patients of the small risk (2% to 6%) of these cancers after colonoscopy. The influence of type of physician and setting on the accuracy of colonoscopy, potentially modifiable risk factors, warrants further study.

Accuracy of colonoscopy in localisation of colorectal cancer.

An audit was performed of 77 patients with a single colorectal cancer visualised and sited before surgery by colonoscopic examination. The site of the cancer described at colonoscopy was compared with the actual site found at laparotomy. Six significant errors in preoperative localisation were encountered, when a change from the preoperatively planned resection to an alternative resection was found necessary. In two of these cases, extra morbidity was encountered as a result of these siting errors. Inaccurate localisation is a potential hazard of colonoscopy, especially when the examination is incomplete.

Hydrocolonic sonography was better than conventional abdominal sonography and approached the accuracy of colonoscopy for detecting colonic tumors

Source Citation Limberg B. Diagnosis and staging of colonic tumors by conventional abdominal sonography as compared with hydrocolonic sonography. N Engl J Med. 1992 Jul 9;327:65-9.

Reliability of colonoscopy.

In an effort to determine the reliability of colonoscopy the authors retrospectively reviewed preoperative colonoscopic findings and compared them with the postoperative pathologic specimen reports. Only lesions greater than 0.5 cm were included in the comparison. Over a 13-year period, 429 patients with colorectal cancer underwent preoperative colonoscopy. Four hundred thirteen (97 percent) of the colonoscopic examinations correlated with the pathologic specimen, but, in 16 cases (3 percent), lesions were missed. In total, 17 adenomatous polyps and 3 cancers were found in the surgical specimens that were not documented at colonoscopy. Eighteen patients had total preoperative colonoscopy and total abdominal colectomy, which makes for a reliable model to judge the accuracy of colonoscopy. In these 18 patients, 17 of the pathologic specimens correlated with the endoscopic findings, which yields an accuracy rate of 94 percent. Blind areas in the colon, plus misjudgment that the scope had reached the cecum, are responsible for the majority of colonoscopic errors.

Colonoscopy in inflammatory bowel disease: Diagnostic accuracy and proposal of an endoscopic score

Colonoscopy is used in the differential diagnosis of inflammatory bowel disease but its accuracy and the “weight” of the various endoscopic signs have not been assessed. In a prospective study 357 patients with 606 colonoscopies, in whom the endoscopic appearances were those of ulcerative colitis, Crohn's colitis, or indeterminate colitis, were followed-up for an average period of 22 mo. A final, definite, endoscopy-independent diagnosis was reached by means of autopsy, surgery, or histology on biopsy in 71% of patients. Accuracy of colonoscopy was 89%, with 4% errors and 7% indeterminate diagnoses. Errors were more frequent in severe inflammatory activity (9%). The most useful endoscopic features in this differential diagnosis were discontinuous involvement, anal lesions, and cobblestoning of mucosa for Crohn's disease, and erosions or microulcers and granularity for ulcerative colitis. After selecting the endoscopic features with best predictive value, an “endoscopic score” was calculated by means of “likelihood ratios”.