Fecal Immunohistochemical Test Research Articles

S319 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database

S319 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: Results from a Large Nationwide Veterans Affairs Database

S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

S322 Sessile Serrated Lesion Detection Rate in Individuals with Positive Fecal Immunohistochemical Test Undergoing Colonoscopy: A Systematic Review and Meta-Analysis

S350 Are Primary Care Providers Accurately Ordering Cologuard in the Community Setting?

Introduction: Colon cancer screening saves lives, and colonoscopy remains the gold standard test. Cologuard (CG), a non-invasive multi-target stool DNA + Fecal Immunohistochemical Test, is 92% sensitive for colon cancer detection, but only 42.4% sensitive for advanced adenoma detection, thus limiting its preventive role. CG is indicated as a screening test for asymptomatic patients without colon cancer risk factors, and is increasingly ordered by primary care providers (PCPs). It is unknown if PCPs are ordering CG according to approved indications. To determine if referring PCPs in our community are ordering the CG test in accordance with approved indications. Methods: Our practice has a wide network of referring providers with multiple offices. This prospective study enrolled all patients referred to our practice with a positive CG test from December 2020 to June 2021. Clinical information was obtained from medical records. Patients responded to a questionnaire asking: (1) Did you see blood in your stool or observe blood from your rectum, and (2) Did you have a stool test showing blood before your CG test? The colonoscopy results were recorded and the data was analyzed. Results: 81 patients (28M:53F) with a positive CG test were enrolled, with a median age 62 years (96.3% patients >50 years old). 9% of the study population self-identified as African-Americans. 54/81 (66.7%) of patients had >1 adenomatous polyp or colon cancer (n=3) on colonoscopy, and specifically 16% (13/81) had advanced adenomatous polyps/mass. 33.3% (27/81) of patients had either a hyperplastic polyp or a normal colonoscopy. The false positive rate for CG in this study was 33.3%. 16% (13/81) of patients who were prescribed a CG test had blood present in stool, and of these 13 patients, 12 reported overt bleeding prior to being prescribed CG. Conclusion: This study reveals that our community-based PCPs are incorrectly ordering CG as a screening test, and specifically, are unaware that overt bleeding is a contraindication for CG testing. 15% of patients initially reported overt bleeding prior to CG testing, and this contributed to the elevated false positive rate observed in our study (33.3%) compared to the accepted false positive rate of 12% for comparable patients. The cost of CG is $500-600 and widespread erroneous testing leads to increased healthcare cost. This study highlights an opportunity for PCP education, and suggests similar regional analysis should be conducted.

S250 Increasing Fecal Immunochemical Test Return Rates by Patient Reminders: A Quality Improvement Study

Introduction: The incidence of colorectal cancer (CRC) in the United States is increasing, and it remains the second leading cause of cancer death in the United States for men and women combined. The American Cancer Society now recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high sensitivity stool-based test or structural (visual) examination, depending on patient preference and test availability. The primary objective of this quality improvement project was to determine if reminder methods, such as telephone or letter reminders, increased the return rate of fecal immunochemical tests (FIT) for colorectal cancer screening. Methods: At public outreach events and daily clinics in the West Texas Panhandle area, participants in the GET FIT program were provided with FIT kits after completing the education on colorectal cancer. Participants who fit the inclusion criteria and had received a FIT kit from the program were included. They were instructed on how to perform the test and mail it back. Participants that did not return the completed kits within two weeks were reminded either by 1) through a reminder letter or 2) by telephone every 2 weeks (+/- 3 days) for 60 days or 5 attempts to contact. We de-identified and analyzed the FIT kit return data from June-November 2019 before instituting these reminder methods. We then calculated the change in return rates from December 2019 to February 2020. Our goal was to increase the FIT return rates by 25% over the baseline return rate. Results: The pre-intervention return rate of kits for June-November 2019 was 67.58%, and the postintervention return rate for December 2019-February 2020 was 81.87%. This rate was equal to an approximately 21% increase in return rates. The average return rate of FIT kits overall was 72.34%. The average rate of returned new patient kits was 69%, and the average % of new patient return kits was 68.51%. We also noticed a significant increase in return of FIT tests after a community cancer screening in October 2019. Conclusion: Fecal immunohistochemical test (FIT) remains one of the primary options for colorectal cancer screening. Due to its lower cost and noninvasiveness, FIT was offered to patients at average risk.We did achieve a significant increase in return rates, although we did not meet our target goal for this project. Our project was limited to studying 3 months post-intervention due to the COVID pandemic and barrier in returning tests. (Table Presented).

Colorectal cancer screening and prevention: A brief review of the current guidelines and modalities

Colorectal cancer (CRC) remains a frequently addressed topic in primary care. Recent studies have been published detailing modifiable risk factors for CRC, as well as preventative measures. Providers must be up to date on screening recommendations and modalities. Colonoscopy is the preferred method of screening for CRC, and the screening recommendations in the United States were recently updated in 2020. It is also common for the practitioner to encounter patients who refuse colonoscopy but are willing to undergo alternative methods of testing. The COVID pandemic has also placed a burden on hospital resources, and colonoscopy may not be logistically feasible in some healthcare settings. Therefore, awareness of the guidelines for the various alternative modalities, along with their respective guidelines for frequency of screening is critical. This article provides a brief review of the risk factors associated with colon cancer, the screening modalities (including colonoscopy, sigmoidoscopy, CT colonography, fecal immunohistochemical testing (FIT), guaiac-based fecal occult blood testing (gFOBT), multi target stool DNA testing (MTs-DNA), and others) and the most recent screening recommendations for the general population.

Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study.

BACKGROUNDScreening provides earlier colorectal cancer (CRC) detection and improves outcomes. It remains poorly understood if these benefits are realized with screening guidelines in remote northern populations of Canada where CRC rates are nearly twice the national average and access to colonoscopy is limited.AIMTo evaluate the participation and impact of CRC screening guidelines in a remote northern population.METHODSThis retrospective cohort study included residents of the Northwest Territories, a northern region of Canada, age 50-74 who underwent CRC screening by a fecal immunohistochemical test (FIT) between January 1, 2014 to March 30, 2019. To assess impact, individuals with a screen-detected CRC were compared to clinically-detected CRC cases for stage and location of CRC between 2014-2016. To assess participation, we conducted subgroup analyses of FIT positive individuals exploring the relationships between signs and symptoms of CRC at the time of screening, wait-times for colonoscopy, and screening outcomes. Two sample Welch t-test was used for normally distributed continuous variables, Mann-Whitney-Wilcoxon Tests for data without normal distribution, and Chi-square goodness of fit test for categorical variables. A P value of < 0.05 was considered to be statistically significant.RESULTS6817 fecal tests were completed, meaning an annual average screening rate of 25.04%, 843 (12.37%) were positive, 629 individuals underwent a follow-up colonoscopy, of which, 24.48% had advanced neoplasia (AN), 5.41% had CRC. There were no significant differences in stage, pathology, or location between screen-detected cancers and clinically-detected cancers. In assessing participation and screening outcomes, we observed 49.51% of individuals referred for colonoscopy after FIT were ineligible for CRC screening, most often due to signs and symptoms of CRC. Individuals were more likely to have AN if they had signs and symptoms of cancer at the time of screening, waited over 180 d for colonoscopy, or were indigenous [respectively, estimated RR 1.18 95%CI of RR (0.89-1.59)]; RR 1.523 (CI: 1.035, 2.240); RR 1.722 (CI: 1.165, 2.547)].CONCLUSIONScreening did not facilitate early cancer detection but facilitated higher than anticipated AN detection. Signs and symptoms of CRC at screening, and long colonoscopy wait-times appear contributory.

S1259 Inappropriate Use of Fecal Immunohistochemical Testing (FIT) in the Hospital and Emergency Department: FIT Is Un-FIT for Inpatient and Emergency Use

INTRODUCTION: Fecal immunochemical testing (FIT) is widely used for colorectal cancer (CRC) screening, its only indication; however, FIT is inappropriately used in emergency room (ER) and inpatient settings for other indications. We studied its use in these settings to determine frequency of use, indications, and impact on clinical care. METHODS: Using electronic medical records, we reviewed all instances of FIT testing originating in the hospital and ER from November 2017 to October 2019. We abstracted data on patient demographics, indication for and results of FIT testing, consultations to gastroenterology (GI), and endoscopic procedures. The test was defined as appropriate if the indication was CRC screening. Descriptive statistics were used for data analysis. RESULTS: We identified a cohort of 550 subjects who had ≥1 FIT test. Only 3 (0.5%; 95% CI, 0.09–1.52%) FIT tests were for CRC screening. The cohort had a mean (SD) age of 54 (18) years, was 48% women, and was comprised of 45% Black, 42% White, and 6% Hispanic individuals. FIT testing was performed in the ER (45%), hospital floor (42%), intensive care unit (11%), and burn unit (2%) for a variety of indications – Figure 1. Anemia was the most common indication (n = 243; 44.2%), while gastrointestinal bleeding was second (n = 216; 39.3%). Fifty-four percent (n = 297) of FITs were negative. Among FIT-positive subjects, GI consultation was obtained for 46.2% (n = 117) as compared with 13.1% (n = 38) of FIT-negative subjects (OR 5.93, P < 0.0001, 95% CI 3.88-9.04). Of the 117 FIT-positive subjects who had a GI consult, upper endoscopy was more likely to follow than was colonoscopy (n = 60 [51.3%] vs. n = 27 [23.1%]; P < 0.0001). Of those who were FIT positive, patients with overt bleeding were still more likely to receive a GI consult than those without (OR 3.3, 95% CI, 1.9–5.5; P < 0.0001). Among the 29 patients who had colonoscopy, 1 colorectal cancer and 1 advanced adenoma were found. CONCLUSION: In this study, FIT in the ER and inpatient settings was overwhelmingly done for inappropriate indications (547 of 550 [99.5%]). Patients with overt bleeding often got a FIT test which indicates poor understanding of the test utility. FIT results did not appear to impact clinical decision-making as upper endoscopy was more common than colonoscopy for those FIT positive and overt bleeding was a better predictor of GI consultation than FIT result. Measures to reduce inappropriate use in these settings are required.Figure 1.: Location and Indication.

Evaluating the practice of canceling colonoscopies for presumed inadequate bowel preparation

Only scant data describe the practice of canceling colonoscopies before colonoscope insertion for presumed inadequate bowel preparation (PIBP). We sought to better understand the ramifications of such cancellations and to characterize the nationwide practice of cancellations for PIBP. We determined the frequency of colonoscopies canceled for PIBP at our institution, assessing practice variation and whether patients who were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. We also surveyed gastroenterology program directors to determine whether canceling colonoscopies for PIBP is commonly permitted and if such cancellations are included in calculations of bowel preparation adequacy rates. Three percent of patients were canceled because of PIBP at our institution, with significant provider practice variability in cancellation rates. Only 67% of patients whose cases were canceled for PIBP completed colonoscopy or fecal immunohistochemical testing within 6 months. The ability of an endoscopist to cancel a colonoscopy for PIBP was reported by 97% of survey respondents. Such cases are frequently not included in calculations of bowel preparation adequacy rates. The ability to cancel colonoscopies because of PIBP is near ubiquitous, but such cases are not uniformly included in calculations of bowel preparation adequacy rates. Variation in provider practice, and resulting impact on patient care, suggests a need for standardized protocols. Colonoscopies canceled for PIBP should be included in calculations of bowel preparation adequacy rates.

Pharmacist intervention in colorectal cancer screening initiative

ObjectivesTo assess the novel approach of using the community pharmacist as the primary health care team member to facilitate colorectal cancer (CRC) risk counseling and screening in socioeconomically disadvantaged populations. SettingA collaborative effort between the UConn Health Colon Cancer Prevention Program and UConn School of Pharmacy in conjunction with large independent chain pharmacies (medium to medium-high volume) located in metropolitan areas of Connecticut, including Hartford, Bridgeport, New Haven, and Stamford. Pharmacies located in hospitals, across the street from a large physician practice, or within the community. Practice descriptionThe study involved 2 phases. The first phase involved education and training for community pharmacists regarding counseling approaches for patients on the topic of CRC. The second phase of the study involved patient recruitment and counseling with subsequent fecal immunohistochemical testing (FIT). Practice innovationA community pharmacist provided face-to-face counseling on CRC risk factor reduction and provided CRC screening to patients who were without insurance or underinsured. No CRC screening or education program existed beforehand. EvaluationA target sample size of 60 participants was needed with a type 1 error rate of 5% and a power of 80%. Exploration of variables using multivariate logistic regression model included any variable with a univariate P < 0.2. Multivariate P values < 0.05 were considered independent predictors. ResultsAfter approaching 312 consumers, 16 of them consented to the study. The majority of participants (88%) were African American or Latino, and 69% were currently unemployed. Eight participants agreed to complete FIT, and 88% of participants completed FIT correctly. Only 1 positive FIT result was observed, but a subsequent colonoscopy was negative. Of the 12 questions that assessed baseline CRC knowledge in the initial survey, 16 participants answered an average of 2.6 (range, 0–6, SD, 1.6) questions incorrectly. Only 4 participants completed the follow-up survey of CRC knowledge and program satisfaction; thus, exploration of variables was not conducted. Patients indicated high satisfaction with the program of education and FIT dispensing. ConclusionThis study faced difficulty in recruiting pharmacists to participate, with the main reason being lack of compensation and disruption to workflow. Patient participation in the trial was also low because of a lack of time or interest in participation. Of the patients who did participate, the level of satisfaction in having the pharmacist speak to them about CRC screening was high. This service is an excellent example of how the pharmacist can provide a more accessible, convenient, and responsive approach to patients’ needs while improving health equity. Future studies that employ a revenue model to build the infrastructure and capacity necessary to offer this service efficiently and consistently are needed.

Analysis of the effectiveness of two noninvasive fecal tests used to screen for colorectal cancer in average-risk adults

ObjectivesColorectal cancer (CRC) is the second leading cause of cancer-related death in the United States. Although a significant proportion of CRC cases and deaths are preventable by screening, the morbidity and mortality from CRC remains high and is attributed to suboptimal screening rates. Low levels of population CRC screening uptake may be due to reluctance toward invasiveness of some screening tests, embarrassment, exposure to anesthesia, and grueling preparation, especially for the invasive screening tests. Noninvasive tests overcome many of these barriers because they are more convenient and potentially more attractive to patients compared to invasive tests. This study uses Markov cohort simulation model developed with the help of TreeAge pro software to compare two noninvasive fecal CRC screens, fecal immunohistochemical test (FIT) and multitarget stool DNA test (Mt-sDNA) with no screening in order to identify the more effective noninvasive fecal test to screen for colorectal cancer in average-risk adults. Study designSimulation study developed with Markov model using TreeAge pro software, which included a hypothetical cohort at the average risk of developing colorectal cancer. MethodsMarkov model was used to compare population-level CRC-related cases and deaths averted, life-years gained (LYG), and colonoscopies required for two noninvasive CRC screening strategies compared with no screening: annual fecal immunohistochemical testing (FIT) and 3-yearly multitarget stool DNA testing (Mt-sDNA). The model simulated the natural history of the adenoma-carcinoma sequence in average-risk persons starting at age 50 years, and natural history parameters were estimated from the literature and via verification to data on precancerous lesions (i.e. adenomas) and CRC incidence. Screening strategies were then superimposed on the natural history component of the model, allowing for precancerous lesions to be detected and removed, or CRC to be detected and treated at a potentially earlier stage. The sensitivity and specificity for each screen for precancerous lesions and CRC were the performance parameters used to estimate the effectiveness. ResultsAnnual FIT was more effective than three yearly Mt-sDNA in reducing CRC cases, averting CRC-related deaths, and increasing the LYG compared to no screening. On average, annual FIT resulted in 3.5 fewer CRC cases, and 2.9 fewer CRC deaths per 1000 persons screened compared to 3-yearly Mt-sDNA. Annual FIT usage resulted in a 0.18 LYG compared to Mt-sDNA, which allowed 0.16 LYG, and an annual FIT screening led to a total of 203 more colonoscopies performed compared to Mt-sDNA. One-way sensitivity analysis conducted over the sensitivity rates of each screen by type of lesion showed that FIT remained the more effective strategy for all ranges of sensitivity. Threshold analysis results identified the lowest FIT sensitivity value at which Mt-sDNA performed better for conventional high-risk adenomas and CRC detection to be 0.16 and 0.052, respectively. ConclusionBoth the noninvasive screens were effective compared to no screening. Additionally, annual FIT as a first step noninvasive screening test for CRC appears to be more effective compared to three-yearly Mt-sDNA.

Single dose aspirin affects fecal immunohistochemical test sensitivity in detecting advanced colorectal neoplasms: Truth or expectation?

Single dose aspirin affects fecal immunohistochemical test sensitivity in detecting advanced colorectal neoplasms: Truth or expectation?

Patient navigation (PN) for colorectal cancer screening (CRC): Experience in program implementation for underserved neighborhoods of Cleveland, Ohio.

147 Background: Cleveland, Ohio has high rates of colorectal cancer (CRC). 50% of CRC in Cleveland is late stage, and rates of CRC screening in Cleveland are low. Colonoscopy is a screening method for CRC, but barriers exist for the underserved population of Cleveland. The Fecal Immunohistochemical Test (FIT) is a less-costly and non-invasive CRC screening method that has demonstrated increased uptake in CRC screening for underserved populations. Previous literature has demonstrated that Patient Navigation (PN) can increase screening rates in underserved populations through education and assistance to overcome barriers to care. Little, however, has been published about the impact of pairing PN with a program that encourages either colonoscopies or FIT utilization to complete screening. Methods: Community members were educated about both colonoscopies and FIT in a neutral manner. After education, interested participants provided preference for screening type. Participants received follow-up calls from patient navigators. Navigators provided encouragement to complete screening and collected information about barriers. Results: N = 612 patients received PN for CRC. 72% of the population (n = 442) were Black. 47% (n = 290) chose colonoscopy, and n = 322 chose FIT. 44% (n = 263) completed a screening. 19% (n = 55) of those choosing colonoscopy completed screening. 66% (n = 213) choosing FIT completed screening. Women who chose FIT were more likely than men who chose FIT to complete screening (86% vs. 45%, p &lt; 0.001). Barriers to screening included appointment coordination, transportation, and insurance. Conclusions: When offered PN and choice of CRC screening, community members in Cleveland equally chose colonoscopy vs. FIT. Those that chose FIT were more likely to complete screening (p &lt; 0.001). Barriers suggest access and use of healthcare remain challenging for underserved communities. The simplicity of FIT paired with PN may remove barriers for this population and increase screening uptake. More research needs to be done to understand the impact of PN on sustained rate of completion.

Combination of immersion in saline solution, pocket-creation method, water-jet hydrodissection, and hybrid knife "probe mode" simplifies endoscopic submucosal dissection in giant rectal polyp.

Combination of immersion in saline solution, pocket-creation method, water-jet hydrodissection, and hybrid knife "probe mode" simplifies endoscopic submucosal dissection in giant rectal polyp.

Screening for new primary cancers in patients with metastatic breast cancer: a provincial analysis of the Choosing Wisely Canada recommendations.

Patients with metastatic cancer have a decreased life expectancy, and with screening and surveillance for new primary cancers, they run the risk of immediate harm with little chance of any benefit. Choosing Wisely Canada therefore recommends that such investigations be avoided in patients with metastatic disease. We examined cancer screening practices in a subset of patients with metastatic cancer in Newfoundland and Labrador. Patients with metastatic breast cancer seen at the provincial cancer clinic during 2014-2016 were identified from the Newfoundland and Labrador Cancer Registry. For each patient, we assessed whether any one or a combination of screening mammography, Pap (Papanicolaou) test, flexible sigmoidoscopy or colonoscopy, or fecal immunohistochemical test were performed at any point after the diagnosis of metastatic disease. Of 305 patients with metastatic breast cancer, 114 (37.4%) underwent at least 1 screening investigation (mean: 2.92 investigations per screened patient). The most common screening investigations were mammography (n = 197) and Pap test (n = 107). Primary care providers ordered most of the screening investigations (70%); oncology specialists ordered 14%, and other specialists, 12%. Median overall survival for patients with breast cancer after a diagnosis of metastatic disease was 42 months, with a 5-year overall survival of 35.9%. A significant proportion of patients with metastatic breast cancer in Newfoundland and Labrador are still undergoing screening for new primary malignancies, which is discordant with oncology guidelines from Choosing Wisely Canada. Increased education strategies are needed if the Choosing Wisely Canada recommendations are to be implemented into routine clinical practice.

675 – Reducing Inappropriate Fecal Immunohistochemical Test (FIT) Utilization At the Durham Veterans Administration Medical Center (Poster Presentation)

675 – Reducing Inappropriate Fecal Immunohistochemical Test (FIT) Utilization At the Durham Veterans Administration Medical Center (Poster Presentation)

The compliance rate for the second diagnostic evaluation after a positive fecal occult blood test: A systematic review and meta-analysis.

Only a minority of patients with a positive fecal occult blood test (FOBT) undergo a follow-up second diagnostic procedure, thus minimizing its contribution for colorectal cancer (CRC) prevention. We aimed to obtain a precise estimation of this problem and also assess the diagnostic yield of CRC and adenomas by colonoscopy in these patients. Literature searches were conducted for "compliance" OR "adherence" AND "fecal occult blood test" OR "fecal immunohistochemical test" AND "colonoscopy." Comprehensive meta-analysis software was used. The search resulted in 42 studies (512,496 patients with positive FOBT), published through December 31, 2017. A funnel plot demonstrates a moderate publication bias. Compliance with any second procedure, colonoscopy, or combination of double-contrast barium enema with or without sigmoidoscopy in patients with a positive FOBT was 0.725 with 95% confidence interval (CI) 0.649-0.790 (p = 0.000), 0.804 with 95% CI 0.740-0.856 (p = 0.000) and 0.197 with 95% CI 0.096-0.361 (p = 0.000), respectively. The diagnostic yield for CRC, advanced adenoma and simple adenoma was 0.058 with 95% CI 0.050-0.068 (p = 0.000), 0.242 with 95% CI 0.188-0.306 (p = 0.000) and 0.147 with 95% CI 0.116-0.184 (p < 0.001), respectively. Compliance with diagnostic evaluation after a positive FOBT is still suboptimal. Therefore, measures to increase compliance need to be taken given the increased risk of CRC in these patients.

Endoscopic submucosal dissection of a rectal nongranular laterally spreading tumor with the use of a new endoscopicplatform.

Endoscopic submucosal dissection (ESD) is a technically demanding and time-consuming procedure. The main challenges are related to the instability of the operating field and to the lack of traction, owing to the single operating channel.1Pimentel-Nunes P. Dinis-Ribeiro M. Ponchon T. et al.Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.Endoscopy. 2015; 47: 829-854Crossref PubMed Scopus (784) Google Scholar The ORISE Tissue Retractor System ([TRS] Boston Scientific, Marlborough, Mass, USA) is a new endoscopic platform that consists of an expandable and dynamically controlled intraluminal chamber, mounted on a flexible overtube, with 2 specifically designed retractor graspers.2Kantsevoy S.V. Bitner M. Piskun G. New endoscopic platform for endoluminal en bloc tissue resection in the gastrointestinal tract (with videos).Surg Endosc. 2016; 30: 3145-3151Crossref PubMed Scopus (19) Google Scholar, 3Kantsevoy S.V. Bitner M. Liu B.R. et al.A new endoluminal platform for endoscopic removal of difficult colonic lesions: initial clinical experiencehttps://www.sages.org/meetings/annual-meeting/abstracts-archive/a-new-endoluminal-platform-for-endoscopic-removal-of-difficult-colonic-lesions-initial-clinical-experience/Google Scholar The system is front-loaded over the endoscope and inserted into the colon. When the target area is reached, the system is positioned, creating an expanded and stable operating field around the lesion. Endoscopic removal of the lesion is then performed with commonly available endoscopic instruments through the operating channel of the endoscope. The resection is simplified by the use of 2 retractor graspers, which can be moved forward and backward, moved left or right, rotated 360°, and pulled in and out. Retractor graspers are used to lift the lesion to visualize the dissection plane. The video (Video 1, available online at www.VideoGIE.org) shows an ESD of a rectal lesion in which the ORISE TRS was used. A 74-year-old woman with hypertension, type-2 diabetes mellitus, and proliferative diabetic retinopathy underwent colonoscopy after a positive fecal immunohistochemical test result. Colonoscopy identified a rectal nongranular laterally spreading tumor 25 mm in diameter, 4 cm from the dentate line, with a slightly pseudodepressed central area (IIa+IIc) and an adenomatous pit pattern (IIIL/IV according to the Kudo classification) (Fig. 1). The ESD was performed with use of a therapeutic gastroscope from the ELUXEO 700 series (Fujifilm), with CO2 insufflation. After submucosal infiltration with adrenaline diluted in physiologic solution and methylene blue, a circumferential incision of the lesion was made with a Hybrid Knife (ERBE Elektromedizin Gmbh, Tubingen, Germany). Subsequently, the ORISE TRS (Boston Scientific, Marlborough, Mass, USA) was positioned, stabilizing the lumen (Fig. 2). The retractor grasper was then used to lift the lesion, to improve visualization of the dissection plane and facilitate en bloc removal of the lesion (Figs. 3 and 4). Finally, the ORISE TRS was removed, and the resected lesion was recovered for histologic typing (Fig. 5). No intraprocedural or postprocedural adverse events occurred. The histologic examination showed a tubulovillous adenoma, with high-grade dysplasia (Fig. 6).Figure 2Placement of the ORISE Tissue Retractor System.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Use of retractor grasper to lift the lesion, improving visualization of the dissection plane and facilitating en bloc removal.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 4En bloc resection.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 5Resected lesion, 30 × 20 mm in diameter.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 6Histologic view showing a tubulovillous adenoma, with high-grade dysplasia (H&E, orig. mag. ×40).View Large Image Figure ViewerDownload Hi-res image Download (PPT) The use of this endoscopic platform may help stabilize the work environment, allowing for retraction and tissue resection and potentially increasing the efficiency of the ESD. Moreover, with the use of the ORISE TRS, improved visualization of lesions and submucosal dissection plane should reduce the risk of adverse events, such as bleeding and perforation, compared with standard ESD. Prospective studies are needed to evaluate the efficacy and safety of this new device for the treatment of colorectal lesions. All authors disclosed no financial relationships relevant to this publication. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0ODU4MGViNzY5MjRkM2I1NzE4Y2U1ZGE5OTFkOTRlNCIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc3NjYwNDk2fQ.Dyboa8288cwdiypuInkut9hjIKs0Spm2npQzOd8VuT1wQVgNFq9BDfWwOqetNQCcczFXFZy_PuU2W0njnuloX31p-ihGSkF3bevLzhExZ2ZWvvVkZUOGvloKL8_Dc5Fw2kKB_BPjmcnttBQQhBb6aaLLayWncVtwaQz-_8hGTNxl4GUlxjVnImQMuYNeqVXbZRPv5gGdruxqS1jGOpPYZU2fUwl3VHB9LbeWmgFvlf80WadbVidyMYYsXnPYwNMQb3EP3NyHnww0WwBLbSIuhIzziFRG7glChGcRVoi9HjMYyqN1J-9X28spMudnlTyv79GgQmJV1foraRTlv_myKw Download .mp4 (66.64 MB) Help with .mp4 files Video 1ESD of a rectal lesion with the use of the ORISE tissue retractor system.

Routine Molecular Analysis for Lynch Syndrome Among Adenomas or Colorectal Cancer Within a National Screening Program

It is important to identify individuals with Lynch syndrome because surveillance programs can reduce their morbidity and mortality from colorectal cancer (CRC). We assessed the diagnostic yield of immunohistochemistry to detect Lynch syndrome in patients with advanced and multiple adenomas within our national CRC screening program. We performed a prospective study of all participants (n= 1101; 55% male; median age, 66 years; interquartile range, 61-70 years) referred to the Erasmus MC in The Netherlands after a positive result from a fecal immunohistochemical test, from December 2013 to December 2016. Colon tissues were collected from patients with advanced adenomas, ≥4 nonadvanced adenomas, or CRC, and analyzed by immunohistochemistry to identify patients with loss of mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, or PMS2): a marker of Lynch syndrome. Specimens from patients with loss of MLH1 were analyzed for MLH1 promoter hypermethylation. Patients with an MMR-deficient tumor or adenoma without MLH1 promoter hypermethylation were referred for genetic analysis. At colonoscopy, 456 patients (41%) (65% male; mean age, 67 years; interquartile range, 63-71 years) were found to have CRC and/or an adenoma eligible for analysis by immunohistochemistry. Of 56 CRCs, 7 (13%) had lost an MMR protein and 5 had hypermethylation of the MLH1 promoter. Analyses of tumor DNA revealed that 2 patients without MLH1 promoter hypermethylation had developed sporadic tumors. In total, 400 patients with adenomas were analyzed. Of the examined adenomas, 208 (52%) had a villous component and/or high-grade dysplasia: 186 (47%) had a villous component and 41 (10%) had high-grade dysplasia. Only 1 adenoma had lost an MMR protein. This adenoma was found to have 2 somatic mutations in MSH6. In a CRC screening program in The Netherlands for individuals aged 55 to 75 years, routine screening for Lynch syndrome by immunohistochemistry analysis of colon tissues from patients with advanced and multiple adenomas identified no individuals with this genetic disorder.

Optical Endoscopy versus Fecal Immunohistochemical Test in Effectiveness Trials for Colorectal Cancer Detection: A Systematic Review and Meta-Analysis

Optical Endoscopy versus Fecal Immunohistochemical Test in Effectiveness Trials for Colorectal Cancer Detection: A Systematic Review and Meta-Analysis

Issue Highlights

Issue Highlights