6 research outputs found
A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program
International audienceIntroduction and study aimsâAccurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool.MethodsâA prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3âââ6 months, a last test (T3âM) was performed, including these same still frames and 20 new ones.ResultsâA total 419 participants followed the teaching program between April 2017 and April 2018.âThe mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3âM, from 51.0â% to 74.0â% and to 66.6â% respectively (Pâ<â0.001). Between pretest and post-test, 343 (86.6â%) trainees improved, and 153 (75.4â%) at T3âM. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1â% to 15.5â% at post-test and to 18.5â% at T3âM (Pâ<â0.001).ConclusionâThe CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp
Bevacizumab et atteinte digestive de la maladie de Rendu Osler (impact clinique, biologique et endoscopique, Ă©tude de 10 cas)
LYON1-BU Santé (693882101) / SudocSudocFranceF
High pressure jet injection of viscous solutions for endoscopic submucosal dissection (ESD): first clinical experience.
Long lasting elevation is a key factor during endoscopic submucosal dissection (ESD) and can be obtained by water jet injection of saline solution or by viscous macromolecular solutions. In a previous animal study, we assessed the Nestis Enki II system to combine jet injection and viscous solutions. In the present work, we used this combination in humans in different sites of the digestive tract
Endoscopic characterization of colorectal neoplasia with different published classifications: comparative study involving CONECCT classification
International audienceBackground and study aimsâThe aim of this study was to validate the COlorectal NEoplasia Classification to Choose the Treatment (CONECCT) classification that groups all published criteria (including covert signs of carcinoma) in a single table.Patients and methodsâFor this multicenter comparative study an expert endoscopist created an image library (nâ=â206 lesions; from hyperplastic to deep invasive cancers) with at least white light Imaging and chromoendoscopy images (virtual ± dye based). Lesions were resected/biopsied to assess histology. Participants characterized lesions using the Paris, Laterally Spreading Tumours, Kudo, Sano, NBI International Colorectal Endoscopic Classification (NICE), Workgroup serrAted polypS and Polyposis (WASP), and CONECCT classifications, and assessed the quality of images on a web-based platform. Krippendorff alpha and Cohenâs Kappa were used to assess interobserver and intra-observer agreement, respectively. Answers were cross-referenced with histology.ResultsâEleven experts, 19 non-experts, and 10 gastroenterology fellows participated. The CONECCT classification had a higher interobserver agreement (Krippendorff alphaâ=â0.738) than for all the other classifications and increased with expertise and with quality of pictures. CONECCT classification had a higher intra-observer agreement than all other existing classifications except WASP (only describing Sessile Serrated Adenoma Polyp). Specificity of CONECCT IIA (89.2, 95â% CI [80.4;94.9]) to diagnose adenomas was higher than the NICE2 category (71.1, 95â% CI [60.1;80.5]). The sensitivity of Kudo Vi, Sano IIIa, NICE 2 and CONECCT IIC to detect adenocarcinoma were statistically different (Pâ<â0.001): the highest sensitivities were for NICE 2 (84.2â%) and CONECCT IIC (78.9â%), and the lowest for Kudo Vi (31.6â%).ConclusionsâThe CONECCT classification currently offers the best interobserver and intra-observer agreement, including between experts and non-experts. CONECCT IIA is the best classification for excluding presence of adenocarcinoma in a colorectal lesion and CONECCT IIC offers the better compromise for diagnosing superficial adenocarcinoma