Artificial intelligence for the detection of colorectal precancerous lesions in colonoscopy

Inteligencia artificial; Lesiones precancerosas colorrectales; ColonoscopiaIntel·ligència artificial; Lesions precanceroses colorectals; ColonoscòpiaArtificial intelligence; Colorectal precancerous lesions; ColonoscopyEl sistema GI Genius™ es un dispositivo de inteligencia artificial que funciona como apoyo a la detección y caracterización de lesiones precancerosas y ayuda al diagnóstico precoz del cáncer colorrectal vía la utilización de marcadores visuales. Este sistema de apoyo funciona como un complemento para el endoscopista durante la colonoscopia, resaltando las regiones con características visuales compatibles con diferentes tipos de alteraciones de la mucosa, como pólipos colorrectales de todos los tamaños, formas y morfología, así como la caracterización en adenoma o no adenoma

The Galectin family as molecular targets: hopes for defeating pancreatic cancer

Galectins are a family of proteins that bind β-galactose residues through a highly conserved carbohydrate recognition domain. They regulate several important biological functions, including cell proliferation, adhesion, migration, and invasion, and play critical roles during embryonic development and cell differentiation. In adults, different galectin members are expressed depending on the tissue type and can be altered during pathological processes. Numerous reports have shown the involvement of galectins in diseases, mostly inflammation and cancer. Here, we review the state-of-the-art of the role that different galectin family members play in pancreatic cancer. This tumor is predicted to become the second leading cause of cancer-related deaths in the next decade as there is still no effective treatment nor accurate diagnosis for it. We also discuss the possible translation of recent results about galectin expression and functions in pancreatic cancer into clinical interventions (i.e., diagnosis, prediction of prognosis and/or therapy) for this fatal disease

Narrow band imaging and white light endoscopy in the characterization of a polypectomy scar: A single-blind observational study

AIM: To assess the incremental benefit of narrow band imaging (NBI) and white light endoscopy (WLE), randomizing the initial technique for the detection of residual neoplasia at the polypectomy scar after an endoscopic piecemeal mucosal resection (EPMR). METHODS: We conducted an observational study in an academic center to assess the incremental benefit of NBI and WLE randomly applied 1:1 (NBI-WLE or WLE-NBI) in the follow-up of a post-EPMR scar by the same endoscopist. RESULTS: A total of 112 EPMR scars were included. The median baseline polyp size was 20 mm (interquartile range: 14-30). At first review, NBI and WLE showed good sensitivity (85.0% vs 78.9%), specificity (77.1% vs 84.2%) and overall accuracy (80.0% vs 82.5%). NBI after WLE (WLE-NBI group) improved accuracy, but this difference was not statistically significant [area under the curve (AUC): 86.8% vs 81.6%, P = 0.15]. WLE after NBI (NBI-WLE group) did not improve accuracy (AUC: 81.4% vs 81.1%, P = 0.9). Overall, recurrence was found in 39/112 (34.8%) lesions. CONCLUSION: Although no statistically significant differences were found between the two techniques at the first post-EPMR assessment, the use of NBI after WLE may improve residual neoplasia detection. Nevertheless, biopsy is still required in the first scar review

Narrow-band imaging and high-definition white-light endoscopy in patients with serrated lesions not fulfilling criteria for serrated polyposis syndrome: a randomized controlled trial with tandem colonoscopy

Background: It is unknown whether narrow-band imaging (NBI) could be more effective than high-definition white-light endoscopy (HD-WLE) in detecting serrated lesions in patients with prior serrated lesions > 5 mm not completely fulfilling serrated polyposis syndrome (SPS) criteria. Methods: We conducted a randomized, cross-over trial in consecutive patients with prior detection of at least one serrated polyp ≥10 mm or ≥ 3 serrated polyps larger than 5 mm, both proximal to the sigmoid colon. Five experienced endoscopists performed same-day tandem colonoscopies, with the order being randomized 1:1 to NBI-HD-WLE or HD-WLE-NBI. All tandem colonoscopies were performed by the same endoscopist. Results: We included 41 patients. Baseline characteristics were similar in the two cohorts: NBI-HD-WLE (n = 21) and HD-WLE-NBI (n = 20). No differences were observed in the serrated lesion detection rate of NBI versus HD-WLE: 47.4% versus 51.9% (OR 0.84, 95% CI: 0.37-1.91) for the first and second withdrawal, respectively. Equally, no differences were found in the polyp miss rate of NBI versus HD-WLE: 21.3% versus 26.1% (OR 0.77, 95% CI: 0.43-1.38). Follow-up colonoscopy in nine patients (22%) allowed them to be reclassified as having SPS. Conclusions: In patients with previous serrated lesions, the serrated lesion detection rate was similar with NBI and HD-WLE. A shorter surveillance colonoscopy interval increases the detection of missed serrated polyps and could change the diagnosis of SPS in approximately one in every five patients

El tatuaje endoscópico en las neoplasias colorrectales intervenidas vía laparoscópica: una propuesta de marcaje selectivo

RESUMEN Introducción y objetivo: el tatuaje endoscópico preoperatorio es un procedimiento eficaz que permite la localización intraoperatoria de neoplasias de pequeño tamaño. Sin embargo, actualmente no existen unos criterios definidos sobre las indicaciones del tatuaje endoscópico de estas neoplasias en el momento del diagnóstico. El objetivo es establecer unos criterios endoscópicos para seleccionar los pacientes que precisarán un tatuaje. Material y métodos: estudio ambispectivo de pacientes intervenidos de neoplasia colorrectal por laparoscopia en los que se realizó tatuaje endoscópico en el periodo (2007-2013 y 2016-2017). De acuerdo con la descripción endoscópica de las neoplasias se clasificaron en: lesiones polipoideas, neoplasias que ocupan < 50% o ≥ 50% de la luz intestinal y neoplasias estenosantes. Resultados: se realizó tatuaje de la lesión en 120 pacientes y en 114 (95%) se identificó el mismo durante la cirugía. La mayor parte de las neoplasias descritas como polipoideas y neoplasias que ocupaban < 50% de la luz intestinal no se visualizaban en la cirugía y por tanto precisaban el tatuaje (33 de 42 y 18 de 26 respectivamente, p = 0.0001, 2). En cambio, aquellas lesiones estenosantes o bien neoplasias que ocupaban ≥ 50% de la luz intestinal se identificaban mayoritariamente en la cirugía (15 de 15 y 36 de 37 respectivamente, p = 0.0001, 2) sin necesidad de tatuaje. En conjunto la identificación de las neoplasias según los criterios establecidos fue del 98%. Conclusiones: estos resultados sugieren que es posible establecer unos criterios endoscópicos que permitan realizar un tatuaje selectivo durante la endoscopia diagnóstica manteniendo el éxito del mismo

Evaluation of an educational telephone intervention strategy to improve non-screening colonoscopy attendance: a randomized controlled trial

Background: Colonoscopy attendance is a key quality parameter in colorectal cancer population screening programmes. Within these programmes, educative interventions with bidirectional contact carried out by trained personnel have been proved to be an important tool for colonoscopy attendance improvement, and because of its huge clinical and economic impact, they have been widely implemented. However, outside of this population programmes, educative measures to improve colonoscopy attendance have been poorly studied and no navigation interventions are usually performed. Aim: To investigate the clinical and economic impacts of an educational telephone intervention on colonoscopy attendance outside colorectal cancer screening programmes. Methods: This randomized controlled trial included consecutive patients referred to colonoscopy from primary care centres from November 2017 to May 2018. The intervention group (IG) received a telephone intervention, while the control group (CG) did not. Patients assigned to the IG received an educational telephone call 7 d before the colonoscopy appointment. The intervention was carried out by two nurses with deep endoscopic knowledge who were previously trained for a telephone educational intervention for colonoscopy. The impact on patient compliance with preparedness protocols related to bowel cleansing, anti-thrombotic management, and sedation scheduling was also evaluated. A second call was conducted to assess patient satisfaction. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed. Results: A total of 738 and 746 patients were finally included in the IG and CG respectively. Six hundred thirteen (83%) patients were contacted in the IG. The non-attendance rate was lower in the IG, both in the ITT analysis (IG 8.4% vs CG 14.3%, P < 0.001) and in the PP analysis (4.4% vs 14.3%, P < 0.001). In a multivariable analysis, belonging to the control group increased the risk of non-attendance in both, the ITT analysis (OR 1.81, 95%CI: 1.27 to 2.58, P = 0.001) and the PP analysis (OR 3.56, 95%CI: 2.25 to 5.64, P < 0.001). There was also a significant difference in compliance with preparedness protocols [bowel cleansing: IG 61.7% vs CG 52.6% (P = 0.001), antithrombotic management: IG 92.5% vs CG 62.8% (P = 0.001), and sedation scheduling: IG 78.8% vs CG 0% (P ≤ 0.001)]. We observed a net benefit of €55600/year after the intervention. The information given before the procedure was rated as excellent by 26% (CG) and 51% (IG) of patients, P ≤ 0.001. Conclusion: Educational telephone nurse intervention improves attendance, protocol compliance and patient satisfaction in the non-screening colonoscopy setting and has a large economic impact, which supports its imple-mentation and maintenance over time