Post-colonoscopy colorectal cancers in a national FIT-based CRC screening program

Background and study aims: Post-colonoscopy colorectal cancers (PCCRCs) decrease the effect of colorectal cancer (CRC) screening programs. To enable PCCRC incidence reduction on the long-term we classified PCCRCs diagnosed after colonoscopies performed in a fecal immunochemical test (FIT-) based screening program. Patients and methods: PCCRCs diagnosed after colonoscopies performed between 2014-2016 for positive FIT in the Dutch CRC screening program were included. PCCRCs were categorized according to the World Endoscopy Organization consensus statement into a) interval PCCRC (diagnosed before the recommended surveillance), b) non-interval-type-A (diagnosed at the recommended surveillance interval), c) non-interval-type-B (diagnosed after the recommended surveillance interval), or d) non-interval-type-C (diagnosed after the intended recommended surveillance interval, but not applied due to comorbidity). The most probable etiology was determined by root-cause analysis. Tumor stage distributions were compared between categories. Results: 116,362 colonoscopies were performed after positive FIT with 9,978 screen-detected CRCs. During follow-up, 432 PCCRCs were diagnosed. The 3-year PCCRC rate was 2.7%. PCCRCs were categorized as interval (53.5%), non-interval-type-A (14.6%), non-interval-type-B (30.6%), and non-interval-type-C (1.4%). Interval PCCRCs had as most common etiology a possible missed lesion with adequate examination (73.6%) and were more often diagnosed at an advanced stage (stage III/IV, 53.2%) compared to non-interval-type-A (15.9%, p&lt;0.001) and non-interval-type-B (40.9%, p=0.025) PCCRCs. Conclusions: The 3-year PCCRC rate was low in this FIT-based CRC screening program. Approximately half of PCCRCs were interval PCCRCs. These were mostly caused by missed lesions and were diagnosed at more advanced stage. This emphasizes the importance of high-quality colonoscopy with optimal polyp detection.</p

Six Months of Balloon Treatment does Not Predict the Success of Gastric Banding

BACKGROUND: We studied whether weight loss by intragastric balloon would predict the outcome of subsequent gastric banding with regard to weight loss and BMI reduction. METHODS: A prospective cohort of patients with a body mass index (BMI)>40 kg/m(2) received an intragastric balloon for 6 months followed by laparoscopic adjustable gastric banding (LAGB). Successful balloon-induced weight loss was defined as > or =10% weight loss after 6 months. Successful surgical weight loss was defined as an additional 15% weight loss in the following 12 months. Patients were divided in group A, losing > or =10% of their initial weight with 6 months' balloon treatment, and group B, losing <10% of their initial weight. RESULTS: In 40 patients (32 female, 8 male; age 36.6 yr, range 26-54), the mean BMI decreased from 46.5 to 40.5 kg/m(2) (P <0.001) after 6 months of balloon treatment and to 35.2 kg/m(2) (P <0.001) 12 months after LAGB. Group A (25 patients) and group B (15 patients) had a significant difference in BMI decrease, 12.4 vs 9.0 kg/m(2) (P <0.05), after the total study duration of 18 months. However, there was no difference in BMI reduction (4.7 kg/m(2) vs 5.8 kg/m(2)) in the 12 months after LAGB. 6 patients in group A lost > or =10% of their starting weight during 6 months balloon treatment as well as > or =15% 12 months following LAGB. 6 patients in group B lost <10% of their starting weight after 6 months of BIB, but also lost > or =15% 12 months following LAGB. CONCLUSION: Intragastric balloon did not predict the success of subsequent LAG

Bekwaam als leraar: begeleiding startende leraren

Deze app biedt leraren en coaches in het po, vo en mbo een handvat bij de ontwikkeling van hun bekwaamheid als leraar. Het beschrijft bekwaamheden van leraren op verschillende niveau's als handvat voor reflectie en biedt een aantal reeflectieve vragen als startpunt voor een professionele dialoog tussen (startende) leraar en coach of binnen lerarenteams. De app komt voort uit het project Junior Leraar en is uitgebreid met een mbo variant

Post-colonoscopy colorectal cancers in a national FIT-based CRC screening program

Background and study aims: Post-colonoscopy colorectal cancers (PCCRCs) decrease the effect of colorectal cancer (CRC) screening programs. To enable PCCRC incidence reduction on the long-term we classified PCCRCs diagnosed after colonoscopies performed in a fecal immunochemical test (FIT-) based screening program. Patients and methods: PCCRCs diagnosed after colonoscopies performed between 2014-2016 for positive FIT in the Dutch CRC screening program were included. PCCRCs were categorized according to the World Endoscopy Organization consensus statement into a) interval PCCRC (diagnosed before the recommended surveillance), b) non-interval-type-A (diagnosed at the recommended surveillance interval), c) non-interval-type-B (diagnosed after the recommended surveillance interval), or d) non-interval-type-C (diagnosed after the intended recommended surveillance interval, but not applied due to comorbidity). The most probable etiology was determined by root-cause analysis. Tumor stage distributions were compared between categories. Results: 116,362 colonoscopies were performed after positive FIT with 9,978 screen-detected CRCs. During follow-up, 432 PCCRCs were diagnosed. The 3-year PCCRC rate was 2.7%. PCCRCs were categorized as interval (53.5%), non-interval-type-A (14.6%), non-interval-type-B (30.6%), and non-interval-type-C (1.4%). Interval PCCRCs had as most common etiology a possible missed lesion with adequate examination (73.6%) and were more often diagnosed at an advanced stage (stage III/IV, 53.2%) compared to non-interval-type-A (15.9%, p&lt;0.001) and non-interval-type-B (40.9%, p=0.025) PCCRCs. Conclusions: The 3-year PCCRC rate was low in this FIT-based CRC screening program. Approximately half of PCCRCs were interval PCCRCs. These were mostly caused by missed lesions and were diagnosed at more advanced stage. This emphasizes the importance of high-quality colonoscopy with optimal polyp detection.</p

Adenoma Detection Rate and Risk for Interval Postcolonoscopy Colorectal Cancer in Fecal Immunochemical Test-Based Screening: A Population-Based Cohort Study

BACKGROUND: The adenoma detection rate (ADR) is an essential quality indicator for endoscopists performing colonoscopies for colorectal cancer (CRC) screening as it is associated with postcolonoscopy CRCs (PCCRCs). Currently, data on ADRs of endoscopists performing colonoscopies in fecal immunochemical testing (FIT)-based screening, the most common screening method, are scarce. Also, the association between the ADR and PCCRC has not been demonstrated in this setting. OBJECTIVE: To evaluate the association between the ADR and PCCRC risk in colonoscopies done after a positive FIT result. DESIGN: Population-based cohort. SETTING: Dutch, FIT-based, CRC screening program. PARTICIPANTS: Patients undergoing colonoscopy, done by accredited endoscopists, after a positive FIT result. MEASUREMENTS: Quality indicator performance and PCCRC incidence for colonoscopies in FIT-positive screenees were assessed. The PCCRCs were classified as interval, a cancer detected before recommended surveillance, or noninterval. The association between ADR and interval PCCRC was evaluated with a multivariable Cox regression model and PCCRC incidence was determined for different ADRs. RESULTS: 362 endoscopists performed 116 360 colonoscopies with a median ADR of 67%. In total, 209 interval PCCRCs were identified. The ADR was associated with interval PCCRC, with an adjusted hazard ratio of 0.95 (95% CI, 0.92 to 0.97) per 1% increase in ADR. For every 1000 patients undergoing colonoscopy, the expected number of interval PCCRC diagnoses after 5 years was approximately 2 for endoscopists with ADRs of 70%, compared with more than 2.5, almost 3.5, and more than 4.5 for endoscopists with ADRs of 65%, 60%, and 55%, respectively. LIMITATION: The relative short duration of follow-up (median, 52 months) could be considered a limitation. CONCLUSION: The ADR of endoscopists is inversely associated with the risk for interval PCCRC in FIT-positive colonoscopies. Endoscopists performing colonoscopy in FIT-based screening should aim for markedly higher ADRs compared with primary colonoscopy.None