Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

Background & aims: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. Methods: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. Results: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. Conclusions: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC

Delphi Initiative for Early-Onset Colorectal Cancer (DIRECt) International Management Guidelines

BACKGROUND & AIMS: Patients with early-onset colorectal cancer (eoCRC) are managed according to guidelines that are not age-specific. A multidisciplinary international group (DIRECt), composed of 69 experts, was convened to develop the first evidence-based consensus recommendations for eoCRC. METHODS: After reviewing the published literature, a Delphi methodology was used to draft and respond to clinically relevant questions. Each statement underwent 3 rounds of voting and reached a consensus level of agreement of ≥80%. RESULTS: The DIRECt group produced 31 statements in 7 areas of interest: diagnosis, risk factors, genetics, pathology-oncology, endoscopy, therapy, and supportive care. There was strong consensus that all individuals younger than 50 should undergo CRC risk stratification and prompt symptom assessment. All newly diagnosed eoCRC patients should receive germline genetic testing, ideally before surgery. On the basis of current evidence, endoscopic, surgical, and oncologic treatment of eoCRC should not differ from later-onset CRC, except for individuals with pathogenic or likely pathogenic germline variants. The evidence on chemotherapy is not sufficient to recommend changes to established therapeutic protocols. Fertility preservation and sexual health are important to address in eoCRC survivors. The DIRECt group highlighted areas with knowledge gaps that should be prioritized in future research efforts, including age at first screening for the general population, use of fecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for eoCRC patients. CONCLUSIONS: The DIRECt group produced the first consensus recommendations on eoCRC. All statements should be considered together with the accompanying comments and literature reviews. We highlighted areas where research should be prioritized. These guidelines represent a useful tool for clinicians caring for patients with eoCRC.publishedVersionPeer reviewe

Hoe belangrijk is de kwaliteit van coloscopie?

Colonoscopy is the reference standard for the detection of polyps and colorectal cancer (CRC). If during colonoscopy, all colorectal lesions are detected and completely removed, this individual will be long-term protected from CRC. The quality of the colonoscopy procedure is essential for an optimal protective effect. Recently published data of negative colonoscopies within the Polish Colonoscopy Screening Program, with a maximum follow-up of 17.4 years, demonstrated that high-quality colonoscopy was associated with a lower CRC incidence and mortality compared to low-quality colonoscopy. Colonoscopy quality was defined by completeness of colonoscopy, quality of the bowel preparation and number of detected colorectal lesions. These results suggest that the interval after a negative colonoscopy for the next screening might be safely prolonged, preventing unnecessary costs and risks for the patient. The quality of the initial colonoscopy is essential and a high quality will be fundamental for surveillance guidelines in the near future

Plasma lecithin:cholesterol acyltransferase and phospholipid transfer protein activity independently associate with nonalcoholic fatty liver disease

BackgroundNonalcoholic fatty liver disease (NAFLD) is a highly prevalent condition which contributes to atherogenic apolipoprotein B dyslipoproteinemias. Lecithin:cholesterol acyltransferase (LCAT) and phospholipid transfer protein (PLTP) are both synthesized by the liver and are important in lipid metabolism. Here, we interrogated the impact of NAFLD on plasma LCAT and PLTP activities. MethodsPlasma LCAT activity (exogenous substrate assay) and PLTP activity (phospholipid vesicles-HDL assay) were determined in 348 subjects (279 men; 81 subjects with type 2 diabetes (T2DM); 123 with metabolic syndrome (MetS)). A Fatty Liver Index (FLI) 60 was used as a proxy of NAFLD. Insulin resistance was determined by homoeostasis model assessment (HOMA-IR). ResultsA total of 147 participants had an FLI 60 coinciding with T2DM and MetS (P ConclusionNAFLD, as inferred from an FLI60, confers higher plasma LCAT and to a lesser extent PLTP activity, even when taking account of T2DM, MetS, central obesity and insulin resistance

Comprehensive review of publicly available colonoscopic imaging databases for artificial intelligence research: availability, accessibility, and usability

Background and Aims: Publicly available databases containing colonoscopic imaging data are valuable resources for artificial intelligence (AI) research. Currently, little is known regarding the available number and content of these databases. This review aimed to describe the availability, accessibility, and usability of publicly available colonoscopic imaging databases, focusing on polyp detection, polyp characterization, and quality of colonoscopy. Methods: A systematic literature search was performed in MEDLINE and Embase to identify AI studies describing publicly available colonoscopic imaging databases published after 2010. Second, a targeted search using Google's Dataset Search, Google Search, GitHub, and Figshare was done to identify databases directly. Databases were included if they contained data about polyp detection, polyp characterization, or quality of colonoscopy. To assess accessibility of databases, the following categories were defined: open access, open access with barriers, and regulated access. To assess the potential usability of the included databases, essential details of each database were extracted using a checklist derived from the Checklist for Artificial Intelligence in Medical Imaging. Results: We identified 22 databases with open access, 3 databases with open access with barriers, and 15 databases with regulated access. The 22 open access databases contained 19,463 images and 952 videos. Nineteen of these databases focused on polyp detection, localization, and/or segmentation; 6 on polyp characterization, and 3 on quality of colonoscopy. Only half of these databases have been used by other researcher to develop, train, or benchmark their AI system. Although technical details were in general well reported, important details such as polyp and patient demographics and the annotation process were under-reported in almost all databases. Conclusions: This review provides greater insight on public availability of colonoscopic imaging databases for AI research. Incomplete reporting of important details limits the ability of researchers to assess the usability of current databases

High-quality colonoscopy: using Textbook Process as a composite quality measure

Background: High-quality colonoscopy is fundamental to good patient outcomes. Textbook Outcome has proven to be a feasible multidimensional measure for quality assurance between surgical centers. In this study, we sought to establish Textbook Process (TP) as a new composite measure for the optimal colonoscopy process and assessed how frequently TP was attained in clinical practice and the variation in TP between endoscopists. Methods: To reach consensus on the definition of TP, international expert endoscopists completed a modified Delphi consensus process. Then, the achievement of TP was applied to clinical practice. Prospectively collected data in two endoscopy services were retrospectively evaluated. Data on colonoscopies performed for symptoms or surveillance between 01-01-2018 and 31-07-2021 were analyzed. Results: The Delphi consensus process was completed by 20 of 27 invited experts (74.1%). TP was defined as a colonoscopy fulfilling the following items: explicit colonoscopy indication, successful cecal intubation, adequate bowel preparation, adequate withdrawal time, acceptable patient comfort score, provision of post-polypectomy surveillance recommendations in line with guidelines, and the absence of the use of reversal agents, early adverse events, readmissions and mortality. In the two endoscopy services studied, TP was achieved in 5.962 of 8.227 (72.5%) colonoscopies. Of 48 endoscopists performing colonoscopy, attainment of TP varied significantly, ranging from 41.0% to 89.1% per endoscopist. Conclusion: This study proposes a new composite measure for colonoscopy: Textbook Process. TP gives a comprehensive summary of performance and demonstrates significant variation between endoscopists, illustrating the potential benefit of TP as measure in future quality assessment programs

High prevalence of apolipoprotein B dyslipoproteinemias in non-alcoholic fatty liver disease:The lifelines cohort study

Objective. Cardiovascular disease (CVD) is a major adverse consequence of non-alcoholic fatty liver disease (NAFLD). The association of NAFLD with various apolipoprotein B (apoB) dyslipoproteinemias is unclear. We determined the prevalence of specific apoB dyslipoproteinemias in subjects with suspected NAFLD. Methods. This study was conducted among 22,865 fasting adults living in the northern part of the Netherlands (Lifelines Cohort Study). Six apoB dyslipoproteinemias were defined using an algorithm derived from apoB, total cholesterol and triglycerides. NAFLD was defined as Fatty Liver Index (FLI) >= 60. Advanced hepatic fibrosis was defined as NAFLD fibrosis score (NFS) >= 0.676. Results. 4790 participants (20.9%) had an FLI >= 60. NAFLD subjects were older, more likely to be men, more obese and more often had diabetes and metabolic syndrome (P <0.001 for each). Among NAFLD subjects, any apoB dyslipoproteinemia was present in 61.5% vs. 16.5% in subjects without NAFLD (P <0.001). Elevated chylomicrons were not observed in NAFLD. In univariate analysis, NAFLD was associated with a higher prevalence of each apoB dyslipoproteinemia vs. subjects with an FLI <60 (P <0.001), except for low density lipoprotein (LDL) dyslipoproteinemia. Additionally, each apoB dyslipoproteinemia was independently associated with NAFLD in age- and sex-adjusted logistic regression analysis, including the apoB dyslipoproteinemias together (P <0.001). The prevalence of apoB dyslipoproteinemias was not altered in subjects with NFS >= 0.676. Conclusions. NAFLD rather than advanced hepatic fibrosis is independently associated with increased prevalence of chylomicrons + very low-density lipoproteins (VLDL) remnants, VLDL, LDL and VLDL + LDL dyslipoproteinemias. ApoB dyslipoproteinemias may contribute to increased CVD risk associated with NAFLD. (C) 2017 Elsevier Inc. All rights reserved