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Evelien Dekker - One of the best experts on this subject based on the ideXlab platform.

  • Automatic optical diagnosis of small colorectal lesions by laser-induced autofluorescence.
    Endoscopy, 2014
    Co-Authors: Teaco Kuiper, Paul Fockens, Yasser A. Alderlieste, Kristien M. A. J. Tytgat, Marije S. Vlug, Joyce A. Nabuurs, Barbara A. J. Bastiaansen, Mark Löwenberg, Evelien Dekker
    Abstract:

    Background and study aims: Endoscopic optical diagnosis can potentially replace histopathological evaluation of small colorectal lesions. The aim of this study was to evaluate diagnostic performance of WavSTAT, a novel system for automatic optical diagnosis based on laser-induced autofluorescence spectroscopy. Patients and methods: Consecutive patients who were scheduled for colonoscopy were included in the study. Each detected lesion with a size of ≤ 9 mm was differentiated using High Resolution Endoscopy (HRE) by the endoscopist, who then reported this as a low or High confidence call. Thereafter, all lesions were analyzed using WavSTAT. Histopathology was used as the reference standard. The primary outcome measures were the accuracy of WavSTAT to differentiate between adenomatous and nonadenomatous lesions, and the accuracy of an algorithm combining HRE (lesions differentiated with High confidence) and WavSTAT (all remaining lesions). The secondary outcome measure was the accuracy of on-site recommended surveillance intervals. Results: At total of 87 patients with 207 small colorectal lesions were evaluated. Accuracy and negative predictive value of WavSTAT were 74.4 % and 73.5 %, respectively. The corresponding figures for the algorithm were 79.2 % and 73.9 %, respectively. Accuracy of on-site recommended surveillance interval was 73.7 % for WavSTAT alone and 77.2 % for the algorithm of HRE and WavSTAT. Conclusions: Both accuracy of WavSTAT alone and the algorithm combining HRE with WavSTAT proved to be insufficient for the in vivo differentiation of small colorectal lesions, and do not fulfill American Society for Gastrointestinal Endoscopy performance thresholds for assessment of diminutive lesions. Future studies should assess whether combining WavSTAT with more advanced imaging techniques could result in a Higher accuracy. Netherlands Trial Registry (NTR 3235).

  • The role of High-Resolution Endoscopy and narrow-band imaging in the evaluation of upper GI neoplasia in familial adenomatous polyposis
    Gastrointestinal endoscopy, 2013
    Co-Authors: María López-cerón, Paul Fockens, Karam S. Boparai, Frank J.c. Van Den Broek, Susanne Van Eeden, Elisabeth M. H. Mathus-vliegen, Evelien Dekker
    Abstract:

    Background The Spigelman classification stratifies cancer risk in familial adenomatous polyposis (FAP) patients with duodenal adenomatosis. High-Resolution Endoscopy (HRE) and narrow-band imaging (NBI) may identify lesions at High risk. Objective To compare HRE and NBI for the detection of duodenal and gastric polyps and to characterize duodenal adenomas harboring advanced histology with HRE and NBI. Design Prospective, nonrandomized, comparative study. Retrospective image evaluation study. Setting Tertiary-care center. Patients Thirty-seven FAP patients undergoing surveillance upper endoscopies. Intervention HRE Endoscopy was followed by NBI. The number of gastric polyps and Spigelman staging were compared. Duodenal polyp images were systematically reviewed in a learning and validation phase. Main Outcome Measurements Number of gastric and duodenal polyps detected by HRE and NBI and prevalence of specific endoscopic features in duodenal adenomas with advanced histology. Results NBI did not identify additional gastric polyps but detected more duodenal adenomas in 16 examinations, resulting in upgrades of the Spigelman stage in 2 cases (4.4%). Pictures of 168 duodenal adenomas (44% advanced histology) were assessed. In the learning phase, 3 endoscopic features were associated with advanced histology: white color, enlarged villi, and size ≥1 cm. Only size ≥1 cm was confirmed in the validation phase (odds ratio 3.0; 95% confidence interval, 1.2-7.4). Limitations Nonrandomized study, scant number of High-grade dysplasia adenomas. Conclusion Inspection with NBI did not lead to a clinically relevant upgrade in the Spigelman classification and did not improve the detection of gastric polyps in comparison with HRE. The only endoscopic feature that predicted advanced histology of a duodenal adenoma was size ≥1 cm.

  • Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2012
    Co-Authors: Teaco Kuiper, Paul Fockens, Ellert J. Van Soest, Jeroen M. Jansen, Willem A. Marsman, Yentl C. Haan, Guido J. Bakker, Evelien Dekker
    Abstract:

    Background & Aims When small colorectal lesions are accurately characterized, adenomas can be removed and discarded without formal histopathology analysis. Previous studies in an academic setting showed that many lesions can be managed accurately on the basis of their endoscopic image (optical diagnosis). We performed a prospective study to assess the accuracy of optical diagnosis of small colorectal polyps in a nonacademic setting (the DISCOUNT trial) by using High-Resolution Endoscopy (HRE) and narrow-band imaging (NBI). Methods During colonoscopy, 1 of 3 nonacademic endoscopists characterized small lesions and declared whether this was done with low or High confidence. In cases of High confidence, the endoscopists decided whether lesions should be removed and discarded or whether they could be left in situ. A surveillance interval was then recommended on-site. Results Of 215 patients in the study, 108 were found to have 281 small lesions. Of these lesions, 231 were characterized with High confidence by using HRE or NBI; the level of corresponding sensitivity was 77.0% (95% confidence interval, 68.4–83.8), and specificity was 78.8% (95% confidence interval, 70.6–85.2). Of these lesions, 164 were assigned for removal, and 67 were assigned to remain in situ, including 9 adenomas. In 54 patients, a surveillance interval could be recommended on-site that was in line with Dutch guidelines for 44 patients. Conclusions Even though many lesions were characterized by HRE or NBI with High confidence, optical diagnosis in a nonacademic setting proved to be disappointing, with a sensitivity of 77.0% and a specificity of 78.8%. Many lesions were accurately assigned to be removed or remain in situ, although few adenomas were assigned to remain in situ. Also, 19% of on-site recommendations for a surveillance interval proved to be inaccurate.

  • Increased polyp detection using narrow band imaging compared with High Resolution Endoscopy in patients with hyperplastic polyposis syndrome.
    Endoscopy, 2011
    Co-Authors: Karam S. Boparai, F. J. C. Van Den Broek, S. Van Eeden, P. Fockens, Evelien Dekker
    Abstract:

    BACKGROUND AND STUDY AIMS: Hyperplastic polyposis syndrome (HPS) is associated with colorectal cancer and is characterized by multiple hyperplastic polyps, sessile serrated adenomas (SSAs) and adenomas. Narrow band imaging (NBI) may improve the detection of polyps in HPS. We aimed to compare polyp miss rates with NBI with those of High Resolution Endoscopy (HRE). PATIENTS AND METHODS: In a single center, randomized crossover study consecutive HPS patients underwent tandem colonoscopy with HRE and NBI, in randomized order with removal of all detected polyps. RESULTS: In 22 patients with HPS, 209 polyps were detected, including 27 with normal histology, 116 hyperplastic polyps, 42 SSAs, and 24 adenomas. Among patients assigned to HRE first (n = 11) a total of 78 polyps was detected; subsequent NBI added 44 polyps. In patients examined with NBI first, 78 polyps were detected and subsequent HRE added 9. Polyp miss rates of HRE and NBI were 36 % and 10 % (OR 0.21; 0.09 – 0.45). Flat polyp shape was independently associated with increased miss rate. CONCLUSION: NBI significantly reduces polyp miss rates in HPS patients. We recommend using either NBI or chromoEndoscopy for colonoscopic surveillance of HPS patients with removal of all detected polyps.

  • High Resolution Endoscopy and the additional value of chromoEndoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis
    Endoscopy, 2009
    Co-Authors: Evelien Dekker, Paul Fockens, Karam S. Boparai, Janwerner Poley, E M H Mathusvliegen, G J Offerhaus, E J Kuipers, Jan Dees
    Abstract:

    BACKGROUND AND STUDY AIM: Duodenal polyposis occurs in approximately 90 % of patients with familial adenomatous polyposis (FAP) and 5 % - 10 % develop duodenal cancer. Novel imaging techniques may improve evaluation of duodenal polyposis using the Spigelman classification. We aimed to analyze the value of High Resolution Endoscopy (HRE) and the additional value of chromoEndoscopy in the evaluation of duodenal polyposis in FAP. PATIENTS AND METHODS: 43 FAP patients scheduled for surveillance Endoscopy in two academic centers underwent gastroduodenoscopy with HRE forward- and side-viewing devices. After number and size of adenomas had been scored, indigo carmine 0.5 % was sprayed onto the mucosa, polyps were scored again and biopsies taken from the larger lesions. Subsequently, Spigelman classifications were assessed for pre- and post-staining. RESULTS: Before staining, a median of 16 adenomas per patient were detected compared with 21 adenomas after staining ( P = 0.02). Staining led to upgrading of Spigelman stage in 5/43 patients (12 %). Using the side-viewing endoscope, ampullary enlargement was detected in 22 patients (51 %) of whom 18 (42 %) had histologically confirmed ampullary adenomas. CONCLUSION: HRE has raised the quality of endoscopic imaging considerably. Consequently, re-evaluation of the original Spigelman classification system seems advisable. ChromoEndoscopy further increases detection of duodenal adenomas in FAP but without considerable change in Spigelman stage. Ampullary adenomas are commonly found in FAP and are best visualized using a side-viewing endoscope. Therefore, a combination of forward-viewing HRE and chromoEndoscopy with side-viewing Endoscopy for the periampullary region seems useful for surveillance of duodenal adenomatosis in FAP.

Oliver Pech - One of the best experts on this subject based on the ideXlab platform.

  • consensus statements for management of barrett s dysplasia and early stage esophageal adenocarcinoma based on a delphi process
    Gastroenterology, 2012
    Co-Authors: Cathy Bennett, Michael Vieth, Jacques J. Bergman, Oliver Pech, Nimish Vakil, Rebecca Harrison, Robert D Odze, Scott Sanders, Gaius Longcroftwheaton, Yvonne Romero
    Abstract:

    Background & Aims Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, High-grade dysplasia (HGD), or early-stage EA. Methods We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. Results Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) High-Resolution Endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. Conclusions We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.

  • How is early Barrett's cancer currently diagnosed and treated in Western Europe? Results of a survey at 52 university hospitals in eight Western European countries.
    Zeitschrift Fur Gastroenterologie, 2012
    Co-Authors: D Heuberger, Christian Ell, H Manner, Oliver Pech
    Abstract:

    Background and study aims: Endoscopic treatment is increasingly being accepted for early Barrett’s cancer (EBC), as it is associated with few complications, excellent long-term results, and almost no mortality. This study investigated current standards and treatment strategies for EBC in eight countries in Western Europe. Methods: A standardized questionnaire with questions on the endoscopic diagnosis, staging, and treatment of EBC was developed and sent to 107 university gastroenterology departments. The data were analyzed anonymously. Results: The response rate was 49 % (52/107). For work-up of early Barrett’s neoplasia, 67 % of hospitals use High-Resolution endoscopes, with routine four-quadrant and targeted biopsies of visible lesions in 94 % of the cases. Narrow-band imaging and chromoEndoscopy are used in 67 % of the cases, and other advanced imaging and staining techniques in 65 %. Before treatment, 63 % of the respondents recommended conventional endosonography, 6 % miniprobe endosonography, and 19 % both. Endoscopic resection is carried out at 98 % of the hospitals. Argon plasma coagulation is used for ablation in 52 % of the cases and radiofrequency ablation in 27 %. An 80-year-old patient with localized mucosal EBC would be treated endoscopically in all of the hospitals. Endoscopic therapy was recommended for 50-year-old patients with mucosal EBC by 87 % of the hospitals; esophageal resection was recommended for multifocal EBC by 15 % in 80-year-old patients, by 63 % in 50-year-old patients and by 44 % in patients with incipient submucosal infiltration. Conclusions: About two-thirds of the university hospitals use High-Resolution Endoscopy and advanced imaging. Endoscopic therapy is the accepted standard for treating localized mucosal Barrett’s cancer in Western Europe; esophageal resection is recommended by the majority (63 %) for a young patient with multifocal EBC.

  • Computed virtual chromoEndoscopy: a new tool for enhancing tissue surface structures.
    Endoscopy, 2007
    Co-Authors: Jürgen Pohl, Andrea May, T. Rabenstein, Oliver Pech, Ch. Ell
    Abstract:

    We conducted a study of a newly developed "computed virtual chromoEndoscopy" (CVC) system that enhances the contrast of the mucosal surface without the use of dyes. The CVC imaging technique is based on narrowing the bandwidth of the conventional endoscopic image arithmetically, using spectral estimation technology. Preliminary clinical tests comparing CVC-enhanced visualization of neoplastic and non-neoplastic lesions with images obtained by conventional Endoscopy show that CVC enhances the vascular network as well as the pit pattern. CVC might therefore complement High-Resolution Endoscopy by facilitating the assessment of the nature and extent of gastrointestinal mucosal lesions.

  • Inter- and Intraobserver Variability in High Resolution ChromoEndoscopy with Acetic Acid for the Detection of Intestinal Metaplasia and Early Neoplasia in Barrett's Esophagus
    Gastrointestinal Endoscopy, 2005
    Co-Authors: Liebwin Gossner, Andrea May, Oliver Pech, Thomas Rabenstein, Hendrik Manner, Angelika Behrens, Christian Ell
    Abstract:

    Interand Intraobserver Variability in High Resolution ChromoEndoscopy with Acetic Acid for the Detection of Intestinal Metaplasia and Early Neoplasia in Barrett’s Esophagus Liebwin Gossner, Oliver Pech, Andrea May, Thomas Rabenstein, Hendrik Manner, Angelika Behrens, Christian Ell Specialized intestinal metaplasia (SIM) in Barrett’s esophagus (BE) embodies the risk of malignant transformation. Optically guided, ‘‘smart’’ biopsies using chromoEndoscopy with acetic acid (AA) are a fascinating option in surveillance procedures for BE. Methods: Consecutive patients with GERD, suspicious of SIM or early neoplasia in BE referred to our center were enclosed in this prospective study. They were studied using Fujinon High Resolution endoscopes (EG HR485ZW5, EG HR490ZW5). The distal esophagus was sprayed with a solution of 1.5% acetic acid. Esophageal columnar mucosal patterns were characterized after AA spraying: Dotted round pits representing cardiac mucosa (pattern I), villous and ridged surface pattern (pattern II) for SIM and an irregular, distorted mucosal pattern (pattern III) representing neoplasia in SIM. The observed surface patterns were digitally stored on PC. All digitally stored images were reassessed by 6 blinded endoscopists. Intraand interobserver variations of the investigators were evaluated by using kappa statistics. Results: 394 endoscopic pictures of 96 patients were studied. SIM could be predicted with a sensitivity of 92%, High-grade intraepithelial neoplasia (HGIN) or early mucosal cancer in 89% respectively. The mean kappa for interobserver agreement was 0.959, whereas intraobserver agreement showed a mean kappa of 1.0. Conclusions: High Resolution Endoscopy with acetic acid is an accurate method for visually predicting SIM and early neoplasia in BE with very low interand intraobserver variability. Abstracts

Paul Fockens - One of the best experts on this subject based on the ideXlab platform.

  • Automatic optical diagnosis of small colorectal lesions by laser-induced autofluorescence.
    Endoscopy, 2014
    Co-Authors: Teaco Kuiper, Paul Fockens, Yasser A. Alderlieste, Kristien M. A. J. Tytgat, Marije S. Vlug, Joyce A. Nabuurs, Barbara A. J. Bastiaansen, Mark Löwenberg, Evelien Dekker
    Abstract:

    Background and study aims: Endoscopic optical diagnosis can potentially replace histopathological evaluation of small colorectal lesions. The aim of this study was to evaluate diagnostic performance of WavSTAT, a novel system for automatic optical diagnosis based on laser-induced autofluorescence spectroscopy. Patients and methods: Consecutive patients who were scheduled for colonoscopy were included in the study. Each detected lesion with a size of ≤ 9 mm was differentiated using High Resolution Endoscopy (HRE) by the endoscopist, who then reported this as a low or High confidence call. Thereafter, all lesions were analyzed using WavSTAT. Histopathology was used as the reference standard. The primary outcome measures were the accuracy of WavSTAT to differentiate between adenomatous and nonadenomatous lesions, and the accuracy of an algorithm combining HRE (lesions differentiated with High confidence) and WavSTAT (all remaining lesions). The secondary outcome measure was the accuracy of on-site recommended surveillance intervals. Results: At total of 87 patients with 207 small colorectal lesions were evaluated. Accuracy and negative predictive value of WavSTAT were 74.4 % and 73.5 %, respectively. The corresponding figures for the algorithm were 79.2 % and 73.9 %, respectively. Accuracy of on-site recommended surveillance interval was 73.7 % for WavSTAT alone and 77.2 % for the algorithm of HRE and WavSTAT. Conclusions: Both accuracy of WavSTAT alone and the algorithm combining HRE with WavSTAT proved to be insufficient for the in vivo differentiation of small colorectal lesions, and do not fulfill American Society for Gastrointestinal Endoscopy performance thresholds for assessment of diminutive lesions. Future studies should assess whether combining WavSTAT with more advanced imaging techniques could result in a Higher accuracy. Netherlands Trial Registry (NTR 3235).

  • The role of High-Resolution Endoscopy and narrow-band imaging in the evaluation of upper GI neoplasia in familial adenomatous polyposis
    Gastrointestinal endoscopy, 2013
    Co-Authors: María López-cerón, Paul Fockens, Karam S. Boparai, Frank J.c. Van Den Broek, Susanne Van Eeden, Elisabeth M. H. Mathus-vliegen, Evelien Dekker
    Abstract:

    Background The Spigelman classification stratifies cancer risk in familial adenomatous polyposis (FAP) patients with duodenal adenomatosis. High-Resolution Endoscopy (HRE) and narrow-band imaging (NBI) may identify lesions at High risk. Objective To compare HRE and NBI for the detection of duodenal and gastric polyps and to characterize duodenal adenomas harboring advanced histology with HRE and NBI. Design Prospective, nonrandomized, comparative study. Retrospective image evaluation study. Setting Tertiary-care center. Patients Thirty-seven FAP patients undergoing surveillance upper endoscopies. Intervention HRE Endoscopy was followed by NBI. The number of gastric polyps and Spigelman staging were compared. Duodenal polyp images were systematically reviewed in a learning and validation phase. Main Outcome Measurements Number of gastric and duodenal polyps detected by HRE and NBI and prevalence of specific endoscopic features in duodenal adenomas with advanced histology. Results NBI did not identify additional gastric polyps but detected more duodenal adenomas in 16 examinations, resulting in upgrades of the Spigelman stage in 2 cases (4.4%). Pictures of 168 duodenal adenomas (44% advanced histology) were assessed. In the learning phase, 3 endoscopic features were associated with advanced histology: white color, enlarged villi, and size ≥1 cm. Only size ≥1 cm was confirmed in the validation phase (odds ratio 3.0; 95% confidence interval, 1.2-7.4). Limitations Nonrandomized study, scant number of High-grade dysplasia adenomas. Conclusion Inspection with NBI did not lead to a clinically relevant upgrade in the Spigelman classification and did not improve the detection of gastric polyps in comparison with HRE. The only endoscopic feature that predicted advanced histology of a duodenal adenoma was size ≥1 cm.

  • Accuracy for optical diagnosis of small colorectal polyps in nonacademic settings.
    Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2012
    Co-Authors: Teaco Kuiper, Paul Fockens, Ellert J. Van Soest, Jeroen M. Jansen, Willem A. Marsman, Yentl C. Haan, Guido J. Bakker, Evelien Dekker
    Abstract:

    Background & Aims When small colorectal lesions are accurately characterized, adenomas can be removed and discarded without formal histopathology analysis. Previous studies in an academic setting showed that many lesions can be managed accurately on the basis of their endoscopic image (optical diagnosis). We performed a prospective study to assess the accuracy of optical diagnosis of small colorectal polyps in a nonacademic setting (the DISCOUNT trial) by using High-Resolution Endoscopy (HRE) and narrow-band imaging (NBI). Methods During colonoscopy, 1 of 3 nonacademic endoscopists characterized small lesions and declared whether this was done with low or High confidence. In cases of High confidence, the endoscopists decided whether lesions should be removed and discarded or whether they could be left in situ. A surveillance interval was then recommended on-site. Results Of 215 patients in the study, 108 were found to have 281 small lesions. Of these lesions, 231 were characterized with High confidence by using HRE or NBI; the level of corresponding sensitivity was 77.0% (95% confidence interval, 68.4–83.8), and specificity was 78.8% (95% confidence interval, 70.6–85.2). Of these lesions, 164 were assigned for removal, and 67 were assigned to remain in situ, including 9 adenomas. In 54 patients, a surveillance interval could be recommended on-site that was in line with Dutch guidelines for 44 patients. Conclusions Even though many lesions were characterized by HRE or NBI with High confidence, optical diagnosis in a nonacademic setting proved to be disappointing, with a sensitivity of 77.0% and a specificity of 78.8%. Many lesions were accurately assigned to be removed or remain in situ, although few adenomas were assigned to remain in situ. Also, 19% of on-site recommendations for a surveillance interval proved to be inaccurate.

  • High Resolution Endoscopy and the additional value of chromoEndoscopy in the evaluation of duodenal adenomatosis in patients with familial adenomatous polyposis
    Endoscopy, 2009
    Co-Authors: Evelien Dekker, Paul Fockens, Karam S. Boparai, Janwerner Poley, E M H Mathusvliegen, G J Offerhaus, E J Kuipers, Jan Dees
    Abstract:

    BACKGROUND AND STUDY AIM: Duodenal polyposis occurs in approximately 90 % of patients with familial adenomatous polyposis (FAP) and 5 % - 10 % develop duodenal cancer. Novel imaging techniques may improve evaluation of duodenal polyposis using the Spigelman classification. We aimed to analyze the value of High Resolution Endoscopy (HRE) and the additional value of chromoEndoscopy in the evaluation of duodenal polyposis in FAP. PATIENTS AND METHODS: 43 FAP patients scheduled for surveillance Endoscopy in two academic centers underwent gastroduodenoscopy with HRE forward- and side-viewing devices. After number and size of adenomas had been scored, indigo carmine 0.5 % was sprayed onto the mucosa, polyps were scored again and biopsies taken from the larger lesions. Subsequently, Spigelman classifications were assessed for pre- and post-staining. RESULTS: Before staining, a median of 16 adenomas per patient were detected compared with 21 adenomas after staining ( P = 0.02). Staining led to upgrading of Spigelman stage in 5/43 patients (12 %). Using the side-viewing endoscope, ampullary enlargement was detected in 22 patients (51 %) of whom 18 (42 %) had histologically confirmed ampullary adenomas. CONCLUSION: HRE has raised the quality of endoscopic imaging considerably. Consequently, re-evaluation of the original Spigelman classification system seems advisable. ChromoEndoscopy further increases detection of duodenal adenomas in FAP but without considerable change in Spigelman stage. Ampullary adenomas are commonly found in FAP and are best visualized using a side-viewing endoscope. Therefore, a combination of forward-viewing HRE and chromoEndoscopy with side-viewing Endoscopy for the periampullary region seems useful for surveillance of duodenal adenomatosis in FAP.

  • Hyperplastic polyposis syndrome: a pilot study for the differentiation of polyps by using High-Resolution Endoscopy, autofluorescence imaging, and narrow-band imaging
    Gastrointestinal endoscopy, 2009
    Co-Authors: Karam S. Boparai, Paul Fockens, Frank J.c. Van Den Broek, Susanne Van Eeden, Evelien Dekker
    Abstract:

    Background Endoscopic differentiation and removal of potentially premalignant sessile serrated adenomas (SSAs) may be important steps in preventing the development of colorectal cancer in hyperplastic polyposis syndrome (HPS). Objective To assess the value of High-Resolution Endoscopy, autofluorescence imaging (AFI), and narrow-band imaging (NBI) for differentiating polyps in HPS. Design A prospective polyp series. Setting Single tertiary referral center. Patients and Interventions Seven patients with HPS underwent colonoscopy with endoscopic trimodal imaging, which incorporates High-Resolution Endoscopy, AFI, and NBI in 1 system. All detected polyps were analyzed with AFI for color and with NBI for Kudo pit pattern and vascular pattern intensity. Main Outcome Measurements The accuracy, sensitivity, and specificity of AFI and NBI in differentiating detected polyps were determined by using histology as the criterion standard. Results A total of 19 hyperplastic polyps (HPs), 32 SSAs, and 15 adenomas were detected. For differentiating SSAs from HPs, AFI color, Kudo pit pattern, and vascular pattern intensity resulted in a diagnostic accuracy of 55%, 55%, and 52%, respectively. For differentiating adenomas from HPs, the accuracy was 65%, 94%, and 90%, respectively. Macroscopically, the combination of a size of 3 mm or larger and a proximal location resulted in the Highest accuracy (76%) for differentiating SSAs from HPs. Limitation Small sample size. Conclusion Endoscopic differentiation between HPs and SSAs by using endoscopic trimodal imaging proved unsatisfactory. Differentiation of adenomas from HPs was possible with NBI but not with AFI.

Christian Ell - One of the best experts on this subject based on the ideXlab platform.

  • How is early Barrett's cancer currently diagnosed and treated in Western Europe? Results of a survey at 52 university hospitals in eight Western European countries.
    Zeitschrift Fur Gastroenterologie, 2012
    Co-Authors: D Heuberger, Christian Ell, H Manner, Oliver Pech
    Abstract:

    Background and study aims: Endoscopic treatment is increasingly being accepted for early Barrett’s cancer (EBC), as it is associated with few complications, excellent long-term results, and almost no mortality. This study investigated current standards and treatment strategies for EBC in eight countries in Western Europe. Methods: A standardized questionnaire with questions on the endoscopic diagnosis, staging, and treatment of EBC was developed and sent to 107 university gastroenterology departments. The data were analyzed anonymously. Results: The response rate was 49 % (52/107). For work-up of early Barrett’s neoplasia, 67 % of hospitals use High-Resolution endoscopes, with routine four-quadrant and targeted biopsies of visible lesions in 94 % of the cases. Narrow-band imaging and chromoEndoscopy are used in 67 % of the cases, and other advanced imaging and staining techniques in 65 %. Before treatment, 63 % of the respondents recommended conventional endosonography, 6 % miniprobe endosonography, and 19 % both. Endoscopic resection is carried out at 98 % of the hospitals. Argon plasma coagulation is used for ablation in 52 % of the cases and radiofrequency ablation in 27 %. An 80-year-old patient with localized mucosal EBC would be treated endoscopically in all of the hospitals. Endoscopic therapy was recommended for 50-year-old patients with mucosal EBC by 87 % of the hospitals; esophageal resection was recommended for multifocal EBC by 15 % in 80-year-old patients, by 63 % in 50-year-old patients and by 44 % in patients with incipient submucosal infiltration. Conclusions: About two-thirds of the university hospitals use High-Resolution Endoscopy and advanced imaging. Endoscopic therapy is the accepted standard for treating localized mucosal Barrett’s cancer in Western Europe; esophageal resection is recommended by the majority (63 %) for a young patient with multifocal EBC.

  • Inter- and Intraobserver Variability in High Resolution ChromoEndoscopy with Acetic Acid for the Detection of Intestinal Metaplasia and Early Neoplasia in Barrett's Esophagus
    Gastrointestinal Endoscopy, 2005
    Co-Authors: Liebwin Gossner, Andrea May, Oliver Pech, Thomas Rabenstein, Hendrik Manner, Angelika Behrens, Christian Ell
    Abstract:

    Interand Intraobserver Variability in High Resolution ChromoEndoscopy with Acetic Acid for the Detection of Intestinal Metaplasia and Early Neoplasia in Barrett’s Esophagus Liebwin Gossner, Oliver Pech, Andrea May, Thomas Rabenstein, Hendrik Manner, Angelika Behrens, Christian Ell Specialized intestinal metaplasia (SIM) in Barrett’s esophagus (BE) embodies the risk of malignant transformation. Optically guided, ‘‘smart’’ biopsies using chromoEndoscopy with acetic acid (AA) are a fascinating option in surveillance procedures for BE. Methods: Consecutive patients with GERD, suspicious of SIM or early neoplasia in BE referred to our center were enclosed in this prospective study. They were studied using Fujinon High Resolution endoscopes (EG HR485ZW5, EG HR490ZW5). The distal esophagus was sprayed with a solution of 1.5% acetic acid. Esophageal columnar mucosal patterns were characterized after AA spraying: Dotted round pits representing cardiac mucosa (pattern I), villous and ridged surface pattern (pattern II) for SIM and an irregular, distorted mucosal pattern (pattern III) representing neoplasia in SIM. The observed surface patterns were digitally stored on PC. All digitally stored images were reassessed by 6 blinded endoscopists. Intraand interobserver variations of the investigators were evaluated by using kappa statistics. Results: 394 endoscopic pictures of 96 patients were studied. SIM could be predicted with a sensitivity of 92%, High-grade intraepithelial neoplasia (HGIN) or early mucosal cancer in 89% respectively. The mean kappa for interobserver agreement was 0.959, whereas intraobserver agreement showed a mean kappa of 1.0. Conclusions: High Resolution Endoscopy with acetic acid is an accurate method for visually predicting SIM and early neoplasia in BE with very low interand intraobserver variability. Abstracts

  • Accuracy of staging in early oesophageal cancer using High Resolution Endoscopy and High Resolution endosonography: a comparative, prospective, and blinded trial
    Gut, 2004
    Co-Authors: Andrea May, E. Günter, F Roth, Liebwin Gossner, M Stolte, Michael Vieth, Christian Ell
    Abstract:

    Background and aims: The increasing use of endoscopic resection for curative treatment of early oesophageal cancers requires accurate staging before therapy. In a prospective blinded trial, we compared staging of early oesophageal carcinoma using High Resolution Endoscopy (HR-E) with staging using High Resolution endosonography (HR-EUS). Patients and methods: A total of 100 patients (89 men, 11 women; mean age 63.9 (10.8) years (range 31–91)) with a suspicion of early oesophageal adenocarcinoma (n = 81) or squamous cell carcinoma (n = 19) were enrolled in the study. After endoscopic staging with High Resolution video Endoscopy by two experienced endoscopists, HR-EUS was performed by an experienced endosonographer who was blinded to the endoscopic assessment. Results of the staging examinations were correlated with the histology of the resected tumours. Results: Overall rates for accuracy of the endoscopic and endosonographic staging were 83.4% and 79.6%, respectively. Sensitivity for mucosal tumours (n = 68) was more than 90% (EUS 91.2%, Endoscopy 94.1%) while sensitivity for submucosal tumours (n = 25) was lower, at 48% for EUS and 56% for endoscopic staging. A combination of the two techniques increased the sensitivity for submucosal tumours to 60%. Submucosal tumours in the tubular oesophagus were significantly better staged with HR-EUS than submucosal tumours close to the oesophagogastric junction (10/11 v 2/14; p Conclusions: The overall diagnostic accuracy of both HR-E and HR-EUS with a 20 MHz miniprobe in early oesophageal cancer was High (approximately 80%), with no significant differences between the two techniques. HR-E and HR-EUS provide a High level of diagnostic accuracy for mucosal tumours and submucosal tumours located in the tubular part of the oesophagus. With submucosal tumours located at the oesophagogastric junction or with infiltration of the first third of the submucosa however, the diagnostic accuracy of both techniques is not yet satisfactory.

Jacques J. Bergman - One of the best experts on this subject based on the ideXlab platform.

  • consensus statements for management of barrett s dysplasia and early stage esophageal adenocarcinoma based on a delphi process
    Gastroenterology, 2012
    Co-Authors: Cathy Bennett, Michael Vieth, Jacques J. Bergman, Oliver Pech, Nimish Vakil, Rebecca Harrison, Robert D Odze, Scott Sanders, Gaius Longcroftwheaton, Yvonne Romero
    Abstract:

    Background & Aims Esophageal adenocarcinoma (EA) is increasingly common among patients with Barrett's esophagus (BE). We aimed to provide consensus recommendations based on the medical literature that clinicians could use to manage patients with BE and low-grade dysplasia, High-grade dysplasia (HGD), or early-stage EA. Methods We performed an international, multidisciplinary, systematic, evidence-based review of different management strategies for patients with BE and dysplasia or early-stage EA. We used a Delphi process to develop consensus statements. The results of literature searches were screened using a unique, interactive, Web-based data-sifting platform; we used 11,904 papers to inform the choice of statements selected. An a priori threshold of 80% agreement was used to establish consensus for each statement. Results Eighty-one of the 91 statements achieved consensus despite generally low quality of evidence, including 8 clinical statements: (1) specimens from endoscopic resection are better than biopsies for staging lesions, (2) it is important to carefully map the size of the dysplastic areas, (3) patients that receive ablative or surgical therapy require endoscopic follow-up, (4) High-Resolution Endoscopy is necessary for accurate diagnosis, (5) endoscopic therapy for HGD is preferred to surveillance, (6) endoscopic therapy for HGD is preferred to surgery, (7) the combination of endoscopic resection and radiofrequency ablation is the most effective therapy, and (8) after endoscopic removal of lesions from patients with HGD, all areas of BE should be ablated. Conclusions We developed a data-sifting platform and used the Delphi process to create evidence-based consensus statements for the management of patients with BE and early-stage EA. This approach identified important clinical features of the diseases and areas for future studies.

  • endoscopic tri modal imaging for detection of early neoplasia in barrett s oesophagus a multi centre feasibility study using High Resolution Endoscopy autofluorescence imaging and narrow band imaging incorporated in one Endoscopy system
    Gut, 2008
    Co-Authors: Wouter L. Curvers, Paul Fockens, Krish Ragunath, Rajvinder Singh, Louis-michel Wong Kee Song, Herbert C. Wolfsen, Kenneth K. Wang, Michael B. Wallace, Jacques J. Bergman
    Abstract:

    Objective: To investigate the diagnostic potential of endoscopic tri-modal imaging and the relative contribution of each imaging modality (i.e. High-Resolution Endoscopy (HRE), autofluorescence imaging (AFI) and narrow-band imaging (NBI)) for the detection of early neoplasia in Barrett’s oesophagus. Design: Prospective multi-centre study. Setting: Tertiary referral centres. Patients: 84 Patients with Barrett’s oesophagus. Interventions: The Barrett’s oesophagus was inspected with HRE followed by AFI. All lesions detected with HRE and/or AFI were subsequently inspected in detail by NBI for the presence of abnormal mucosal and/or microvascular patterns. Biopsies were obtained from all suspicious lesions for blinded histopathological assessment followed by random biopsies. Main outcome measures: (1) Number of patients with early neoplasia diagnosed by HRE and AFI; (2) number of lesions with early neoplasia detected with HRE and AFI; and (3) reduction of false positive AFI findings after NBI. Results: Per patient analysis: AFI identified all 16 patients with early neoplasia identified with HRE and detected an additional 11 patients with early neoplasia that were not identified with HRE. In three patients no abnormalities were seen but random biopsies revealed HGIN. After HRE inspection, AFI detected an additional 102 lesions; 19 contained HGIN/EC (false positive rate of AFI after HRE: 81%). Detailed inspection with NBI reduced this false positive rate to 26%. Conclusions: In this international multi-centre study, the addition of AFI to HRE increased the detection of both the number of patients and the number of lesions with early neoplasia in patients with Barrett’s oesophagus. The false positive rate of AFI was reduced after detailed inspection with NBI.

  • Endoscopic Tri-Modal Imaging for Detection of Early Neoplasia in Barrett’s Oesophagus; A multi-centre feasibility study using High-Resolution Endoscopy, autofluorescence imaging and narrow band imaging incorporated in one Endoscopy system.
    Gut, 2007
    Co-Authors: Wouter L. Curvers, Paul Fockens, Krish Ragunath, Rajvinder Singh, Louis-michel Wong Kee Song, Herbert C. Wolfsen, Kenneth K. Wang, Michael B. Wallace, Jacques J. Bergman
    Abstract:

    Objective: To investigate the diagnostic potential of endoscopic tri-modal imaging and the relative contribution of each imaging modality (i.e. High-Resolution Endoscopy (HRE), autofluorescence imaging (AFI) and narrow-band imaging (NBI)) for the detection of early neoplasia in Barrett’s oesophagus. Design: Prospective multi-centre study. Setting: Tertiary referral centres. Patients: 84 Patients with Barrett’s oesophagus. Interventions: The Barrett’s oesophagus was inspected with HRE followed by AFI. All lesions detected with HRE and/or AFI were subsequently inspected in detail by NBI for the presence of abnormal mucosal and/or microvascular patterns. Biopsies were obtained from all suspicious lesions for blinded histopathological assessment followed by random biopsies. Main outcome measures: (1) Number of patients with early neoplasia diagnosed by HRE and AFI; (2) number of lesions with early neoplasia detected with HRE and AFI; and (3) reduction of false positive AFI findings after NBI. Results: Per patient analysis: AFI identified all 16 patients with early neoplasia identified with HRE and detected an additional 11 patients with early neoplasia that were not identified with HRE. In three patients no abnormalities were seen but random biopsies revealed HGIN. After HRE inspection, AFI detected an additional 102 lesions; 19 contained HGIN/EC (false positive rate of AFI after HRE: 81%). Detailed inspection with NBI reduced this false positive rate to 26%. Conclusions: In this international multi-centre study, the addition of AFI to HRE increased the detection of both the number of patients and the number of lesions with early neoplasia in patients with Barrett’s oesophagus. The false positive rate of AFI was reduced after detailed inspection with NBI.

  • The endoscopic diagnosis and staging of oesophageal adenocarcinoma.
    Best practice & research. Clinical gastroenterology, 2006
    Co-Authors: Jacques J. Bergman
    Abstract:

    The endoscopic evaluation of patients with oesophageal adenocarcinoma does not only serve the purpose of diagnosing the lesion and obtaining biopsies for histological evaluation: a systematic description of advanced lesions is also required to guide further therapeutic decisions. New endoscopic imaging modalities hold the promise of better endoscopic detection of early cancer and its precursor lesions in Barrett's oesophagus. Video-autofluorescence and narrow band imaging are the most promising techniques in this respect. The former may be used as a 'red flag' technique, identifying lesions that remain occult with white light Endoscopy; the latter may be used as a targeted imaging technique, allowing for detailed inspection of the mucosal and vascular patterns that may help to distinguish early neoplasia from non-dysplastic tissue. Currently, prototypes are under investigation that combine High-Resolution Endoscopy, narrow band imaging and video-autofluorescence in one Endoscopy system. Endoscopic ultrasonography (EUS) is superior to any other imaging modality in the assessment of local tumour infiltration of oesophageal adenocarcinoma and locoregional lymph nodes status. EUS allows for the identification of patients with advanced disease who are unlikely to benefit from attempts at curative surgery and in whom a conservative palliative treatment is indicated. EUS may also play a role in the selection of patients for local endoscopic treatment of early oesophageal cancer. EUS guided fine needle aspiration (EUS-FNA) of locoregional lymph nodes is safe with a High sensitivity and an impeccable specificity for assessment of malignant involvement. The indications for EUS-FNA of lymph nodes, however, depend on local treatment protocols: caeliac nodes (M1a) and lymph nodes located at or above the subcarinal area are the most widely used indications. In addition, it may be important if the choice for specific treatment protocols (e.g. neoadjuvant chemoradiotherapy) depends on lymph node status.

  • Endoscopic treatment of High-grade intraepithelial neoplasia and early cancer in Barrett oesophagus
    Best practice & research. Clinical gastroenterology, 2005
    Co-Authors: Jacques J. Bergman
    Abstract:

    In the last 5 years, endoscopic therapy for High-grade intraepithelial neoplasia (HGIN) and early cancer (EC) in Barrett oesophagus has emerged as an effective and safe alternative to surgery. Adequate work-up of patients includes histopathological review of the initial biopsies, a High-Resolution Endoscopy with four-quadrant random biopsies every 1 cm of Barrett mucosa and staging with endoscopic ultrasonography. Endoscopic resection (ER) forms the mainstay of the endoscopic treatment since it provides large tissue specimens for optimal histopathological evaluation. The ER-cap technique with submucosal injection and the ‘suck-band-and cut’ method are the resection methods most widely used in Barrett oesophagus patients. ER monotherapy for HGIN or EC in Barrett oesophagus is associated with recurrent lesions in up to 30% of treated patients. ER may be combined with ablative techniques such as photodynamic therapy (PDT) to treat all of the mucosa at risk for neoplastic progression. Unlike ER, PDT lacks histopathological correlation and residual Barrett mucosa may remain after treatment or may be hidden underneath the neosquamous epithelium. Management of Barrett oesophagus patients with HGIN or EC should be performed in centres with multi-disciplinary experience in this field and future studies should focus on development of ER techniques that allow radical resection of the whole Barrett segment.