3 results on '"Koens, L"'
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2. Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry.
- Author
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Zwager LW, Bastiaansen BAJ, van der Spek BW, Heine DN, Schreuder RM, Perk LE, Weusten BLAM, Boonstra JJ, van der Sluis H, Wolters HJ, Bekkering FC, Rietdijk ST, Schwartz MP, Nagengast WB, Ten Hove WR, Terhaar Sive Droste JS, Rando Munoz FJ, Vlug MS, Beaumont H, Houben MHMG, Seerden TCJ, de Wijkerslooth TR, Gielisse EAR, Hazewinkel Y, de Ridder R, Straathof JA, van der Vlugt M, Koens L, Fockens P, and Dekker E
- Subjects
- Humans, Neoplasm, Residual etiology, Registries, Retrospective Studies, Treatment Outcome, Colorectal Neoplasms pathology, Endoscopic Mucosal Resection adverse effects, Endoscopic Mucosal Resection methods
- Abstract
Background: Complete endoscopic resection and accurate histological evaluation for T1 colorectal cancer (CRC) are critical in determining subsequent treatment. Endoscopic full-thickness resection (eFTR) is a new treatment option for T1 CRC < 2 cm. We aimed to report clinical outcomes and short-term results., Methods: Consecutive eFTR procedures for T1 CRC, prospectively recorded in our national registry between November 2015 and April 2020, were retrospectively analyzed. Primary outcomes were technical success and R0 resection. Secondary outcomes were histological risk assessment, curative resection, adverse events, and short-term outcomes., Results: We included 330 procedures: 132 primary resections and 198 secondary scar resections after incomplete T1 CRC resection. Overall technical success, R0 resection, and curative resection rates were 87.0 % (95 % confidence interval [CI] 82.7 %-90.3 %), 85.6 % (95 %CI 81.2 %-89.2 %), and 60.3 % (95 %CI 54.7 %-65.7 %). Curative resection rate was 23.7 % (95 %CI 15.9 %-33.6 %) for primary resection of T1 CRC and 60.8 % (95 %CI 50.4 %-70.4 %) after excluding deep submucosal invasion as a risk factor. Risk stratification was possible in 99.3 %. The severe adverse event rate was 2.2 %. Additional oncological surgery was performed in 49/320 (15.3 %), with residual cancer in 11/49 (22.4 %). Endoscopic follow-up was available in 200/242 (82.6 %), with a median of 4 months and residual cancer in 1 (0.5 %) following an incomplete resection., Conclusions: eFTR is relatively safe and effective for resection of small T1 CRC, both as primary and secondary treatment. eFTR can expand endoscopic treatment options for T1 CRC and could help to reduce surgical overtreatment. Future studies should focus on long-term outcomes., Competing Interests: Prof. dr. Fockens reports personal fees from Cook, Ethicon and Olympus, research support from Boston Scientific, outside the submitted work. Prof. dr. Dekker has endoscopic equipment on loan of FujiFilm, received a research grant from FujiFilm, received a honorarium for consultancy from FujiFilm, Olympus, Tillots, GI Supply and CPP-FAP and a speakers' fee from Olympus, Roche and GI Supply. Prof. dr. Weusten received research support from Pentax Medical Inc and Aqua Medical, outside the submitted work. Dr. Bastiaansen received a speakers’ fee from Olympus, Tillotts Pharma AG and Ovesco Endoscopy AG. All other authors have nothing to disclose., (Thieme. All rights reserved.)
- Published
- 2022
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3. Optical diagnosis expanded to small polyps: post-hoc analysis of diagnostic performance in a prospective multicenter study.
- Author
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Vleugels JLA, Hazewinkel Y, Dijkgraaf MGW, Koens L, Fockens P, and Dekker E
- Subjects
- Aged, Colonic Polyps pathology, Colorectal Neoplasms pathology, Female, Humans, Male, Middle Aged, Netherlands, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Colonic Polyps diagnosis, Colonoscopy education, Colonoscopy methods, Colorectal Neoplasms diagnosis, Narrow Band Imaging methods
- Abstract
Background: Optical diagnosis can replace histopathology of diminutive (1 - 5 mm) polyps if surveillance intervals based on optical diagnosis of polyps have ≥ 90 % agreement with intervals based on polyp histology and if the negative predictive value (NPV) for predicting neoplastic histology in the rectosigmoid is ≥ 90 %. This study aims to assess whether small (6 - 9 mm) polyps can be included in optical diagnosis strategies., Method: This is a post-hoc analysis of a prospective multicenter study in which 27 endoscopists, all performing endoscopies for the Dutch screening program, were trained in optical diagnosis. For 1 year, endoscopists recorded the predicted histology for all lesions detected using narrow-band imaging during 3144 consecutive colonoscopies after a positive fecal immunochemical test, along with confidence levels. Surveillance interval agreement and NPV were calculated for high confidence predictions for polyps of 1 - 9 mm and compared with histopathology. Surveillance interval agreement was calculated using the European Society of Gastrointestinal Endoscopy surveillance guideline., Results: Surveillance interval agreement was 95.4 % (confidence interval [CI] 94.2 % - 96.4 %), and NPV for predicting neoplastic histology in the rectosigmoid 90.0 % (CI 87.3 % - 92.2 %). The reduction in histology (45.9 % vs. 30.5 %) and the proportion of patients who could have received direct surveillance advice (15.6 % vs. 7.3 %) was higher when small polyps were included ( P < 0.001). T1 cancer was found in seven small polyps (0.33 %), five of which would have been discarded without histopathology., Conclusion: Including small polyps in the optical diagnosis strategy improves its efficacy while maintaining performance thresholds. However, there is a small risk of missing T1 cancers when small polyps are included in the optical diagnosis strategy., Competing Interests: Evelien Dekker and Paul Fockens both received equipment on loan from Olympus and FujiFilm. Evelien Dekker has received an unrestricted research grant from Fujifilm and consulting fees for medical advice from Tillots, FujiFilm, and Olympus. Paul Fockens has received personal fees for consulting from Medtronic, Fujifilm, Cook, Ethicon Endosurgery, and Olympus. The other authors have no relevant disclosures to report., (© Georg Thieme Verlag KG Stuttgart · New York.)
- Published
- 2019
- Full Text
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