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52. METHYLENE BLUE-MMX FOR SCREENING COLONOSCOPY

Author

Repici, A, additional, Hassan, C, additional, Bisschops, R, additional, Bhandari, P, additional, Dekker, E, additional, Rutter, M, additional, East, J, additional, Kiesslich, R, additional, Siersema, P, additional, Spaander, M, additional, and Radaelli, F, additional

Published
2019
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53. Treatment of refractory post-esophagectomy anastomotic esophageal strictures using temporary fully covered esophageal metal stenting compared to repeated bougie dilation: results of a randomized controlled trial

Author

Kappelle, W., additional, van Hooft, J., additional, Spaander, M., additional, Vleggaar, F., additional, Bruno, M., additional, Maluf-Filho, F., additional, Bogte, A., additional, van Halsema, E., additional, and Siersema, P., additional

Published
2019
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54. Biopsy Sampling in Upper Gastrointestinal Endoscopy: A Survey from 10 Tertiary Referral Centres Across Europe.

Author

Bornschein, Jan, Tran-Nguyen, Terry, Fernandez-Esparrach, Gloria, Ash, Stephen, Balaguer, Francesc, Bird-Lieberman, Elisabeth L., Córdova, Henry, Dzerve, Zane, Fassan, Matteo, Leja, Marcis, Lyutakov, Ivan, Middelburg, Tim, Moreira, Leticia, Nakov, Radislav, Nieuwenburg, Stella A. V., O'Connor, Anthony, Realdon, Stefano, De Schepper, Heiko, Smet, Annemieke, and Spaander, M. C. W.

Subjects
BIOPSY, ENDOSCOPY, GASTRITIS, GASTROSCOPY
Abstract

Background: Guidelines give robust recommendations on which biopsies should be taken when there is endoscopic suggestion of gastric inflammation. Adherence to these guidelines often seems arbitrary. This study aimed to give an overview on current practice in tertiary referral centres across Europe. Methods: Data were collected at 10 tertiary referral centres. Demographic data, the indication for each procedure, endoscopic findings, and the number and sampling site of biopsies were recorded. Findings were compared between centres, and factors influencing the decision to take biopsies were explored. Results: Biopsies were taken in 56.6% of 9,425 procedures, with significant variation between centres (p < 0.001). Gastric biopsies were taken in 43.8% of all procedures. Sampling location varied with the procedure indication (p < 0.001) without consistent pattern across the centres. Fewer biopsies were taken in centres which routinely applied the updated Sydney classification for gastritis assessment (46.0%), compared to centres where this was done only upon request (75.3%, p < 0.001). This was the same for centres stratifying patients according to the OLGA system (51.8 vs. 73.0%, p < 0.001). More biopsies were taken in centres following the MAPS guidelines on stomach surveillance (68.1 vs. 37.1%, p < 0.001). Biopsy sampling was more likely in younger patients in 8 centres (p < 0.05), but this was not true for the whole cohort (p = 0.537). The percentage of procedures with biopsies correlated directly with additional costs charged in case of biopsies (r = 0.709, p = 0.022). Conclusion: Adherence to guideline recommendations for biopsy sampling at gastroscopy was inconsistent across the participating centres. Our data suggest that centre-specific policies are applied instead. [ABSTRACT FROM AUTHOR]

Published
2021
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55. Nationwide comprehensive gastro-intestinal cancer cohorts : The 3P initiative

Author

van den Braak, R. R. J. Coebergh, van Rijssen, L. B., van Kleef, J. J., Vink, G. R., Berbee, M., Henegouwen, M. I. van Berge, Bloemendal, H. J., Bruno, M. J., Burgmans, M. C., Busch, O. R. C., Coene, P. P. L. O., Coupe, V. M. H., Dekker, J. W. T., van Eijck, C. H. J., Elferink, M. A. G., Erdkamp, F. L. G., van Grevenstein, W. M. U., de Groot, J. W. B., van Grieken, N. C. T., de Hingh, I. H. J. T., Hulshof, M. C. C. M., Ijzermans, J. N. M., Kwakkenbos, L., Lemmens, V. E. P. P., Los, M., Meijer, G. A., Molenaar, I. Q., Nieuwenhuijzen, G. A. P., de Noo, M. E., van de Poll-Franse, L. V., Punt, C. J. A., Rietbroek, R. C., Roeloffzen, W. W. H., Rozema, T., Ruurda, J. P., van Sandick, J. W., Schiphorst, A. H. W., Schipper, H., Siersema, P. D., Slingerland, M., Sommeijer, D. W., Spaander, M. C. W., Sprangers, M. A. G., Stockmann, H. B. A. C., Strijker, M., van Tienhoven, G., Timmermans, L. M., Tjin-a-Ton, M. L. R., van der Velden, A. M. T., Verhaar, M. J., Verkooijen, H. M., Vles, W. J., de Vos-Geelen, J. M. P. G. M., Wilmink, J. W., Zimmerman, D. D. E., van Oijen, M. G. H., Koopman, M., Besselink, M. G. H., van Laarhoven, H. W. M., van den Braak, R. R. J. Coebergh, van Rijssen, L. B., van Kleef, J. J., Vink, G. R., Berbee, M., Henegouwen, M. I. van Berge, Bloemendal, H. J., Bruno, M. J., Burgmans, M. C., Busch, O. R. C., Coene, P. P. L. O., Coupe, V. M. H., Dekker, J. W. T., van Eijck, C. H. J., Elferink, M. A. G., Erdkamp, F. L. G., van Grevenstein, W. M. U., de Groot, J. W. B., van Grieken, N. C. T., de Hingh, I. H. J. T., Hulshof, M. C. C. M., Ijzermans, J. N. M., Kwakkenbos, L., Lemmens, V. E. P. P., Los, M., Meijer, G. A., Molenaar, I. Q., Nieuwenhuijzen, G. A. P., de Noo, M. E., van de Poll-Franse, L. V., Punt, C. J. A., Rietbroek, R. C., Roeloffzen, W. W. H., Rozema, T., Ruurda, J. P., van Sandick, J. W., Schiphorst, A. H. W., Schipper, H., Siersema, P. D., Slingerland, M., Sommeijer, D. W., Spaander, M. C. W., Sprangers, M. A. G., Stockmann, H. B. A. C., Strijker, M., van Tienhoven, G., Timmermans, L. M., Tjin-a-Ton, M. L. R., van der Velden, A. M. T., Verhaar, M. J., Verkooijen, H. M., Vles, W. J., de Vos-Geelen, J. M. P. G. M., Wilmink, J. W., Zimmerman, D. D. E., van Oijen, M. G. H., Koopman, M., Besselink, M. G. H., and van Laarhoven, H. W. M.

Published
2018

56. Nationwide comprehensive gastro-intestinal cancer cohorts: The 3P initiative

Author

Cancer, Onderzoek Medische Oncologie, MS Medische Oncologie, MS CGO, Trialbureau Beeld, Epi Kanker Team A, Circulatory Health, JC onderzoeksprogramma Kanker, van den Braak, R. R. J. Coebergh, van Rijssen, L. B., van Kleef, J. J., Vink, G. R., Berbee, M., Henegouwen, M. I. van Berge, Bloemendal, H. J., Bruno, M. J., Burgmans, M. C., Busch, O. R. C., Coene, P. P. L. O., Coupe, V. M. H., Dekker, J. W. T., van Eijck, C. H. J., Elferink, M. A. G., Erdkamp, F. L. G., van Grevenstein, W. M. U., de Groot, J. W. B., van Grieken, N. C. T., de Hingh, I. H. J. T., Hulshof, M. C. C. M., Ijzermans, J. N. M., Kwakkenbos, L., Lemmens, V. E. P. P., Los, M., Meijer, G. A., Molenaar, I. Q., Nieuwenhuijzen, G. A. P., de Noo, M. E., van de Poll-Franse, L. V., Punt, C. J. A., Rietbroek, R. C., Roeloffzen, W. W. H., Rozema, T., Ruurda, J. P., van Sandick, J. W., Schiphorst, A. H. W., Schipper, H., Siersema, P. D., Slingerland, M., Sommeijer, D. W., Spaander, M. C. W., Sprangers, M. A. G., Stockmann, H. B. A. C., Strijker, M., van Tienhoven, G., Timmermans, L. M., Tjin-a-Ton, M. L. R., van der Velden, A. M. T., Verhaar, M. J., Verkooijen, H. M., Vles, W. J., de Vos-Geelen, J. M. P. G. M., Wilmink, J. W., Zimmerman, D. D. E., van Oijen, M. G. H., Koopman, M., Besselink, M. G. H., van Laarhoven, H. W. M., Cancer, Onderzoek Medische Oncologie, MS Medische Oncologie, MS CGO, Trialbureau Beeld, Epi Kanker Team A, Circulatory Health, JC onderzoeksprogramma Kanker, van den Braak, R. R. J. Coebergh, van Rijssen, L. B., van Kleef, J. J., Vink, G. R., Berbee, M., Henegouwen, M. I. van Berge, Bloemendal, H. J., Bruno, M. J., Burgmans, M. C., Busch, O. R. C., Coene, P. P. L. O., Coupe, V. M. H., Dekker, J. W. T., van Eijck, C. H. J., Elferink, M. A. G., Erdkamp, F. L. G., van Grevenstein, W. M. U., de Groot, J. W. B., van Grieken, N. C. T., de Hingh, I. H. J. T., Hulshof, M. C. C. M., Ijzermans, J. N. M., Kwakkenbos, L., Lemmens, V. E. P. P., Los, M., Meijer, G. A., Molenaar, I. Q., Nieuwenhuijzen, G. A. P., de Noo, M. E., van de Poll-Franse, L. V., Punt, C. J. A., Rietbroek, R. C., Roeloffzen, W. W. H., Rozema, T., Ruurda, J. P., van Sandick, J. W., Schiphorst, A. H. W., Schipper, H., Siersema, P. D., Slingerland, M., Sommeijer, D. W., Spaander, M. C. W., Sprangers, M. A. G., Stockmann, H. B. A. C., Strijker, M., van Tienhoven, G., Timmermans, L. M., Tjin-a-Ton, M. L. R., van der Velden, A. M. T., Verhaar, M. J., Verkooijen, H. M., Vles, W. J., de Vos-Geelen, J. M. P. G. M., Wilmink, J. W., Zimmerman, D. D. E., van Oijen, M. G. H., Koopman, M., Besselink, M. G. H., and van Laarhoven, H. W. M.

Published
2018

57. Nationwide comprehensive gastro-intestinal cancer cohorts: The 3P initiative

Author

Coebergh Van Den Braak, R. R. J., Van Rijssen, L. B., Van Kleef, J. J., Vink, G. R., Berbee, M., Van Berge Henegouwen, M. I., Bloemendal, H. J., Bruno, M. J., Burgmans, M. C., Busch, O. R. C., Coene, P. P. L. O., Coupé, V. M. H., Dekker, J. W. T., Van Eijck, C. H. J., Elferink, M. A. G., Erdkamp, F. L. G., Van Grevenstein, W. M. U., De Groot, J. W. B., Van Grieken, N. C. T., De Hingh, I. H. J. T., Hulshof, M. C. C. M., Ijzermans, J. N. M., Kwakkenbos, L., Lemmens, V. E. P. P., Los, M., Meijer, G. A., Molenaar, I. Q., Nieuwenhuijzen, G. A. P., De Noo, M. E., van de Poll-Franse, L.V., Punt, C. J. A., Rietbroek, R. C., Roeloffzen, W. W. H., Rozema, T., Ruurda, J. P., Van Sandick, J. W., Schiphorst, A. H. W., Schipper, H., Siersema, P. D., Slingerland, M., Sommeijer, D. W., Spaander, M. C. W., Sprangers, M. A. G., Stockmann, H. B. A. C., Strijker, M., Van Tienhoven, G., Timmermans, L. M., Tjin-a-ton, M. L. R., Van Der Velden, A. M. T., Verhaar, M. J., Verkooijen, H. M., Vles, W. J., De Vos-geelen, J. M. P. G. M., Wilmink, J. W., Zimmerman, D. D. E., Van Oijen, M. G. H., Koopman, M., Besselink, M. G. H., Van Laarhoven, H. W. M., Coebergh Van Den Braak, R. R. J., Van Rijssen, L. B., Van Kleef, J. J., Vink, G. R., Berbee, M., Van Berge Henegouwen, M. I., Bloemendal, H. J., Bruno, M. J., Burgmans, M. C., Busch, O. R. C., Coene, P. P. L. O., Coupé, V. M. H., Dekker, J. W. T., Van Eijck, C. H. J., Elferink, M. A. G., Erdkamp, F. L. G., Van Grevenstein, W. M. U., De Groot, J. W. B., Van Grieken, N. C. T., De Hingh, I. H. J. T., Hulshof, M. C. C. M., Ijzermans, J. N. M., Kwakkenbos, L., Lemmens, V. E. P. P., Los, M., Meijer, G. A., Molenaar, I. Q., Nieuwenhuijzen, G. A. P., De Noo, M. E., van de Poll-Franse, L.V., Punt, C. J. A., Rietbroek, R. C., Roeloffzen, W. W. H., Rozema, T., Ruurda, J. P., Van Sandick, J. W., Schiphorst, A. H. W., Schipper, H., Siersema, P. D., Slingerland, M., Sommeijer, D. W., Spaander, M. C. W., Sprangers, M. A. G., Stockmann, H. B. A. C., Strijker, M., Van Tienhoven, G., Timmermans, L. M., Tjin-a-ton, M. L. R., Van Der Velden, A. M. T., Verhaar, M. J., Verkooijen, H. M., Vles, W. J., De Vos-geelen, J. M. P. G. M., Wilmink, J. W., Zimmerman, D. D. E., Van Oijen, M. G. H., Koopman, M., Besselink, M. G. H., and Van Laarhoven, H. W. M.

Abstract

Background: The increasing sub-classification of cancer patients due to more detailed molecular classification of tumors, and limitations of current trial designs, require innovative research designs. We present the design, governance and current standing of three comprehensive nationwide cohorts including pancreatic, esophageal/gastric, and colorectal cancer patients (NCT02070146). Multidisciplinary collection of clinical data, tumor tissue, blood samples, and patient-reported outcome (PRO) measures with a nationwide coverage, provides the infrastructure for future and novel trial designs and facilitates research to improve outcomes of gastrointestinal cancer patients.Material and methods: All patients aged 18 years with pancreatic, esophageal/gastric or colorectal cancer are eligible. Patients provide informed consent for: (1) reuse of clinical data; (2) biobanking of primary tumor tissue; (3) collection of blood samples; (4) to be informed about relevant newly identified genomic aberrations; (5) collection of longitudinal PROs; and (6) to receive information on new interventional studies and possible participation in cohort multiple randomized controlled trials (cmRCT) in the future.Results: In 2015, clinical data of 21,758 newly diagnosed patients were collected in the Netherlands Cancer Registry. Additional clinical data on the surgical procedures were registered in surgical audits for 13,845 patients. Within the first two years, tumor tissue and blood samples were obtained from 1507 patients; during this period, 1180 patients were included in the PRO registry. Response rate for PROs was 90%. The consent rate to receive information on new interventional studies and possible participation in cmRCTs in the future was >85%. The number of hospitals participating in the cohorts is steadily increasing.Conclusion: A comprehensive nationwide multidisciplinary gastrointestinal cancer cohort is feasible and surpasses

Published
2018

58. PS02.064: ACCURACY OF F-18-FDG-PET/CT IN MONITORING TUMOUR RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY IN PATIENTS WITH OESOPHAGEAL CANCER

Author

Valkema, Maria, primary, Noordman, B, additional, Wijnhoven, Bas P L, additional, Spaander, M C W, additional, Lagarde, Sjoerd M, additional, Ruurda, Jelle, additional, Nieuwenhuijzen, Grard A P, additional, Van Berge Henegouwen, M I, additional, Sosef, M N, additional, Siersema, P D, additional, Van Lanschot, J J B, additional, and Valkema, R, additional

Published
2018
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59. RA07.06: BASELINE FDG-PET/CT PARAMETERS AS PREDICTOR FOR RESIDUAL TUMOUR AFTER NEOADJUVANT CHEMORADIOTHERAPY IN OESOPHAGEAL CANCER PATIENTS

Author

Valkema, Maria, primary, Noordman, B, additional, Wijnhoven, Bas P L, additional, Spaander, M C W, additional, Lagarde, Sjoerd M, additional, Ruurda, Jelle, additional, Nieuwenhuijzen, Grard A P, additional, Van Berge Henegouwen, M I, additional, Sosef, M N, additional, Siersema, P D, additional, Van Lanschot, J J B, additional, and Valkema, R, additional

Published
2018
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62. Fecal immunochemical test-based colorectal cancer screening: The gender dilemma

Author

Grobbee, E., Wieten, E., Hansen, B., Stoop, E., de Wijkerslooth, T., Lansdorp-Vogelaar, Iris, Bossuyt, P., Dekker, E., Kuipers, E., Spaander, M., Grobbee, E., Wieten, E., Hansen, B., Stoop, E., de Wijkerslooth, T., Lansdorp-Vogelaar, Iris, Bossuyt, P., Dekker, E., Kuipers, E., and Spaander, M.

Abstract

© 2016, © Author(s) 2016. Background: Despite differences between men and women in incidence of colorectal cancer (CRC) and its precursors, screening programs consistently use the same strategy for both genders. Objective: The objective of this article is to illustrate the effects of gender-tailored screening, including the effects on miss rates of advanced neoplasia (AN). Methods: Participants (age 50–75 years) in a colonoscopy screening program were asked to complete a fecal immunochemical test (FIT) before colonoscopy. Positivity rates, sensitivity and specificity for detection of AN at multiple cut-offs were determined. Absolute numbers of detected and missed AN per 1000 screenees were calculated. Results: In total 1,256 individuals underwent FIT and colonoscopy, 51% male (median age 61 years; IQR 56–66) and 49% female (median age 60 years; IQR 55–65). At all cut-offs men had higher positivity rates than women, ranging from 3.8% to 10.8% versus 3.2% to 4.8%. Sensitivity for AN was higher in men than women; 40%–25% and 35%–22%, respectively. More AN were found and missed in absolute numbers in men at all cut-offs. Conclusion: More AN were both detected and missed in men compared to women at all cut-offs. Gender-tailored cut-offs could either level sensitivity in men and women (i.e., lower cut-off in women) or level the amount of missed lesions (i.e., lower cut-off in men).

Published
2017

63. Do men and women need to be screened differently with fecal immunochemical testing? A cost-effectiveness analysis

Author

Van Der Meulen, M., Kapidzic, A., Van Leerdam, M., Van Der Steen, A., Kuipers, E., Spaander, M., De Koning, H., Hol, L., Lansdorp_Vogelaar, Iris, Van Der Meulen, M., Kapidzic, A., Van Leerdam, M., Van Der Steen, A., Kuipers, E., Spaander, M., De Koning, H., Hol, L., and Lansdorp_Vogelaar, Iris

Abstract

© 2017 American Association for Cancer Research. Background: Several studies suggest that test characteristics for the fecal immunochemical test (FIT) differ by gender, triggering a debate on whether men and women should be screened differently. We used the microsimulation model MISCAN-Colon to evaluate whether screening stratified by gender is cost-effective. Methods: We estimated gender-specific FIT characteristics based on first-round positivity and detection rates observed in a FIT screening pilot (CORERO-1). Subsequent ly, we used the model to estimate harms, benefits, and costs of 480 genderspecific FIT screening strategies and compared them with uniform screening. Results: Biennial FIT screening from ages 50 to 75 was less effective in women than men [35.7 vs. 49.0 quality-adjusted life years (QALY) gained, respectively] at higher costs (€42, 161 vs. -€5, 471, respectively). However, the incremental QALYs gained and costs of annual screening compared with biennial screening were more similar for both genders (8.7 QALYs gained and €26, 394 for women vs. 6.7 QALYs gained and €20, 863 for men). Considering all evaluated screening strategies, optimal gender-based screening yielded at most 7% more QALYs gained than optimal uniform screening and even resulted in equal costs and QALYs gained from a willingness- to-pay threshold of €1, 300. Conclusions: FIT screening is less effective in women, but the incremental cost-effectiveness is similar in men and women. Consequently, screening stratified by gender is not more costeffective than uniform FIT screening. Impact: Our conclusions support the current policy of uniform FIT screening. Cancer Epidemiol Biomarkers Prev; 26(8); 1328-36.

Published
2017

64. Interval Colorectal Cancer Incidence Among Subjects Undergoing Multiple Rounds of Fecal Immunochemical Testing

Author

van der Vlugt, M., Grobbee, E., Bossuyt, P., Bos, A., Bongers, E., Spijker, W., Kuipers, E., Lansdorp_Vogelaar, Iris, Spaander, M., Dekker, E., van der Vlugt, M., Grobbee, E., Bossuyt, P., Bos, A., Bongers, E., Spijker, W., Kuipers, E., Lansdorp_Vogelaar, Iris, Spaander, M., and Dekker, E.

Abstract

© 2017 AGA Institute Background & Aims Among subjects screened for colorectal cancer (CRC) by the guaiac fecal occult blood test, interval cancers develop in 48% to 55% of the subjects. Data are limited on how many persons screened by fecal immunochemical tests (FIT), over multiple rounds, develop interval cancers. In the Netherlands, a pilot FIT-based biennial CRC screening program was conducted between 2006 and 2014. We collected and analyzed data from the program on CRCs detected during screening (SD-CRC) and CRCs not detected within the screening program (non–SD-CRC; such as FIT interval cancers, colonoscopy interval cancers, and cancer in nonparticipants). Methods Screenees with a negative FIT result received a letter explaining that no blood had been detected in the stool sample and were re-invited, if eligible, for screening biennially. Screenees with a positive FIT result (hemoglobin concentration of 10 µg Hb/g feces) were invited for consultation and scheduled for colonoscopy; results were collected. After the fourth round of FIT screening, the cohort was linked to the Netherlands Cancer Registry, through March 31, 2015; participant characteristics, data on tumor stage, location (at time of resection), and survival status were collected for all identified CRC cases. A reference group comprised all persons with CRC diagnosed in the Netherlands general population during the same period, in the same age range (50–76 years), who had not been offered CRC screening. The median time between invitations (2.37 years) was used as a cutoff to categorize participants within the FIT interval cancer category. We compared participant characteristics, tumor characteristics, and mortality among subjects with SD-CRC and with non–SD-CRC. Results A total of 27,304 eligible individuals were invited for FIT screening, of whom 18,716 (69%) participated at least once. Of these, 3005 (16%) had a positive result from the FIT in 1 of the 4 screening rounds. In total, CRC was detected

Published
2017

65. Colorectal cancer surveillance in Hodgkin lymphoma survivors at increased risk of therapy-related colorectal cancer: Study design

Author

Rigter, L., Spaander, M., Moons, L., Bisseling, T., Aleman, B., de Boer, J., Lugtenburg, P., Janus, C., Petersen, E., Roesink, J., Raemaekers, J., van der Maazen, R., Cats, A., Bleiker, E., Snaebjornsson, P., Carvalho, B., Lansdorp_Vogelaar, Iris, Józwiak, K., te Riele, H., Meijer, G., van Leeuwen, F., van Leerdam, M., Rigter, L., Spaander, M., Moons, L., Bisseling, T., Aleman, B., de Boer, J., Lugtenburg, P., Janus, C., Petersen, E., Roesink, J., Raemaekers, J., van der Maazen, R., Cats, A., Bleiker, E., Snaebjornsson, P., Carvalho, B., Lansdorp_Vogelaar, Iris, Józwiak, K., te Riele, H., Meijer, G., van Leeuwen, F., and van Leerdam, M.

Abstract

Background: Second primary malignancies are a major cause of excess morbidity and mortality in cancer survivors. Hodgkin lymphoma survivors who were treated with infradiaphragmatic radiotherapy and/or high-dose procarbazine have an increased risk to develop colorectal cancer. Colonoscopy surveillance plays an important role in colorectal cancer prevention by removal of the precursor lesions (adenomas) and early detection of cancer, resulting in improved survival rates. Therefore, Hodgkin lymphoma survivors treated with infradiaphragmatic radiotherapy and/or high-dose procarbazine could benefit from colonoscopy, or other surveillance modalities, which are expected to reduce colorectal cancer incidence and mortality. Current knowledge on clinicopathological and molecular characteristics of therapy-related colorectal cancer is limited. The pathogenesis of such colorectal cancers might be different from the pathogenesis in the general population and therefore these patients might require a different clinical approach. We designed a study with the primary aim to assess the diagnostic yield of a first surveillance colonoscopy among Hodgkin lymphoma survivors at increased risk of colorectal cancer and to compare these results with different screening modalities in the general population. Secondary aims include assessment of the test characteristics of stool tests and evaluation of burden, acceptance and satisfaction of CRC surveillance through two questionnaires. Methods/Design: This prospective multicenter cohort study will include Hodgkin lymphoma survivors who survived =8years after treatment with infradiaphragmatic radiotherapy and/or procarbazine (planned inclusion of 259 participants). Study procedures will consist of a surveillance colonoscopy with removal of precursor lesions (adenomas) and 6-8 normal colonic tissue biopsies, a fecal immunochemical test and a stool DNA test. All neoplastic lesions encountered will be classified using relevant histomorphological, im

Published
2017

66. Adherence to colorectal cancer screening: Four rounds of faecal immunochemical test-based screening

Author

Van Der Vlugt, M., Grobbee, E., Bossuyt, P., Bongers, E., Spijker, W., Kuipers, E., Lansdorp_Vogelaar, Iris, Essink-Bot, M., Spaander, M., Dekker, E., Van Der Vlugt, M., Grobbee, E., Bossuyt, P., Bongers, E., Spijker, W., Kuipers, E., Lansdorp_Vogelaar, Iris, Essink-Bot, M., Spaander, M., and Dekker, E.

Abstract

Background:The effectiveness of faecal immunochemical test (FIT)-based screening programs is highly dependent on consistent participation over multiple rounds. We evaluated adherence to FIT screening over four rounds and aimed to identify determinants of participation behaviour.Methods:A total of 23 339 randomly selected asymptomatic persons aged 50-74 years were invited for biennial FIT-based colorectal cancer screening between 2006 and 2014. All were invited for every consecutive round, except for those who had moved out of the area, passed the upper age limit, or had tested positive in a previous screening round. A reminder letter was sent to non-responders. We calculated participation rates per round, response rates to a reminder letter, and differences in participation between subgroups defined by age, sex, and socioeconomic status (SES).Results:Over the four rounds, participation rates increased significantly, from 60% (95% CI 60-61), 60% (95% CI 59-60), 62% (95% CI 61-63) to 63% (95% CI 62-64; P for trend<0.001) with significantly higher participation rates in women in all rounds (P<0.001). Of the 17 312 invitees eligible for at least two rounds of FIT screening, 12 455 (72%) participated at least once, whereas 4857 (28%) never participated; 8271 (48%) attended all rounds when eligible. Consistent participation was associated with older age, female sex, and higher SES. Offering a reminder letter after the initial invite in the first round increased uptake with 12%; in subsequent screening rounds this resulted in an additional uptake of up to 10%.Conclusions:In four rounds of a pilot biennial FIT-screening program, we observed a consistently high and increasing participation rate, whereas sending reminders remain effective. The substantial proportion of inconsistent participants suggests the existence of incidental barriers to participation, which, if possible, should be identified and removed.

Published
2017

68. Evaluation of current prediction models for Lynch syndrome: updating the PREMM5 model to identify PMS2 mutation carriers

Author

Goverde, A., primary, Spaander, M. C. W., additional, Nieboer, D., additional, van den Ouweland, A. M. W., additional, Dinjens, W. N. M., additional, Dubbink, H. J., additional, Tops, C. J., additional, ten Broeke, S. W., additional, Bruno, M. J., additional, Hofstra, R. M. W., additional, Steyerberg, E. W., additional, and Wagner, A., additional

Published
2017
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70. Effects of Increasing Screening Age and Fecal Hemoglobin Cutoff Concentrations in a Colorectal Cancer Screening Program

Author

Wieten, E., Schreuders, E., Nieuwenburg, S., Hansen, B., Lansdorp_Vogelaar, Iris, Kuipers, E., Bruno, M., Spaander, M., Wieten, E., Schreuders, E., Nieuwenburg, S., Hansen, B., Lansdorp_Vogelaar, Iris, Kuipers, E., Bruno, M., and Spaander, M.

Abstract

Background & Aims: Several countries have implemented programs to screen for colorectal cancer (CRC) by using the fecal immunochemical test (FIT). These programs vary considerably in age of the population screened and the cutoff concentration of fecal hemoglobin (Hb) used to identify candidates for further evaluation; these variations are usually based on a country’s colonoscopy resources. We calculated how increasing the Hb cutoff concentration and screening age affects colonoscopy yield, missed lesions, and demand. Methods: We collected data from 10,008 average-risk individuals in The Netherlands, 50–74 years old, who were invited for an FIT in the first round of a population-based CRC screening program from November 2006 through December 2008. Fecal samples were collected, and levels of Hb were measured by using the OC-sensor Micro analyzer; concentrations ≥10 μg Hb/g feces were considered positive. Subjects with a positive FIT were scheduled for colonoscopy within 4 weeks. Logistic regression analysis was performed to evaluate the association between age and detection of advanced neoplasia. Results: In total, 5986 individuals (62%) participated in the study; 503 (8.4%) had a positive test result. Attendance, positive test results, detection of advanced neoplasia, and the FIT’s positive predictive value all increased significantly with age (P < .001). Detection of advanced neoplasia ranged from 1.3% in the youngest age group to 6.2% in the oldest group; the positive predictive value of the FIT was 26% in the youngest group and 47% in the oldest group. Increasing the starting age of invitees from 50–74 years to 55–74 years reduced the proportion of subjects who underwent colonoscopy evaluation by 14% and resulted in 9% more subjects with advanced neoplasia being missed. Increasing the cutoff concentration from 10 to 15 μg Hb/g feces reduced the proportion of subjects who underwent colonoscopy evaluation by 11% and resulted in 6% of advanced neoplasia being missed.

Published
2016

71. Population-Based colonoscopy screening for colorectal cancer : A randomized clinical trial

Author

Bretthauer, M., Kaminski, M., Løberg, M., Zauber, A., Regula, J., Kuipers, E., Hernán, M., McFadden, E., Sunde, A., Kalager, M., Dekker, E., Lansdorp_Vogelaar, Iris, Garborg, K., Rupinski, M., Spaander, M., Bugajski, M., Høie, O., Stefansson, T., Hoff, G., Adami, H., Bretthauer, M., Kaminski, M., Løberg, M., Zauber, A., Regula, J., Kuipers, E., Hernán, M., McFadden, E., Sunde, A., Kalager, M., Dekker, E., Lansdorp_Vogelaar, Iris, Garborg, K., Rupinski, M., Spaander, M., Bugajski, M., Høie, O., Stefansson, T., Hoff, G., and Adami, H.

Abstract

Importance: Although some countries have implemented widespread colonoscopy screening, most European countries have not introduced it because of uncertainty regarding participation rates, procedure-related pain and discomfort, endoscopist performance, and effectiveness. To our knowledge, no randomized trials on colonoscopy screening currently exist. Objective: To investigate participation rate, adenoma yield, performance, and adverse events of population-based colonoscopy screening in several European countries. Design, Setting, and Population: A population-based randomized clinical trialwas conducted among 94 959 men and women aged 55 to 64 years of average risk for colon cancer in Poland, Norway, the Netherlands, and Sweden from June 8, 2009, to June 23, 2014. Interventions Colonoscopy screening or no screening. Main outcomes and Measures: Participation in colonoscopy screening, cancer and adenoma yield, and participant experience. Study outcomes were compared by country and endoscopist. Results: Of 31 420 eligible participants randomized to the colonoscopy group, 12 574 (40.0%) underwent screening. Participation rates were 60.7%in Norway (5354 of 8816), 39.8%in Sweden (486 of 1222), 33.0%in Poland (6004 of 18 188), and 22.9% in the Netherlands (730 of 3194) (P <.001). The cecum intubation rate was 97.2%(12 217 of 12 574), with 9726 participants (77.4%) not receiving sedation. Of the 12 574 participants undergoing colonoscopy screening, we observed 1 perforation (0.01%), 2 postpolypectomy serosal burns (0.02%), and 18 cases of bleeding owing to polypectomy (0.14%). Sixty-two individuals (0.5%) were diagnosed with colorectal cancer and 3861 (30.7%) had adenomas, of which 1304 (10.4%) were high-risk adenomas. Detection rates were similar in the proximal and distal colon. Performance differed significantly between endoscopists; recommended benchmarks for cecal intubation (95%) and adenoma detection (25%) were not met by 6 (17.1%) and 10 of 35 endoscopists (28.6%), re

Published
2016

72. A randomised comparison of two faecal immunochemical tests in population-based colorectal cancer screening

Author

Grobbee, E., van der Vlugt, M., van Vuuren, A., Stroobants, A., Mundt, M., Spijker, W., Bongers, E., Kuipers, E., Lansdorp_Vogelaar, Iris, Bossuyt, P., Dekker, E., Spaander, M., Grobbee, E., van der Vlugt, M., van Vuuren, A., Stroobants, A., Mundt, M., Spijker, W., Bongers, E., Kuipers, E., Lansdorp_Vogelaar, Iris, Bossuyt, P., Dekker, E., and Spaander, M.

Abstract

Objective: Colorectal cancer screening programmes are implemented worldwide; many are based on faecal immunochemical testing (FIT). The aim of this study was to evaluate two frequently used FITs on participation, usability, positivity rate and diagnostic yield in population-based FIT screening. Design: Comparison of two FITs was performed in a fourth round population-based FIT-screening cohort. Randomly selected individuals aged 50-74 were invited for FIT screening and were randomly allocated to receive an OC -Sensor (Eiken, Japan) or faecal occult blood (FOB)-Gold (Sentinel, Italy) test (March-December 2014). A cut-off of 10 µg haemoglobin (Hb)/g faeces (ie, 50 ng Hb/mL buffer for OC-Sensor and 59 ng Hb for FOB-Gold) was used for both FITs. Results: In total, 19 291 eligible invitees were included (median age 61, IQR 57-67; 48% males): 9669 invitees received OC-Sensor and 9622 FOB-Gold; both tests were returned by 63% of invitees ( p=0.96). Tests were nonanalysable in 0.7% of participants using OC-Sensor vs 2.0% using FOB-Gold (p<0.001). Positivity rate was 7.9% for OC-Sensor, and 6.5% for FOB-Gold (p=0.002). There was no significant difference in diagnostic yield of advanced neoplasia (1.4% for OC-Sensor vs 1.2% for FOB-Gold; p=0.15) or positive predictive value (PPV; 31% vs 32%; p=0.80). When comparing both tests at the same positivity rate instead of cut-off, they yielded similar PPV and detection rates. Conclusions: The OC-Sensor and FOB-Gold were equally acceptable to a screening population. However, FOB-Gold was prone to more non-analysable tests. Comparison between FIT brands is usually done at the same Hb stool concentration. Our findings imply that for a fair comparison on diagnostic yield between FIT's positivity rate rather than Hb concentration should be used. Trial registration number: NTR5385; Results.

Published
2016

73. Immunochemical faecal occult blood testing to screen for colorectal cancer: Can the screening interval be extended?

Author

Haug, U., Grobbee, E., Lansdorp-Vogelaar, Iris, Spaander, M., Kuipers, E., Haug, U., Grobbee, E., Lansdorp-Vogelaar, Iris, Spaander, M., and Kuipers, E.

Abstract

Objective: Colorectal cancer (CRC) screening programmes based on faecal immunochemical testing for haemoglobin (FIT) typically use a screening interval of 2 years. We aimed to estimate how alternative FIT strategies that use a lower than usual positivity threshold followed by a longer screening interval compare with conventional strategies. Methods: We analysed longitudinal data of 4523 Dutch individuals (50-74 years at baseline) participating in round I of a one-sample FIT screening programme, of which 3427 individuals also participated in round II after 1-3 years. The cohort was followed until 2 years after round II. In both rounds, a cut-off level of =50 ng haemoglobin (Hb)/mL buffer (corresponding to 10 mg Hb/g faeces) was used, representing the standard scenario. We determined the cumulative positivity rate (PR) and the numbers of subjects diagnosed with advanced adenomas (N_AdvAd) and early stage CRC (N_earlyCRC) in the cohort over two rounds of screening (standard scenario) and compared it with hypothetical single-round screening with use of a lower cut-off and omission of the second round (alternative scenario). Results: In the standard scenario, the cumulative (ie, round I and II combined) PR, N_AdvAd and N_earlyCRC were 13%, 180% and 26%, respectively. In alternative scenarios using a cut-off level of respectively =11 and =22 ng/HbmL buffer (corresponding to 2 and 4 mg Hb/g faeces), the PRs were 18% and 13%, the N_AdvAd were 180 and 162 and the N_earlyCRC ranged between 22-27 and 22-26. Conclusions: The diagnostic yield of FIT screening using a lowered positivity threshold in combination with an extended screening interval (up to 5 years) may be similar to conventional FIT strategies. This justifies and motivates further research steps in this direction.

Published
2016

76. Second-Look Colonoscopies and the Impact on Capacity in FIT-Based Colorectal Cancer Screening

Author

Grobbee, E., Kapidzic, A., van Vuuren, A., van Leerdam, M., Lansdorp-Vogelaar, Iris, Looman, C., Bruno, M., Kuipers, E., Spaander, M., Grobbee, E., Kapidzic, A., van Vuuren, A., van Leerdam, M., Lansdorp-Vogelaar, Iris, Looman, C., Bruno, M., Kuipers, E., and Spaander, M.

Abstract

Objectives: Fecal immunochemical testing (FIT) and colonoscopy are tandem procedures in colorectal cancer (CRC) screening. A positive FIT predicts advanced neoplasia (AN) that requires endoscopic detection and removal. En bloc or piecemeal resection of AN is associated with a significant rate of residual or recurrent neoplasia. Second-look colonoscopies are indicated to assess completeness of removal of AN. These colonoscopies can make a substantial demand on colonoscopy capacity and health-care system. This study is the first to evaluate the demand and risk factors for second-look colonoscopy in FIT CRC screening. Methods: All colonoscopies after a positive FIT, in subjects aged 50–74 years approached for 3 rounds of FIT screening, were prospectively registered. Second-look colonoscopies were defined as any colonoscopy within 1 year following a colonoscopy after positive FIT. Results: Out of 1,215 FIT-positive screenees undergoing colonoscopy, 105 (8.6%) patients underwent a second-look colonoscopy, of whom 30 (2.5%) underwent more than one colonoscopy (range 2–9), leading to a total of 149 (12.3%) additional colonoscopies. Main reasons for second-look colonoscopies were assessment of complete AN removal (41.9%) and need for additional polypectomy (34.3%). Risk factors were advanced adenomas and poor bowel preparation (P<0.001). High fecal hemoglobin concentration was the only predictor of a second-look colonoscopy before index colonoscopy (P<0.001). Conclusions: Second-look colonoscopies have substantial impact on colonoscopy resources, increasing the demand with 12%. The main reasons for these second-look colonoscopies were previous incomplete polypectomy and control of completeness of removal of neoplastic lesions. A high fecal hemoglobin concentration as measured by FIT can help to identify patients at risk of a second-look colonoscopy.

Published
2015

77. Evaluation of current prediction models for Lynch syndrome: updating the PREMM5 model to identify PMS2 mutation carriers.

Author

Goverde, A., Spaander, M. C. W., Nieboer, D., van den Ouweland, A. M. W., Dinjens, W. N. M., Dubbink, H. J., Tops, C. J., ten Broeke, S. W., Bruno, M. J., Hofstra, R. M. W., Steyerberg, E. W., and Wagner, A.

Abstract

Until recently, no prediction models for Lynch syndrome (LS) had been validated for PMS2 mutation carriers. We aimed to evaluate MMRpredict and PREMM5 in a clinical cohort and for PMS2 mutation carriers specifically. In a retrospective, clinic-based cohort we calculated predictions for LS according to MMRpredict and PREMM5. The area under the operator receiving characteristic curve (AUC) was compared between MMRpredict and PREMM5 for LS patients in general and for different LS genes specifically. Of 734 index patients, 83 (11%) were diagnosed with LS; 23 MLH1, 17 MSH2, 31 MSH6 and 12 PMS2 mutation carriers. Both prediction models performed well for MLH1 and MSH2 (AUC 0.80 and 0.83 for PREMM5 and 0.79 for MMRpredict) and fair for MSH6 mutation carriers (0.69 for PREMM5 and 0.66 for MMRpredict). MMRpredict performed fair for PMS2 mutation carriers (AUC 0.72), while PREMM5 failed to discriminate PMS2 mutation carriers from non-mutation carriers (AUC 0.51). The only statistically significant difference between PMS2 mutation carriers and non-mutation carriers was proximal location of colorectal cancer (77 vs. 28%, p < 0.001). Adding location of colorectal cancer to PREMM5 considerably improved the models performance for PMS2 mutation carriers (AUC 0.77) and overall (AUC 0.81 vs. 0.72). We validated these results in an external cohort of 376 colorectal cancer patients, including 158 LS patients. MMRpredict and PREMM5 cannot adequately identify PMS2 mutation carriers. Adding location of colorectal cancer to PREMM5 may improve the performance of this model, which should be validated in larger cohorts. [ABSTRACT FROM AUTHOR]

Published
2018
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80. Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study

Author

Tringali, Andrea, Didden, P, Repici, A, Spaander, M, Bourke, Mj, Williams, Sj, Spicak, J, Drastich, P, Mutignani, Massimiliano, Perri, Vincenzo, Roy, A, Johnston, K, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Perri, Vincenzo (ORCID:0000-0002-0551-0873), Costamagna, Guido (ORCID:0000-0002-8100-2731), Tringali, Andrea, Didden, P, Repici, A, Spaander, M, Bourke, Mj, Williams, Sj, Spicak, J, Drastich, P, Mutignani, Massimiliano, Perri, Vincenzo, Roy, A, Johnston, K, Costamagna, Guido, Tringali, Andrea (ORCID:0000-0002-9614-3449), Mutignani, Massimiliano (ORCID:0000-0002-1272-4888), Perri, Vincenzo (ORCID:0000-0002-0551-0873), and Costamagna, Guido (ORCID:0000-0002-8100-2731)

Abstract

Malignant gastric outlet obstruction is often treated by stent placement.

Published
2014

87. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death.

Author

Bretthauer, M., Loberg, M., Wieszczy, P., Kalager, M., Emilsson, L., Garborg, K., Rupinski, M., Dekker, E., Spaander, M., Bugajski, M., Holme, Ø., Zauber, A. G., Pilonis, N. D., Mroz, A., Kuipers, E. J., Shi, J., Hernan, M. A., Adami, H.-O., Regula, J., and Hoff, G.

Subjects
*EVALUATION research, *RESEARCH funding, *EARLY detection of cancer, *COLORECTAL cancer, *RELATIVE medical risk, *RANDOMIZED controlled trials, *RESEARCH, *RESEARCH methodology, *MEDICAL screening, *COMPARATIVE studies, *COLONOSCOPY
Abstract

Background: Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear.Methods: We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio either to receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause.Results: Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04).Conclusions: In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.). [ABSTRACT FROM AUTHOR]

Published
2022
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89. Endoscopic resection for residual oesophageal neoplasia after definitive chemoradiotherapy.

Author

Honing J, Koch AD, Siersema PD, and Spaander M

Subjects
Humans, Neoplasm Recurrence, Local therapy, Chemoradiotherapy, Treatment Outcome, Retrospective Studies, Carcinoma, Squamous Cell surgery, Carcinoma, Squamous Cell pathology, Esophageal Neoplasms surgery, Esophageal Neoplasms pathology, Esophageal Squamous Cell Carcinoma surgery
Abstract

Definitive chemoradiation is the recommended treatment for locally advanced, irresectable oesophageal cancer and a valid alternative to neoadjuvant chemoradiotherapy (CRT) with surgery in oesophageal squamous cell cancer (OSCC) patients. In case of locoregional recurrence, salvage treatment can be considered in fit and resectable patients. Salvage surgery is a valid option but associated with significant morbidity. Therefore, for tumors confined to the mucosa or submucosal layers endoscopic resection is a good and less-invasive alternative. Over the last decade several case-series have demonstrated a high technical success rate of endoscopic treatment after definitive CRT. In this review we summarize the clinical outcomes and challenges of endoscopic treatment of early recurrence after definitive CRT in oesophageal cancer., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2024
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90. Colorectal Cancer Stage Distribution at First and Repeat Fecal Immunochemical Test Screening.

Author

Kooyker A, de Jonge L, Toes-Zoutendijk E, Spaander M, van Vuuren H, Kuipers E, van Kemenade F, Ramakers C, Dekker E, Nagtegaal I, van Leerdam M, and Lansdorp-Vogelaar I

Subjects
Humans, Occult Blood, Neoplasm Staging, Hemoglobins analysis, Feces chemistry, Mass Screening methods, Colonoscopy, Early Detection of Cancer methods, Colorectal Neoplasms diagnosis, Colorectal Neoplasms pathology
Abstract

Background & Aims: For colorectal cancer (CRC) screening to be effective, it is important that screen-detected cancers are found at an early stage. Studies on stage distribution of screen-detected CRC at repeat screening of large population-based fecal immunochemical test (FIT)-based screening programs and the impact of FIT cut-off values on staging currently are lacking., Methods: We obtained data for FIT-positive participants (FIT cut-off, 47 μg hemoglobin/g feces) at their first or second (ie, repeat) screening from the Dutch National Screening Database from 2014 to 2018. Tumor characteristics were acquired through linkage with The Netherlands Cancer Registry. We compared stage at diagnosis (I-II vs III-IV) of CRCs detected at a first or second screening. In addition, we analyzed the hypothetical yield and stage distribution of CRC for different FIT cut-off values up to 250 μg hemoglobin/g feces., Results: At the first and second screenings, respectively, 15,755 and 3304 CRCs were detected. CRCs detected at the first or second screening were equally likely to be stages I to II (66.5% vs 67.7%; relative risk, 1.02; 95% CI, 1.00-1.05). A hypothetical increase of the FIT cut-off value from 47 μg to 250 μg resulted in a reduction of detected CRCs by 88.3% and 79.0% at the first or second screening, respectively. Even then, the majority of detected CRCs (63%-64%) still would be diagnosed at stages I to II., Conclusions: FIT-based screening is effective in downstaging CRC, and also at repeat screening. Increasingly, the FIT cut-off level has a limited impact on the stage distribution of detected CRCs, although it greatly affects CRC detection and thus is important to keep low., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2023
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91. Colorectal cancer risk after removal of polyps in fecal immunochemical test based screening.

Author

van Toledo DEFWM, IJspeert JEG, Spaander MCW, Nagtegaal ID, van Leerdam ME, Lansdorp-Vogelaar I, and Dekker E

Abstract

Background: Colonoscopy surveillance intervals are based on the predicted risk of metachronous colorectal cancer (CRC) after polyp removal. However, risk estimation per polyp subtype is difficult due to the fact that many patients have multiple polyps. To enable risk estimation per polyp subtypes we examined the metachronous CRC risk of subgroups based on presence or absence of co-occurring findings., Methods: Using high-quality screening colonoscopies performed after a positive fecal immunochemical test between 2014 and 2020 within the Dutch CRC screening program, we applied Cox regression analysis to evaluate the association between findings at baseline colonoscopy and metachronous CRCs. For our primary outcome, we appointed each patient to unique subgroups based on removed polyp subtypes that were present or absent at baseline colonoscopy and used the groups without polyps as reference. High-risk subgroups were individuals with high-risk serrated polyps, defined as serrated polyp ≥10 mm, sessile serrated lesions with dysplasia, or traditional serrated adenomas, as well as high-risk adenomas, defined as adenoma ≥10 mm or containing high-grade dysplasia., Findings: In total 253,833 colonoscopies were included. Over a median follow-up of 36 months (IQR, 21-57), we identified 504 metachronous CRCs. Hazard ratios for metachronous CRC was 1.70 (95% CI, 1.07-2.69) for individuals with high-risk serrated polyps without high-risk adenomas, 1.22 (0.96-1.55) for individuals with high-risk adenomas without high-risk serrated polyps, and 2.00 (1.19-3.39) for individuals with high-risk serrated polyps and high-risk adenomas, compared to patients without polyps., Interpretation: Accounting for co-occurring findings, we observed an increased metachronous CRC risk for individuals that had high-risk serrated polyps with the presence of high-risk adenomas, or individuals with high-risk serrated polyps without high-risk adenomas. These findings could provide more evidence to support post-polypectomy surveillance guidelines., Funding: None., Competing Interests: ED: Received endoscopic equipment on loan of Olympus and FujiFilm and research grant from FujiFilm; received honorarium for consultancy from FujiFilm, Tillots, Olympus, GI Supply, Cancer Prevention Pharmaceuticals, PAION and Ambu; and a speakers' fee from Olympus, Roche, GI Supply, PAION and IPSEN. MS: received research support from Sentinel, Sysmex, Boston Scientific, Norgine and Medtronic. All other authors have nothing to disclose., (© 2023 The Author(s).)

Published
2023
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92. The evolving role of small-bowel capsule endoscopy.

Author

Pecere S, Chiappetta MF, Del Vecchio LE, Despott E, Dray X, Koulaouzidis A, Fuccio L, Murino A, Rondonotti E, Spaander M, and Spada C

Subjects
Humans, Intestine, Small diagnostic imaging, Gastrointestinal Hemorrhage, Capsule Endoscopy
Abstract

Competing Interests: Declaration of competing interest Cristiano Spada is a consultant for Medtronic, Norgine, and AlfaSigma, and received grants from Olympus and Pentax. The other authors have no potential conflicts of interest.

Published
2023
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93. Low Risk of Progression of Barrett's Esophagus to Neoplasia in Women.

Author

Allen JE, Desai M, Roumans CAM, Vennalaganti S, Vennalaganti P, Bansal A, Falk G, Lieberman D, Sampliner R, Thota P, Vargo J, Gupta N, Moawad F, Bruno M, Kennedy KF, Gaddam S, Young P, Mathur S, Cash B, Spaander M, and Sharma P

Subjects
Cohort Studies, Disease Progression, Europe, Female, Humans, Male, Retrospective Studies, Risk Assessment, United States epidemiology, Barrett Esophagus epidemiology, Esophageal Neoplasms epidemiology, Esophageal Neoplasms etiology, Precancerous Conditions epidemiology
Abstract

Background and Aims: Men are at a higher risk for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), but little is known about BE progression to dysplasia and EAC in women. We performed a retrospective, multicenter cohort study to assess risk of BE progression to dysplasia and EAC in women compared with men. We also investigated comorbidities, medication use, and endoscopic features that contribute to sex differences in risk of BE progression., Methods: We collected data from large cohort of patients with BE seen at 6 centers in the United States and Europe, followed for a median 5.7 years. We obtained demographic information (age, sex, ethnicity), clinical history (tobacco use, body mass index, comorbidities), endoscopy results (procedure date, BE segment length), and histopathology findings. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Rates of disease progression between women and men were compared using χ2 analysis and the Student t test. Multivariable logistic regression was used to assess the association between sex and disease progression after adjusting for possible confounding variables., Results: Of the total 4263 patients in the cohort, 2145 met the inclusion criteria, including 324 (15%) women. There was a total of 34 (1.6%) incident EACs, with an overall annual incidence of 0.3% (95% confidence interval: 0.2%-0.4%). We found significant differences between women and men in annual incidence rates of EAC (0.05% for women vs. 0.3% in men; P=0.04) and in the combined endpoint of HGD or EAC (0.1% for women vs. 1.1% for men; P<0.001). Female gender was an independent predictor for reduced progression to HGD or EAC when rates of progression were adjusted for body mass index, smoking history, race, use of aspirin, nonsteroidal anti-inflammatory drugs, proton-pump inhibitors, or statins, hypertriglyceridemia, BE length, and histology findings at baseline (hazard ratio: 0.11; 95% confidence interval: 0.03-0.45; P=0.002)., Conclusions: In a multicenter study of men versus women with BE, we found a significantly lower risk of disease progression to cancer and HGD in women. The extremely low risk of EAC in women with BE (0.05%/y) indicates that surveillance endoscopy may not be necessary for this subgroup of patients with BE., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2021
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94. [Long-term consequences of esophageal atresia; esophageal and lung abnormalities in adulthood].

Author

Ten Kate CA, Vlot J, Kamphuis LS, IJsselstijn H, and Spaander MCW

Subjects
Adult, Esophagus pathology, Female, Gastroesophageal Reflux complications, Humans, Lung pathology, Male, Middle Aged, Quality of Life, Survivors, Young Adult, Barrett Esophagus etiology, Bronchiectasis etiology, Esophageal Atresia complications, Esophageal Neoplasms etiology, Esophageal Squamous Cell Carcinoma etiology, Esophagitis etiology
Abstract

Esophageal atresia is a rare congenital anomaly. Due to increased survival rates, the population of adults born with this malformation is growing. These patients turn out to have an increased risk to develop Barrett's esophagus, esophageal carcinoma or lung abnormalities like bronchiectasis. This is illustrated by three cases: a 42-year-old man with an irresectable esophageal squamous cell carcinoma; a 23-year-old man with a Barrett's esophagus without any reflux complaints; and a 51-year-old women with a reflux esophagitis and extensive bronchiectasis due to a combination of gastroesophageal reflux with chronic aspiration and a reduced sputum clearance because of a history of tracheomalacia. It is important for healthcare providers to be aware of these risks and the possible absence of symptoms, in order to detect abnormalities at an early stage and improve quality of life of these patients.

Published
2021

95. Residual disease after neoadjuvant chemoradiotherapy for oesophageal cancer: locations undetected by endoscopic biopsies in the preSANO trial.

Author

van der Wilk BJ, Eyck BM, Doukas M, Spaander MCW, Schoon EJ, Krishnadath KK, Oostenbrug LE, Lagarde SM, Wijnhoven BPL, Looijenga LHJ, Biermann K, and van Lanschot JJB

Subjects
Adenocarcinoma diagnostic imaging, Adenocarcinoma pathology, Aftercare, Aged, Biopsy, Carcinoma, Squamous Cell diagnostic imaging, Carcinoma, Squamous Cell pathology, Esophageal Mucosa diagnostic imaging, Esophageal Neoplasms diagnostic imaging, Esophageal Neoplasms pathology, Female, Humans, Male, Middle Aged, Neoplasm, Residual, Predictive Value of Tests, Prospective Studies, Adenocarcinoma therapy, Carcinoma, Squamous Cell therapy, Chemoradiotherapy, Adjuvant, Esophageal Mucosa pathology, Esophageal Neoplasms therapy, Esophagoscopy, Neoadjuvant Therapy
Abstract

Background: Active surveillance has been proposed for patients with oesophageal cancer in whom there is a complete clinical response after neoadjuvant chemoradiotherapy (nCRT). However, endoscopic biopsies have limited negative predictive value in detecting residual disease. This study determined the location of residual tumour following surgery to improve surveillance and endoscopic strategies., Methods: The present study was based on patients who participated in the prospective preSANO trial with adenocarcinoma or squamous cell carcinoma of the oesophagus or oesophagogastric junction treated in four Dutch hospitals between 2013 and 2016. Resection specimens and endoscopic biopsies taken during clinical response evaluations after nCRT were reviewed by two expert gastrointestinal pathologists. The exact location of residual disease in the oesophageal wall was determined in resection specimens. Endoscopic biopsies were assessed for the presence of structures representing the submucosal layer of the oesophageal wall., Results: In total, 119 eligible patients underwent clinical response evaluations after nCRT followed by standard surgery. Residual tumour was present in endoscopic biopsies from 70 patients, confirmed on histological analysis of the resected organ. Residual tumour was present in the resection specimen from 27 of the other 49 patients, despite endoscopic biopsies being negative. Of these 27 patients, residual tumour was located in the mucosa in 18, and in the submucosa beneath tumour-free mucosa in eight. One patient had tumour in muscle beneath tumour-free mucosa and submucosa., Conclusion: Most residual disease after nCRT missed by endoscopic biopsies was located in the mucosa. Active surveillance could be improved by more sampling and considering submucosal biopsies., (© 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd.)

Published
2020
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96. Recent advances in the detection and management of early gastric cancer and its precursors.

Author

Waddingham W, Nieuwenburg SAV, Carlson S, Rodriguez-Justo M, Spaander M, Kuipers EJ, Jansen M, Graham DG, and Banks M

Abstract

Despite declines in incidence, gastric cancer remains a disease with a poor prognosis and limited treatment options due to its often late stage of diagnosis. In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. There remains an East-West divide for this disease, with high incidence countries such as Japan seeing earlier diagnoses and reduced mortality, in part thanks to the success of a national screening programme. With missed cancers still prevalent at upper endoscopy in the West, and variable approaches to assessment of the high-risk stomach, the quality of endoscopy we provide must be a focus for improvement, with particular attention paid to the minority of patients at increased cancer risk. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. An endoscopy-led staging strategy would mean biopsies could be targeted to histologically confirm the endoscopic impression of premalignant lesions including atrophic gastritis, gastric intestinal metaplasia, dysplasia and early cancer. This approach to quality improvement will reduce missed diagnoses and, combined with the latest endoscopic resection techniques performed at expert centres, will improve early detection and ultimately patient outcomes. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Published
2020
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97. Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors.

Author

Ykema B, Rigter L, Spaander M, Moons L, Bisseling T, Aleman B, de Boer JP, Lugtenburg P, Janus C, Petersen E, Roesink J, Raemaekers J, van der Maazen R, Lansdorp-Vogelaar I, Gini A, Verbeek W, Lemmens M, Meijer G, van Leeuwen F, Snaebjornsson P, Carvalho B, and van Leerdam M

Abstract

Background: Hodgkin lymphoma (HL) survivors have an increased colorectal cancer (CRC) risk. Diagnostic accuracy of quantitative fecal immunochemical testing (FIT, OC Sensor) and/or a multi-target stool DNA test (mt-sDNA, Cologuard ® ) for advanced neoplasia (AN) was evaluated., Methods: 101 HL survivors underwent a surveillance colonoscopy and were asked to perform two stool tests (FIT and mt-sDNA). Advanced adenoma (AA), advanced serrated lesion (ASL), and AN (AA, ASL, CRC) were evaluated. Sensitivity, specificity, and area under the curve (AUC) for AN were calculated for different FIT cut-offs and mt-sDNA with colonoscopy as reference., Results: FIT and mt-sDNA were analyzed in 73 (72%) and 82 (81%) participants, respectively. AN was detected in 19 (26%) and 22 (27%), respectively. AN sensitivities for FIT cut-off of 10 ug Hb/g feces (FIT10) and mt-sDNA were 37% (95% confidence interval (CI): 16-62) and 68% (95% CI: 45-86), with corresponding specificities of 91% (95% CI: 80-97) and 70% (95% CI: 57-86), respectively. AUC for FIT was 0.68 (95% CI: 0.54-0.82) and for mt-sDNA 0.76 (95% CI: 0.63-0.89)., Conclusions: In HL survivors, mt-sDNA showed highest sensitivity but with relatively low specificity for AN. Cost-effectiveness analyses is necessary to determine the optimal surveillance strategy.

Published
2020
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98. Achalasia and associated esophageal cancer risk: What lessons can we learn from the molecular analysis of Barrett's-associated adenocarcinoma?

Author

Nesteruk K, Spaander MCW, Leeuwenburgh I, Peppelenbosch MP, and Fuhler GM

Subjects
Adenocarcinoma etiology, Adenocarcinoma genetics, Barrett Esophagus complications, Barrett Esophagus genetics, Disease Progression, Esophageal Achalasia complications, Esophageal Achalasia genetics, Esophageal Neoplasms genetics, Esophageal Squamous Cell Carcinoma etiology, Esophageal Squamous Cell Carcinoma genetics, Gene Expression Regulation, Gene Regulatory Networks, Genetic Predisposition to Disease, Humans, Barrett Esophagus immunology, Esophageal Achalasia immunology, Esophageal Neoplasms etiology
Abstract

Idiopathic achalasia and Barrett's esophagus (BE) are preneoplastic conditions of the esophagus. BE increases the risk of esophageal adenocarcinoma (EAC), while achalasia is associated with both EAC and esophageal squamous cell carcinoma (ESCC). However, while the molecular mechanisms underlying the transformation of esophageal epithelial cells in BE are relatively well characterized, less is known regarding these processes in achalasia. Nevertheless, both conditions are associated with chronic inflammation and BE can occur in achalasia patients, and it is likely that similar processes underlie cancer risk in both diseases. The present review will discuss possible lessons that we can learn from the molecular analysis of BE for the study of achalasia-associated cancer and contrast findings in BE with those in achalasia. First, we will describe cellular fate during development of BE, EAC, and ESCC, and consider the inflammatory status of the epithelial barrier in BE and achalasia in terms of its contribution to carcinogenesis. Next, we will summarize current data on genetic alterations and molecular pathways involved in these processes. Lastly, the plausible role of the microbiota in achalasia-associated carcinogenesis and its contribution to abnormal lower esophageal sphincter (LES) functioning, the maintenance of chronic inflammatory status and influence on the esophageal mucosa through carcinogenic by-products, will be discussed., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Published
2019
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99. Low Incidence of Advanced Neoplasia in Serrated Polyposis Syndrome After (Sub)total Colectomy: Results of a 5-Year International Prospective Cohort Study.

Author

Bleijenberg AGC, IJspeert JEG, Carballal S, Pellise M, Jung G, van Herwaarden YJ, Bisseling TM, Nagtegaal ID, van Leerdam ME, Spaander MCW, van Lelyveld N, Bessa X, Rodríguez-Alcalde D, Bastiaansen BAJ, de Klaver W, Bemelman WA, Bujanda L, Koornstra JJ, Rivero L, Rodríguez-Moranta F, Balaguer F, and Dekker E

Subjects
Adenomatous Polyps pathology, Aged, Cohort Studies, Colonoscopy, Colorectal Neoplasms pathology, Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Prospective Studies, Adenomatous Polyps surgery, Carcinoma epidemiology, Colectomy methods, Colonic Polyps surgery, Colorectal Neoplasms surgery, Neoplasm Recurrence, Local epidemiology, Neoplasms, Multiple Primary surgery
Abstract

Introduction: Serrated polyposis syndrome (SPS) is accompanied by a substantially increased colorectal cancer (CRC) risk. To prevent or treat CRC in patients with a very high polyp burden, (sub)total colectomy with ileorectal or ileosigmoidal anastomosis is regularly performed. The CRC risk after (sub)total colectomy might be decreased, but evidence is lacking. We aimed to assess the yield of endoscopic surveillance in patients with SPS who underwent (sub)total colectomy., Methods: For this post hoc analysis, we used prospectively collected data from a large international prospective cohort study. We included patients diagnosed with SPS (World Health Organization type I and/or III) who underwent (sub)total colectomy. Primary endpoint was the cumulative 5-year incidence of CRC and advanced neoplasia (AN)., Results: Forty-eight patients (mean age 61 [±7.8]; 52% men) were included and followed up for a median of 4.7 years (interquartile range 4.7-5.1). None of the patients developed CRC during follow-up. Five patients developed AN, corresponding to a cumulative 5-year AN incidence of 13% (95% confidence interval 1.2-23). In 4 patients, AN was diagnosed at the first surveillance endoscopy after study inclusion, and in 1 patient, AN was detected during subsequent rounds of surveillance. The risk of AN was similar for patients with ileorectal and ileosigmoidal anastomosis (logrank P = 0.83)., Discussion: (Sub)total colectomy mitigates much of the excess risk of CRC in patients with SPS. Advanced neoplasms are mainly detected at the first endoscopy after (sub)total colectomy. Based on these results, after the first surveillance, intervals might be extended beyond the currently recommended 1-2 years.

Published
2019
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100. Composition of the mucosa-associated microbiota along the entire gastrointestinal tract of human individuals.

Author

Vuik F, Dicksved J, Lam SY, Fuhler GM, van der Laan L, van de Winkel A, Konstantinov SR, Spaander M, Peppelenbosch MP, Engstrand L, and Kuipers EJ

Subjects
Adenocarcinoma microbiology, Adenocarcinoma pathology, Adult, Bacterial Load, Biopsy, Cecal Neoplasms microbiology, Cecal Neoplasms pathology, Double-Balloon Enteroscopy, Female, Humans, Male, Middle Aged, Peutz-Jeghers Syndrome microbiology, Peutz-Jeghers Syndrome pathology, Polymerase Chain Reaction, RNA, Ribosomal, 16S genetics, Sequence Analysis, RNA, Gastric Mucosa microbiology, Gastrointestinal Microbiome
Abstract

Background: Homeostasis of the gastrointestinal tract depends on a healthy bacterial microbiota, with alterations in microbiota composition suggested to contribute to diseases. To unravel bacterial contribution to disease pathology, a thorough understanding of the microbiota of the complete gastrointestinal tract is essential. To date, most microbial analyses have either focused on faecal samples, or on the microbial constitution of one gastrointestinal location instead of different locations within one individual., Objective: We aimed to analyse the mucosal microbiome along the entire gastrointestinal tract within the same individuals., Methods: Mucosal biopsies were taken from nine different sites in 14 individuals undergoing antegrade and subsequent retrograde double-balloon enteroscopy. The bacterial composition was characterised using 16 S rRNA sequencing with Illumina Miseq., Results: At double-balloon enteroscopy, one individual had a caecal adenocarcinoma and one individual had Peutz-Jeghers polyps. The composition of the microbiota distinctively changed along the gastrointestinal tract with larger bacterial load, diversity and abundance of Firmicutes and Bacteroidetes in the lower gastrointestinal tract than the upper gastrointestinal tract, which was predominated by Proteobacteria and Firmicutes ., Conclusions: We show that gastrointestinal location is a larger determinant of mucosal microbial diversity than inter-person differences. These data provide a baseline for further studies investigating gastrointestinal microbiota-related disease.

Published
2019
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