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Colonoscopy, virtual colonoscopy, capsule endoscopy European School of Oncology Rome, Italy Dr James East Consultant Gastr...
Overview <ul><li>Colonoscopy </li></ul><ul><ul><li>Interval cancers </li></ul></ul><ul><ul><li>Serrated lesions </li></ul>...
Background <ul><li>1 st   endoscopic snare polypectomies “very dangerous” </li></ul><ul><li>FOBT +  flexible sigmoidoscopy...
“ Hot button” issue – Cancer prevention Distal rectum and sigmoid: HR 0.50 (0.42-0.59) Proximal colon: HR 0.97 (0.80–1.17)
Colonoscopy outcomes Baxter NN  et al.  Ann Intern Med. 2009; 150 :1-8. Baxter NN  et al.  Gastroenterology 2011; 140 :65–72
Adenoma detection and interval cancer Kaminski MF  et al.  N Engl J Med 2010;362:1795-803
Proximal serrated lesion detection Adenoma and proximal serrated polyp detection correlated R=0.76, P<.001 Kahi CJ  et al ...
Colonoscopic cancer prevention <ul><li>Left colon </li></ul><ul><ul><li>Sessile & pedunculated adenomas </li></ul></ul><ul...
CT colonography in nationwide practice France, n=845, 22 centres 1 of 9 cancer missed – diagnostically unacceptable scan H...
CT colonography performance Conclusions:  Radiologist sensitivity CTC for detection of polyps  ≥ 6 mm in training was the ...
CT colonography – serrated lesions <ul><li>Hyperplastic and serrated lesions ignored in CTC studies </li></ul><ul><li>Flat...
Colon capsule <ul><li>Pilots reported 2006 </li></ul><ul><ul><li>Sensitivity 50-77% </li></ul></ul><ul><ul><li>Specificity...
Colon capsule Van Gossum A  et al.  N Engl J Med 2009; 361 :264-70 Sacher-Huvelin S  et al. Aliment Pharmacol Ther 2010; 3...
Colon capsule development <ul><li>PillCam Colon 2 </li></ul><ul><ul><li>Adaptive frame rates 4-35 images / sec </li></ul><...
Summary <ul><li>Colorectal cancer outcomes now key </li></ul><ul><li>Colonoscopy </li></ul><ul><ul><li>High detection need...
Serrated lesions and follow up colonoscopy Schreiner M  et al.  Gastroenterology 2010; 139 :1497–1502
Serrated lesions and follow up colonoscopy Schreiner M  et al.  Gastroenterology 2010; 139 :1497–1502
Serrated lesions and follow up colonoscopy Schreiner M  et al.  Gastroenterology 2010; 139 :1497–1502
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Endoscopy in Gastrointestinal Oncology - Slide 16 - J. East - Colonoscopy, virtual colonoscopy, capsule endoscopy

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Endoscopy in Gastrointestinal Oncology - Slide 16 - J. East - Colonoscopy, virtual colonoscopy, capsule endoscopy

  1. 1. Colonoscopy, virtual colonoscopy, capsule endoscopy European School of Oncology Rome, Italy Dr James East Consultant Gastroenterologist, John Radcliffe Hospital 12 April 2011
  2. 2. Overview <ul><li>Colonoscopy </li></ul><ul><ul><li>Interval cancers </li></ul></ul><ul><ul><li>Serrated lesions </li></ul></ul><ul><li>CT colonography </li></ul><ul><ul><li>Nationwide performance and training </li></ul></ul><ul><ul><li>Serrated lesions </li></ul></ul><ul><li>Capsule endoscopy (colon) </li></ul><ul><ul><li>Accuracy </li></ul></ul><ul><ul><li>Development </li></ul></ul>
  3. 3. Background <ul><li>1 st endoscopic snare polypectomies “very dangerous” </li></ul><ul><li>FOBT + flexible sigmoidoscopy for UK bowel cancer screening </li></ul><ul><li>Atkin WS et al. Lancet 2010; 375 :1624-33 </li></ul><ul><li>http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_120076 </li></ul>
  4. 4. “ Hot button” issue – Cancer prevention Distal rectum and sigmoid: HR 0.50 (0.42-0.59) Proximal colon: HR 0.97 (0.80–1.17)
  5. 5. Colonoscopy outcomes Baxter NN et al. Ann Intern Med. 2009; 150 :1-8. Baxter NN et al. Gastroenterology 2011; 140 :65–72
  6. 6. Adenoma detection and interval cancer Kaminski MF et al. N Engl J Med 2010;362:1795-803
  7. 7. Proximal serrated lesion detection Adenoma and proximal serrated polyp detection correlated R=0.76, P<.001 Kahi CJ et al . Clin Gastro Hep 2011; 9 :42–46 Hetzel JT et al. Am J Gastroenterol 2010; 105 :2656–2664
  8. 8. Colonoscopic cancer prevention <ul><li>Left colon </li></ul><ul><ul><li>Sessile & pedunculated adenomas </li></ul></ul><ul><li>Right colon </li></ul><ul><ul><li>Flat adenomas & serrated lesions </li></ul></ul>Easy & effective Harder
  9. 9. CT colonography in nationwide practice France, n=845, 22 centres 1 of 9 cancer missed – diagnostically unacceptable scan Heresbach D et al. Gut 2010.doi:10.1136/gut.2010.225623 [E-pub] Mulhall BP et al. Ann Intern Med 2005; 142 :635-50. Mulhall meta analysis 85% (79 to 91)
  10. 10. CT colonography performance Conclusions: Radiologist sensitivity CTC for detection of polyps ≥ 6 mm in training was the sole independent predictor for subsequent sensitivity in detection of such polyps
  11. 11. CT colonography – serrated lesions <ul><li>Hyperplastic and serrated lesions ignored in CTC studies </li></ul><ul><li>Flat and difficult to detect </li></ul><ul><li>Height 27% less than adenomas </li></ul><ul><li>Summers RM et al. AJR 2009; 193 :1305–1310 </li></ul>
  12. 12. Colon capsule <ul><li>Pilots reported 2006 </li></ul><ul><ul><li>Sensitivity 50-77% </li></ul></ul><ul><ul><li>Specificity 70-83% </li></ul></ul><ul><li>Large NEJM study (n=328) </li></ul><ul><ul><li>No FDA approval </li></ul></ul><ul><ul><li>5 of 19 cancers missed </li></ul></ul><ul><li>Eliakim R et al. Endoscopy 2006;38:963-70 </li></ul><ul><li>Schoofs N et al. Endoscopy 2006;38:971-77 </li></ul><ul><li>Van Gossum A et al. N Engl J Med 2009;361:264-70 </li></ul>
  13. 13. Colon capsule Van Gossum A et al. N Engl J Med 2009; 361 :264-70 Sacher-Huvelin S et al. Aliment Pharmacol Ther 2010; 32 :1145–1153
  14. 14. Colon capsule development <ul><li>PillCam Colon 2 </li></ul><ul><ul><li>Adaptive frame rates 4-35 images / sec </li></ul></ul><ul><ul><li>Wider field of view 172 ° </li></ul></ul><ul><ul><li>Eliakim R et al . Gastrointest Endosc 2010; 71 :AB117 </li></ul></ul><ul><li>Improved prep scoring </li></ul><ul><ul><li>Leighton JA et al. Endoscopy 2011; 43 :123-127 </li></ul></ul><ul><li>FICE capsule images (small bowel) </li></ul><ul><ul><li>Imagawa H et al. Gastrointest Endosc 2011; 73 :299-306 </li></ul></ul><ul><li>Steerable capsules (gastric) </li></ul><ul><ul><li>Rey JF et al. Endoscopy 2010; 42 : 541–545 </li></ul></ul>
  15. 15. Summary <ul><li>Colorectal cancer outcomes now key </li></ul><ul><li>Colonoscopy </li></ul><ul><ul><li>High detection needed for right-sided cancer prevention </li></ul></ul><ul><ul><li>Serrated lesions increasingly important </li></ul></ul><ul><li>CT colonography </li></ul><ul><ul><li>Quality similar issue to colonoscopy </li></ul></ul><ul><ul><li>Serrated lesions hard to detect </li></ul></ul><ul><li>Colon capsule </li></ul><ul><ul><li>Not as good as colonoscopy (missed cancers) </li></ul></ul><ul><ul><li>Potential for the future </li></ul></ul>
  16. 16. Serrated lesions and follow up colonoscopy Schreiner M et al. Gastroenterology 2010; 139 :1497–1502
  17. 17. Serrated lesions and follow up colonoscopy Schreiner M et al. Gastroenterology 2010; 139 :1497–1502
  18. 18. Serrated lesions and follow up colonoscopy Schreiner M et al. Gastroenterology 2010; 139 :1497–1502

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