Endoscopic scar assessment after colorectal endoscopic mucosal resection scars: when is biopsy necessary (EMR Scar Assessment Project for Endoscope (ESCAPE) trial) : When is biopsy necessary (EMR Scar Assessment Project for Endoscope (ESCAPE) trial)
| Autor: | Kandel, Pujan, Brand, Eelco Christiaan, Pelt, Joe, Ball, Colleen T., Chen, Wei Chung, Bouras, Ernest P., Gomez, Victoria, Raimondo, Massimo, Woodward, Timothy A., Wallace, Michael B. |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Colorectal Neoplasms/diagnostic imaging
Male Adult endoscopic procedures Endoscopic Mucosal Resection Colonoscopy/methods Biopsy Cicatrix/pathology Observational Study Unnecessary Procedures Sensitivity and Specificity Neoplasm Recurrence Local/diagnostic imaging colonoscopy Predictive Value of Tests Journal Article Humans Prospective Studies Aged Aged 80 and over Observer Variation Research Support Non-U.S. Gov't Gastroenterology Middle Aged Narrow Band Imaging/methods Female Follow-Up Studies |
| Zdroj: | Gut, 68(9), 1633. BMJ Publishing Group |
| ISSN: | 0017-5749 |
| Popis: | OBJECTIVE: It is unclear whether endoscopic assessment of scars after colorectal endoscopic mucosal resection (EMR) has to include biopsies, even if endoscopy is negative. Vice versa, endoscopic diagnosis of recurrent adenoma may not require biopsy before endoscopic reinterventions. We prospectively analysed various endoscopic modalities in the diagnosis of recurrence following EMR. DESIGN: We conducted a prospective study of patients undergoing colonoscopy after EMR of large (≥20 mm) colorectal neoplasia. Endoscopists predicted recurrence and confidence level with four imaging modes: high-definition white light (WL) and narrow-band imaging (NBI) with and without near focus (NF). Separately, 26 experienced endoscopists assessed offline images. RESULTS: Two hundred and thirty patients with 255 EMR scars were included. The prevalence of recurrent adenoma was 24%. Diagnostic values were high for all modes (negative predictive value (NPV) ≥97%, positive predictive value (PPV) ≥81%, sensitivity ≥90%, specificity ≥93% and accuracy ≥93%). In high-confidence cases, NBI with NF had NPV of 100% (95% CI 98% to 100%) and sensitivity of 100% (95% CI 93% to 100%). Use of clips at initial EMR increased diagnostic inaccuracy (adjusted OR=1.68(95% CI 1.01 to 2.75)). In offline assessment, specificity was high for all imaging modes (mean: ≥93% (range: 55%-100%)), while sensitivity was significantly higher for NBI-NF (82%(72%-93%)%)) compared with WL (69%(38%-86%); p |
| Databáze: | OpenAIRE |
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