Clinical Endoscopy

Original Article

Assessing the potential of artificial intelligence to enhance colonoscopy adenoma detection in clinical practice: a prospective observational trial: Søren Nicolaj Rønborg, Suresh Ujjal, Rasmus Kroijer, Magnus Ploug; Received February 19, 2024 Accepted May 23, 2024 Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.038 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aim: This study aimed to evaluate the effectiveness of the GI Genius (Medtronic) module in clinical practice, focusing on the adenoma detection rate (ADR) during colonoscopy. Computer-aided polyp detection (CADe) systems using artificial intelligence have been shown to improve adenoma detection in controlled trials. However, the effectiveness of these systems in clinical practice has recently been questioned.
Methods
This single-center prospective observational study was conducted at the University Hospital of Southern Denmark and included all individuals referred for colonoscopy between November 2020 and January 2021. The primary outcome was ADR, comparing patients examined with CADe to those examined without it. The selection of patients to be examined with the CADe module was completely random.
Results
A total of 502 patients were analyzed (318 in the control group and 184 in the CADe group). The overall ADR was 32.1% with a slight increase in the CADe group (34.7% vs. 30.5%). Multivariable analysis showed a very modest and statistically insignificant increase in ADR (risk ratio, 1.12; 95% confidence interval, 0.88–1.43).
Conclusions
The use of CADe in clinical practice did not increase ADR with statistical significance when compared to colonoscopy without CADe. These findings suggest that the impact of CADe systems in everyday clinical practice are modest.

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Review

Quality indicators in colonoscopy: the chasm between ideal and reality: Su Bee Park, Jae Myung Cha; Clin Endosc 2022;55(3):332-338. Published online April 4, 2022; DOI: https://doi.org/10.5946/ce.2022.037

Abstract PDF PubReader ePub

Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

Citations

Citations to this article as recorded by

What are the priority quality indicators for colonoscopy in real‐world clinical practice?
Kasenee Tiankanon, Satimai Aniwan
Digestive Endoscopy.2024; 36(1): 30. CrossRef
Strategies to improve screening colonoscopy quality for the prevention of colorectal cancer
Joo Hye Song, Eun Ran Kim
The Korean Journal of Internal Medicine.2024; 39(4): 547. CrossRef
A Systematic Review of Exercise Therapy for Bowel Preparation
Yuan-Yuan Zhang, Ramoo Vimala, Ping Lei Chui, Ida Normiha Hilmi
Gastroenterology Nursing.2023;[Epub] CrossRef
Detecting colorectal lesions with image-enhanced endoscopy: an updated review from clinical trials
Mizuki Nagai, Sho Suzuki, Yohei Minato, Fumiaki Ishibashi, Kentaro Mochida, Ken Ohata, Tetsuo Morishita
Clinical Endoscopy.2023; 56(5): 553. CrossRef
AI-powered medical devices for practical clinicians including the diagnosis of colorectal polyps
Donghwan Kim, Eunsun Kim
Journal of the Korean Medical Association.2023; 66(11): 658. CrossRef

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5 Crossref

Original Articles

Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan: Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva; Clin Endosc 2022;55(1):101-112. Published online July 15, 2021; DOI: https://doi.org/10.5946/ce.2021.066

Abstract PDF PubReader ePub: Background
/Aims: The aim of our study was to determine the efficacy of computed tomography colonography (CTC) in screening for colorectal cancer (CRC).
Methods
A total of 612 females and 588 males aged 45 to 75 years were enrolled in CTC screening. CTC was performed following standard bowel preparation and colonic insufflation with carbon dioxide. The main outcomes were the detection rate of CRC and advanced adenoma (AA), prevalence of colorectal lesions in relation to socio-demographic and health factors, and overall diagnostic performance of CTC.
Results
Overall, 56.5% of the 1,200 invited subjects underwent CTC screening. The sensitivity for CRC and AA was 0.89 and 0.97, respectively, while the specificity was 0.71 and 0.99, respectively. The prevalence of CRC and AA was 3.0% (18/593) and 7.1% (42/593), respectively, with the highest CRC prevalence in the 66-75 age group (≥12 times; odds ratio [OR], 12.11; 95% confidence interval [CI], 4.45-32.92). CRC and AA prevalence were inversely correlated with Asian descent, physical activity, and negative fecal immunochemical test results (OR=0.43; 95% CI, 0.22-0.83; OR=0.16; 95% CI, 0.04-0.68; OR=0.5; 95% CI, 0.07-3.85, respectively).
Conclusions
Our study revealed high accuracy of CTC in diagnosing colonic neoplasms, good compliance with CTC screening, and high detection rate of CRC.

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Incidence of Infection among Subjects with Helicobacter pylori Seroconversion: Young Jung Kim, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park; Clin Endosc 2022;55(1):67-76. Published online April 1, 2021; DOI: https://doi.org/10.5946/ce.2020.299

Abstract PDF PubReader ePub

Background
/Aims: Helicobacter pylori (H. pylori) seroconversion may occur during screening for gastric cancer. Our study aimed to assess the number of seroconverted subjects with H. pylori and their results in follow-up tests.
Methods
Data were consecutively collected on subjects who were H. pylori-seronegative and presented for gastric cancer screening. Subjects who were followed up using the same serology test and pepsinogen (PG) assays on the day of endoscopy were included in the study.
Results
During the follow-up of 57.7±21.4 months, 61 (15.0%) of 407 seronegative subjects showed seroconversion. H. pylori infection was detected in six (9.8%) of 61 seroconverted subjects. A diffuse red fundal appearance, with a significant increase in the Kyoto classification scores for gastritis, was observed in the infected subjects (p<0.001). Compared to the false-seropositive subjects, infected subjects showed higher serology titers (p<0.001) and PG II levels (p<0.001) and lower PG I/II ratios (p=0.002), in the follow-up tests.
Conclusions
Seroconversion occurred in 3.3% of seronegative subjects per year; however, only 9.8% had H. pylori infection. The majority (90.2%) of the seroconverted subjects showed false seropositivity without significant changes in the follow-up test results. The diffuse red fundal appearance could be an indicator of H. pylori infection.

Citations

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Type A, Type B, and Non-atrophic Gastritis
Sun-Young Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(2): 108. CrossRef
Endoscopic Resection for Gastric Adenocarcinoma of the Fundic Gland Type: A Case Series
Hwa Jin Lee, Gwang Ha Kim, Dong Chan Joo, Moon Won Lee, Bong Eun Lee, Kyungbin Kim
The Korean Journal of Gastroenterology.2023; 81(6): 259. CrossRef
Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
Hee Seok Moon
Journal of the Korean Medical Association.2022; 65(5): 259. CrossRef
Serum Assay Findings after Successful Helicobacter pylori Eradication
Sun-Young Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(4): 287. CrossRef
Prognosis of Seronegative Subjects with a Helicobacter pylori-infected Spouse
Jae Min Park, Sun-Young Lee, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2021; 21(4): 311. CrossRef

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Review

Current Status of Colorectal Cancer and Its Public Health Burden in Thailand: Kasenee Tiankanon, Satimai Aniwan, Rungsun Rerknimitr; Clin Endosc 2021;54(4):499-504. Published online March 15, 2021; DOI: https://doi.org/10.5946/ce.2020.245-IDEN

Abstract PDF PubReader ePub

Colorectal cancer (CRC) accounts for approximately 10.3% of new cancer cases in Thailand and is currently the 3rd most prevalent cancer found among the Thai population. Starting in 2017, the Thai government announced the national CRC screening program as a response to this important issue. Among the 70 million people currently residing in Thailand, 14 million require screening, while there are approximately a total of 1,000 endoscopists available to perform colonoscopy. Due to the limited resources and shortage of endoscopists in Thailand, applying a population-based one-step colonoscopy program as a primary screening method is not feasible. To reduce colonoscopy workload, with the help of others, including village health volunteers, institution-based health personnel, reimbursement coders, pathologists, and patients due for CRC screening, a two-step approach of one-time fecal immunochemical test (FIT), which prioritizes and filters out subjects for colonoscopy, is chosen. Moreover, additional adjustments to the optimal FIT cutoff value and the modified Asia-Pacific Colorectal Screening risk score, including body weight, were proposed to stratify the priority of colonoscopy schedule. This article aims to give an overview of the past and current policy developmental strategies and the current status of the Thailand CRC screening program.

Citations

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Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand
Ampornpan Theeranut, Nonglak Methakanjanasak, Sunee Lertsinudom, Pattama Surit, Nichanun Panyaek, Saisamon Leeladapattarakul, Peangtikumporn Nilpetch, Pattapong Kessomboon, Chalongchai Chalermwat, Watcharapong Rintara, Wudipong Khongtong, Pawich Paktipat,
Journal of Primary Care & Community Health.2024;[Epub] CrossRef
Cost-Effectiveness of Increasing Access to Colorectal Cancer Diagnosis: Analysis From Thailand
Peeradon Wongseree, Zeynep Hasgul, Mohammad S. Jalali
Value in Health Regional Issues.2024; 43: 101010. CrossRef
Dynamics of colorectal cancer screening in low and middle-income countries: A modeling analysis from Thailand
Peeradon Wongseree, Zeynep Hasgul, Borwornsom Leerapan, Cherdsak Iramaneerat, Pochamana Phisalprapa, Mohammad S. Jalali
Preventive Medicine.2023; 175: 107694. CrossRef
An Assessment of Physicians’ Recommendations for Colorectal Cancer Screening and International Guidelines Awareness and Adherence: Results From a Thai National Survey
Nonthalee Pausawasdi, Pongkamon Tongpong, Tanawat Geeratragool, Phunchai Charatcharoenwitthaya
Frontiers in Medicine.2022;[Epub] CrossRef
Cytotoxic effect of metformin on butyrate-resistant PMF-K014 colorectal cancer spheroid cells
Kesara Nittayaboon, Kittinun Leetanaporn, Surasak Sangkhathat, Sittirak Roytrakul, Raphatphorn Navakanitworakul
Biomedicine & Pharmacotherapy.2022; 151: 113214. CrossRef

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Original Article

Safety and Recipient Satisfaction of Propofol Sedation in Outpatient Endoscopy: A 24-Hour Prospective Investigation Using a Questionnaire Survey: Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Shinsuke Koshita, Takahisa Ogawa, Hiroaki Kusunose, Yoshiki Koike, Taku Yamagata, Toshitaka Sakai, Kaori Masu, Keisuke Yonamine, Kazuaki Miyamoto, Megumi Tanaka, Tomohiro Shimada, Fumisato Kozakai, Kazuki Endo, Haruka Okano, Daichi Komabayashi, Takeshi Shimizu, Shohei Suzuki, Kei Ito; Clin Endosc 2021;54(3):340-347. Published online December 11, 2020; DOI: https://doi.org/10.5946/ce.2020.138

Abstract PDF PubReader ePub

Background
/Aims: The aim of this study was to evaluate the safety of sedation with propofol as an alternative to benzodiazepine drugs in outpatient endoscopy.
Methods
In this prospective study, examinees who underwent outpatient endoscopy under propofol sedation and submitted a nextday questionnaire with providing informed consent were evaluated. Periprocedural acute responses, late adverse events within 24 hours, and examinee satisfaction were evaluated.
Results
Among the 4,122 patients who received propofol in the 17,978 outpatient-based endoscopic examinations performed between November 2016 and March 2018, 2,305 eligible examinees (esophagogastroduodenoscopy for 1,340, endoscopic ultrasonography for 945, and total colonoscopy for 20) were enrolled, and their responses to a questionnaire were analyzed. The mean propofol dose was 69.6±24.4 mg (range, 20–200 mg). Diazepam, midazolam, and/or pentazocine in combination with propofol was administered to 146 examinees. Mild oxygen desaturation was observed in 59 examinees (2.6%); and mild bradycardia, in 2 (0.09%). Other severe reactions or late events did not occur. After eliminating 181 invalid responses, 97.7% (2,065/2,124) of the patients desired propofol sedation in future examinations.
Conclusions
Propofol sedation was found to be safe—without severe adverse events or accidents—for outpatient endoscopy on the basis of the patients’ next-day self-evaluation. Given the high satisfaction level, propofol sedation might be an ideal tool for painless endoscopic screening.

Citations

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Remimazolam and Its Place in the Current Landscape of Procedural Sedation and General Anesthesia
Matthew Brohan, Janette Brohan, Basavana Goudra
Journal of Clinical Medicine.2024; 13(15): 4362. CrossRef
How to implement adverse events as a quality indicator in gastrointestinal endoscopy
Tom G. Moreels
Digestive Endoscopy.2024; 36(1): 89. CrossRef
Propofol Alone versus Propofol in Combination with Midazolam for Sedative Endoscopy in Patients with Paradoxical Reactions to Midazolam
Ji Hyung Nam, Dong Kee Jang, Jun Kyu Lee, Hyoun Woo Kang, Byung-Wook Kim, Byung Ik Jang
Clinical Endoscopy.2022; 55(2): 234. CrossRef
Drugs used for sedation in gastrointestinal endoscopy
Jun Kyu Lee
Journal of the Korean Medical Association.2022; 65(11): 735. CrossRef

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Review

Trends of Colorectal Cancer Prevalence in Kazakhstan Related to Screening: Alma Zhylkaidarova, Dilyara Kaidarova, Kanat Batyrbekov, Oxana Shatkovskaya, Dinara Begimbetova; Clin Endosc 2021;54(1):32-37. Published online May 25, 2020; DOI: https://doi.org/10.5946/ce.2019.198

Abstract PDF PubReader ePub

We carried out an analysis of the total incidence of colon cancer throughout Kazakhstan. Retrospectively, according to the regional reports on endoscopic screening, the study showed an increase in the age-related incidence of colorectal cancer (CRC) cases from 2004–2008 to 2009–2014. The peak of morbidity in both periods was noted in the age category of >70 years. The indicators of the territorial distribution of CRC incidence make it possible to divide the regions into areas with low or high rates of CRC. Specific indicators showed newly diagnosed cases of CRC stages I, II, III, and IV in 2004–2018. The incidence rates of stages I and II showed a two-fold increase (35%–67.4%) and the incidence of stage IV showed a decline from 19.3% to 13.1% and of stage III from 45.7% to 19.5% from 2004 to 2018, respectively. An analysis of CRC incidence throughout Kazakhstan showed an increase in the overall incidence. Since population-based CRC screening was introduced in 2011, the morbidity was found to increase for stages I and II.

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Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries
Gu Liu, Chang-Min Li, Fei Xie, Qi-Lai Li, Liang-Yan Liao, Wen-Jun Jiang, Xiao-Pan Li, Guan-Ming Lu
World Journal of Gastrointestinal Oncology.2024; 16(1): 182. CrossRef
Serum Interleukins 8, 17, and 33 as Potential Biomarkers of Colon Cancer
Constantin-Dan Tâlvan, Liviuța Budișan, Elena-Teodora Tâlvan, Valentin Grecu, Oana Zănoagă, Cosmin Mihalache, Victor Cristea, Ioana Berindan-Neagoe, Călin Ilie Mohor
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Kazakh version of the beck depression inventory: Validation study in female cancer patients
Indira Karibayeva, Botagoz Turdaliyeva, Nor Zuraida Zainal, Fatima Bagiyarova, Dinara Kussainova
Heliyon.2023; 9(7): e18146. CrossRef
Colorectal Cancer Screening with Computed Tomography Colonography: Single Region Experience in Kazakhstan
Jandos Amankulov, Dilyara Kaidarova, Zhamilya Zholdybay, Marianna Zagurovskaya, Nurlan Baltabekov, Madina Gabdullina, Akmaral Ainakulova, Dias Toleshbayev, Alexandra Panina, Elvira Satbayeva, Zhansaya Kalieva
Clinical Endoscopy.2022; 55(1): 101. CrossRef
Association of four genetic variants with colorectal cancer in Kazakhstan population
Yevgeniya Kolesnikova, Dmitriy Babenko, Irina Kadyrova, Svetlana Kolesnichenko, Lyudmila Akhmaltdinova, Ilya Korshukov, Naylya Kabildina, Valentina Sirota, Vera Zhumaliyeva, Dana Taizhanova, Dmitriy Vazenmiller, Anar Turmukhambetova
Oncotarget.2021; 12(21): 2215. CrossRef

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Case Report

Colonic Intramucosal Cancer in the Interposed Colon Treated with Endoscopic Mucosal Resection: A Case Report and Review of Literature: Seung-Ho Baek, Jang-Ho Lee, Dong Ryeol Yoo, Hye Yeong Kim, Meihua Jin, Ah-reum Jang, Dong-Hoon Yang, Jeong-Sik Byeon; Clin Endosc 2019;52(4):377-381. Published online July 30, 2019; DOI: https://doi.org/10.5946/ce.2018.129

Abstract PDF Supplementary Material PubReader ePub

Colon interposition is a surgical procedure used for maintenance of luminal conduit after esophagectomy. Although epithelial neoplasia, such as adenoma and adenocarcinoma, may develop in the interposed colon, there are only few case reports on the condition. Due to the rarity of this condition, there is no definite consensus on recommending screening endoscopy for the early detection of neoplasia in the interposed colons. Here, we report a case of intramucosal adenocarcinoma in an interposed colon. Initial endoscopic resection for this tumor failed to accomplish complete resection. A subsequent endoscopic resection was performed 1 month later and complete resection was achieved. Based on our experience and recommendation on screening endoscopy for gastric cancer in Korea, we suggest that regular screening esophagogastroduodenoscopies should be performed following esophagectomy to detect early neoplasia in the stomach and interposed colon and avoid adverse results induced by delayed detection.

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The presence of adenocarcinoma of the right colon and polyp in colonic graft in a female patient with colon interposition due to caustic stricture of the esophagus in childhood
Stojan Latincic, Maja Pavlov, Jovica Vasiljevic, Dragan Vasin, Milena Papovic
Srpski arhiv za celokupno lekarstvo.2024; 152(1-2): 71. CrossRef

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Reviews

Assessment of Endoscopic Gastric Atrophy according to the Kimura-Takemoto Classification and Its Potential Application in Daily Practice: Duc Trong Quach, Toru Hiyama; Clin Endosc 2019;52(4):321-327. Published online July 22, 2019; DOI: https://doi.org/10.5946/ce.2019.072

Abstract PDF PubReader ePub

The assessment of endoscopic gastric atrophy (EGA) according to the Kimura-Takemoto classification has been reported to correlate well with histological assessment. Although agreement among beginner endoscopists was less than that among experienced endoscopists, it has been shown that agreement level could markedly improve and remained stable after proper training. Several cohort studies have consistently shown that the severity of EGA at baseline is significantly associated with the presence of advanced precancerous gastric lesions and gastric cancer, as well as the development of gastric cancer in future. Patients with moderate-to-severe EGA still have high risk of gastric cancer even after successful Helicobacter pylori eradication and should be candidates for gastric cancer surveillance. The assessment of EGA, therefore, could be used as a preliminary tool to identify individuals at high risk for gastric cancer. In this paper, we review the agreement on mucosal atrophy assessment between the Kimura-Takemoto classification and histology as well as the potential application of this endoscopic classification to identify precancerous gastric lesions and gastric cancer in daily practice.

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Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
Hee Seok Moon
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Current status of the gastric cancer screening program in Korea
Young-Il Kim, Il Ju Choi
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Usefulness of the Kyoto Classification Score for Prediction of Current Helicobacter pylori Infection
Heejun Kang, Chul-Hyun Lim, Sukil Kim, Arum Choi, Jung-Hwan Oh
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Screening Relevance of Sessile Serrated Polyps: Charles J. Kahi; Clin Endosc 2019;52(3):235-238. Published online January 8, 2019; DOI: https://doi.org/10.5946/ce.2018.112

Abstract PDF PubReader ePub

Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursor lesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulate incremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this “conventional” pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is a disproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levels of methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be considered adenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear to have a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serrated polyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively support that SSPs are highly relevant to CRC prevention.

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Revision of Quality Indicators for the Endoscopy Quality Improvement Program of the National Cancer Screening Program in Korea: Jun Ki Min, Jae Myung Cha, Yu Kyung Cho, Jie-Hyun Kim, Soon Man Yoon, Jong Pil Im, Yunho Jung, Jeong Seop Moon, Jin-Oh Kim, Yoon Tae Jeen; Clin Endosc 2018;51(3):239-252. Published online May 31, 2018; DOI: https://doi.org/10.5946/ce.2018.075

Abstract PDF PubReader ePub

Gastroscopy and colonoscopy are widely used for the early diagnosis of stomach and colorectal cancer. The present revision integrates recent data regarding previous quality indicators and novel indicators suggested for gastroscopy and colonoscopy procedures for the National Cancer Screening Program in Korea. The new indicators, developed by the Quality Improvement Committee of the Korean Society for Gastrointestinal Endoscopy, vary in the level of supporting evidence, and most are based solely on expert opinion. Updated indicators validated by clinical research were prioritized, but were chosen by expert consensus when such studies were absent. The resultant quality indicators were graded according to the levels of consensus and recommendations. The updated indicators will provide a relevant guideline for high-quality endoscopy. The future direction of quality indicator development should include relevant outcome measures and an evidence-based approach to support proposed performance targets.

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Quality is the Key for Emerging Issues of Population-Based Colonoscopy Screening: Jin Young Yoon, Jae Myung Cha, Yoon Tae Jeen, on behalf of Medical Policy Committee of Korean Association for the Study of Intestinal Diseases (KASID), Quality Improvement Committee of Korean Society of Gastrointestinal Endoscopy (KSGE); Clin Endosc 2018;51(1):50-55. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2018.010

Abstract PDF PubReader ePub

Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

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Colorectal Cancer Screening—Who, How, and When?: Roisin Bevan, Matthew D Rutter; Clin Endosc 2018;51(1):37-49. Published online January 31, 2018; DOI: https://doi.org/10.5946/ce.2017.141

Abstract PDF PubReader ePub

Colorectal cancer (CRC) is the third most common cancer worldwide. It is amenable to screening as it occurs in premalignant, latent, early, and curable stages. PubMed, Cochrane Database of Systematic Reviews, and national and international CRC screening guidelines were searched for CRC screening methods, populations, and timing. CRC screening can use direct or indirect tests, delivered opportunistically or via organized programs. Most CRCs are diagnosed after 60 years of age; most screening programs apply to individuals 50–75 years of age. Screening may reduce disease-specific mortality by detecting CRC in earlier stages, and CRC incidence by detecting premalignant polyps, which can subsequently be removed. In randomized controlled trials (RCTs) guaiac fecal occult blood testing (gFOBt) was found to reduce CRC mortality by 13%–33%. Fecal immunochemical testing (FIT) has no RCT data comparing it to no screening, but is superior to gFOBt. Flexible sigmoidoscopy (FS) trials demonstrated an 18% reduction in CRC incidence and a 28% reduction in CRC mortality. Currently, RCT evidence for colonoscopy screening is scarce. Although not yet corroborated by RCTs, it is likely that colonoscopy is the best screening modality for an individual. From a population perspective, organized programs are superior to opportunistic screening. However, no nation can offer organized population-wide colonoscopy screening. Thus, organized programs using cheaper modalities, such as FS/FIT, can be tailored to budget and capacity.

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How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program: Yu Kyung Cho; Clin Endosc 2016;49(4):312-317. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.084

Abstract PDF PubReader ePub

In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary.

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Screening for gastric cancer: East and West, features of diagnostic criteria
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Original Articles

Feedback Survey of the Effect, Burden, and Cost of the National Endoscopic Quality Assessment Program during the Past 5 Years in Korea: Yu Kyung Cho, Jeong Seop Moon, Dong Su Han, Yong Chan Lee, Yeol Kim, Bo Young Park, Il-Kwun Chung, Jin-Oh Kim, Jong Pil Im, Jae Myung Cha, Hyun Gun Kim, Sang Kil Lee, Hang Lak Lee, Jae Young Jang, Eun Sun Kim, Yunho Jung, Chang Mo Moon, Ethics and Quality Control Committee of Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2016;49(6):542-547. Published online March 2, 2016; DOI: https://doi.org/10.5946/ce.2015.113

Abstract PDF PubReader ePub

Background
/Aims: In Korea, the nationwide gastric cancer screening program recommends biennial screening for individuals aged 40 years or older by way of either an upper gastrointestinal series or endoscopy. The national endoscopic quality assessment (QA) program began recommending endoscopy in medical institutions in 2009. We aimed to assess the effect, burden, and cost of the QA program from the viewpoint of medical institutions.
Methods
We surveyed the staff of institutional endoscopic units via e-mail.
Results
Staff members from 67 institutions replied. Most doctors were endoscopic specialists. They responded as to whether the QA program raised awareness for endoscopic quality (93%) or improved endoscopic practice (40%). The percentages of responders who reported improvements in the diagnosis of gastric cancer, the qualifications of endoscopists, the quality of facilities and equipment, endoscopic procedure, and endoscopic reprocessing were 69%, 60%, 66%, 82%, and 75%, respectively. Regarding reprocessing, many staff members reported that they had bought new automated endoscopic preprocessors (3%), used more disinfectants (34%), washed endoscopes longer (28%), reduced the number of endoscopies performed to adhere to reprocessing guidelines (9%), and created their own quality education programs (59%). Many responders said they felt that QA was associated with some degree of burden (48%), especially financial burden caused by purchasing new equipment. Reasonable quality standards (45%) and incentives (38%) were considered important to the success of the QA program.
Conclusions
Endoscopic quality has improved after 5 years of the mandatory endoscopic QA program.

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Monthly endoscopy surveillance culture facilitates detection of breaches in the scope reprocessing procedure: 5‐year experience in an endoscopy center
Shu‐Hui Chen, Theophile Liu, Huei‐Wen Lai, Hui‐Lan Chang, Hsu‐Heng Yen
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Jae Gyu Shin, Hyung Wook Kim, Su Bum Park, Cheol Woong Choi, Dae Hwan Kang, Su Jin Kim, Hyeong Seok Nam, Dae Gon Ryu
Medicine.2017; 96(19): e6742. CrossRef
Education and Training Guidelines for the Board of the Korean Society of Gastrointestinal Endoscopy
Hee Seok Moon, Eun Kwang Choi, Ji Hyun Seo, Jeong Seop Moon, Ho June Song, Kyoung Oh Kim, Jong Jin Hyun, Sung Kwan Shin, Beom Jae Lee, Sang Heon Lee
Clinical Endoscopy.2017; 50(4): 345. CrossRef
How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program
Yu Kyung Cho
Clinical Endoscopy.2016; 49(4): 312. CrossRef
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Light-Emitting Diode-Assisted Narrow Band Imaging Video Endoscopy System in Head and Neck Cancer: Hsin-Jen Chang, Wen-Hung Wang, Yen-Liang Chang, Tzuan-Ren Jeng, Chun-Te Wu, Ludovic Angot, Chun-Hsing Lee, Pa-Chun Wang; Clin Endosc 2015;48(2):142-146. Published online March 27, 2015; DOI: https://doi.org/10.5946/ce.2015.48.2.142

Abstract PDF PubReader ePub

Background/Aims

To validate the effectiveness of a newly developed light-emitting diode (LED)-narrow band imaging (NBI) system for detecting early malignant tumors in the oral cavity.

Methods

Six men (mean age, 51.5 years) with early oral mucosa lesions were screened using both the conventional white light and LED-NBI systems.

Results

Small elevated or ulcerative lesions were found under the white light view, and typical scattered brown spots were identified after shifting to the LED-NBI view for all six patients. Histopathological examination confirmed squamous cell carcinoma. The clinical stage was early malignant lesions (T1), and the patients underwent wide excision for primary cancer. This is the pilot study documenting the utility of a new LED-NBI system as an adjunctive technique to detect early oral cancer using the diagnostic criterion of the presence of typical scattered brown spots in six high-risk patients.

Conclusions

Although large-scale screening programs should be established to further verify the accuracy of this technology, its lower power consumption, lower heat emission, and higher luminous efficiency appear promising for future clinical applications.

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LED-Based Light Source Combined with Quantum Dot for Spectral Imaging
Young Min Bae, Dong-Goo Kang, Ki Young Shin, Wonju Lee, Dong-Wook Yoo
Journal of Nanomaterials.2019; 2019: 1. CrossRef

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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancers

Colon Cancer Screening with Image-Enhanced Endoscopy: Bong Min Ko; Clin Endosc 2014;47(6):504-508. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.504

Abstract PDF PubReader ePub

Colorectal cancer (CRC) is a major cause of cancer mortality worldwide, and this has led to an increased use of screening colonoscopy. This screening has resulted in long-term risk reduction in asymptomatic individuals. However, endoscopists may fail to detect advanced adenomas or colon cancer during screening. The reasons that adenomas or cancers are missed are thought to be associated with the location of the lesions or the skills of the endoscopist. To address the limitations of white light endoscopy (WLE) for adenoma detection, advanced endoscopic images have recently been used. Image-enhanced endoscopies (IEEs), including the use of topical dyes, optical filtering, and ultramagnification, allow for gastrointestinal lesion analysis. Many studies have compared the adenoma detection rate (ADR) obtained by using WLE and IEE, but with different results. IEE can be used to help the endoscopist to improve their ADR in screening colonoscopy. This review examines the possible roles of image-enhanced colonoscopy in CRC screening.

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Tae H Ro
World Journal of Gastroenterology.2015; 21(33): 9693. CrossRef

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Endoscopic Gastric Cancer Screening and Surveillance in High-Risk Groups: Il Ju Choi; Clin Endosc 2014;47(6):497-503. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.497

Abstract PDF PubReader ePub

Gastric cancer remains a major cancer problem world-wide and future incidence will likely increase due to rapidly aging population demographics. Population-based screening is being undertaken in Korea and Japan, where gastric cancer incidence rates are high, and seems to be effective in reducing mortality from gastric cancer. However, such strategies are difficult to implement in countries with a low incidence or limited resources. Thus, screening strategies should be directed towards high-risk population subgroups. Gastric cancer has a relatively long mean sojourn time, and prognosis of early-stage disease is excellent. In general population, screening at 2-year interval in Korea seems to be effective for early-stage diagnosis. In subjects with atrophic gastritis or intestinal metaplasia, surveillance is recommended at 1 to 3 years intervals according to European and Japanese recommendation. Screening intervals for family members with sporadic gastric cancer has not yet been adequately evaluated, but 1-year interval is recommended for hereditary diffuse gastric cancer family-members. Gastric cancer patients treated by endoscopic resection are the highest-risk group, and 1-year interval surveillance can detect most metachronous gastric cancers at an early stage. Future gastric cancer surveillance strategies using endoscopy should be guided by risk-stratification assessment, and further refinement of optimal surveillance intervals is needed.

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Screening for Gastric Cancer: The Usefulness of Endoscopy: Kui Son Choi, Mina Suh; Clin Endosc 2014;47(6):490-496. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.490

Abstract PDF PubReader ePub

Gastric cancer screening is common in countries with high prevalence rates of gastric cancer. However, data supporting the effectiveness of gastric cancer screening are lacking. Thus, the aim of this review was to examine the current evidence on gastric cancer screening. Herein, we reviewed radiographic and endoscopic tests as methods of gastric cancer screening. Previous cohort studies and case-control studies have demonstrated reduced gastric cancer mortality in study populations that had undergone gastric cancer screening with radiographic tests. Recently, a case-control study in Japan reported a 30% reduction in gastric cancer mortality when screening was undertaken via endoscopy. Also, endoscopic screening for gastric cancer exhibited higher sensitivity and specificity than radiographic screening. Moreover, most cost-effectiveness analyses on the best strategy for detecting early gastric cancer have generally concluded that endoscopy is more cost-effective than radiographic testing. Although data on the impact of endoscopy screening programs on gastric cancer mortality are limited, recent study results suggest that gastric cancer screening by endoscopy in average-risk populations performs better than radiography screening. Further evaluation of the impact of these screening methods should take into account cost and any associated reduction in gastric cancer mortality.

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World Journal of Gastroenterology.2015; 21(33): 9693. CrossRef

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Prevention Strategies for Gastric Cancer: A Global Perspective: Jin Young Park, Lawrence von Karsa, Rolando Herrero; Clin Endosc 2014;47(6):478-489. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.478

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Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.

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Focused Review Series: Endoscopic and Molecular Imaging of Premalignant GI Lesions, Part II

Barrett Esophagus: When to Endoscope: Joshua Butt, Gabor Kandel; Clin Endosc 2014;47(1):40-46. Published online January 24, 2014; DOI: https://doi.org/10.5946/ce.2014.47.1.40

Abstract PDF PubReader ePub

Increasing interest in identifying an effective strategy for decreasing the burden of esophageal adenocarcinoma (EAC) has been fuelled by the rising EAC rates worldwide, the morbidity associated with esophagectomy, and the development of endoscopic methods for curing early-stage EAC. In the face of this enthusiasm, however, we should be cautious about continuing our current evidence-free approach to screening and one with unclear benefits and unclear costs to the community. The literature is increasingly recognizing that the value of traditional endoscopy for screening and surveillance of Barrett esophagus may be more limited than initially believed. A better understanding of the risk factors for Barrett esophagus and progression to dysplasia and a more individualized risk calculation will be useful in defining populations to consider for Barrett screening. The development of novel, nonendoscopic screening techniques and of less expensive endoscopic techniques holds promise for a cost-effective screening and surveillance method to curtail the increasing rates of EAC.

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Vincenzo Villanacci, Marianna Salemme, Italo Stroppa, Valerio Balassone, Gabrio Bassotti
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Results of Screening Colonoscopy in Asymptomatic Average-risk Koreans at a Community-based Secondary Hospital: Jong Kyu Kim, M.D., Yong Sung Choi, M.D., Jung Pil Suh, M.D., In Taek Lee, M.D.*, Eui Gon Youk, M.D.* and Doo Seok Lee, M.D.*; Korean J Gastrointest Endosc 2010;41(5):266-272. Published online November 30, 2010

Abstract PDF: Background
/Aims: Colonoscopy has emerged as the dominant colorectal cancer screening strategy, yet the data on the results of performing screening colonoscopy in asymptomatic average risk Koreans is limited. The aim of this study is to determine the results of screening colonoscopy at a community-based single center in Korea.
Methods
A total of 13,743 individuals (5,935 males and 7,808 females, age: 50.6±11.8 years) who underwent screening colonoscopy at a community based hospital from April 2006 to March 2008 were analyzed.
Results
Of the 13,743 subjects, neoplasia, advanced neoplasia and early colon cancer were detected in 3,270 subjects (23.8%), 315 subjects (2.3%) and 60 subjects (0.5%), respectively. The prevalence of neoplasia and advanced neoplasia increased with age (p＜0.001), and this was higher among males as compared to that of females (p＜0.001). Of the 3,666 subjects with neoplasia, 1,440 subjects (38.3%) had multiple neoplasia. Old age and male gender were associated with multiple neoplasia.
Conclusions
The overall prevalence of colorectal neoplasia in asymptomatic average-risk Koreans at a community based hospital is comparable with that in a health care setting or university hospitals. Old age and male gender are associated with a higher risk of colorectal neoplasia and having multiple neoplasia. (Korean J Gastrointest Endosc 2010;41:266-272)

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Postpolypectomy Colonoscopy Surveillance: Hyun Soo Kim, M.D.; Korean J Gastrointest Endosc 2009;39(5):257-264. Published online November 30, 2009

Abstract PDF: Colonoscopy and polypectomy are increasingly being used as the most effective interventions for preventing colorectal cancer (CRC), which has resulted in a growing cohort of patients who require postpolypectomy surveillance (PPS). The goal of PPS is to prevent the development of significant metachronous adenomas and CRCs. The surveillance interval depends on an accurate assessment of the individual patient's risk of developing subsequent colonic neoplasm. The newly developed consensus guidelines (CG) emphasize the concept of 'risk stratification' and these guidelines are more user-friendly than the previous ones, thus eliminate conflicting recommendations that are a barrier to physicians using the guideline. Despite the development of CGs, many specialists and non-specialists overutilize colonoscopy for PPS, which causes an ineffective large burden of cost and it strains already limited resources. The safest and most cost-effective approach by colonoscopists to preventing CRC is to maximize the effectiveness of colonoscopy for clearing the colon and then follow the recommended intervals between procedures, including extended intervals for the low-risk cohorts. Educating colonoscopists and the widespread implementation of continuous quality improvement programs are required to bridge the gap between the guidelines and their clinical application. (Korean J Gastrointest Endosc 2009;39:257-264)

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The Colonoscopic Miss Rates of Colorectal Polyps as Determined by a Polypectomy: Se Young Park, M.D., Won Moon, M.D., Seun Ja Park, M.D., Moo In Park, M.D., Kyu Jong Kim, M.D., Sun Jung Kim, M.D., Hong Jun You, M.D. and Woo Seong Jeon, M.D.; Korean J Gastrointest Endosc 2008;36(3):132-137. Published online March 30, 2008

Abstract PDF: Background
/Aims: Colonoscopy is the most effective method to detect and remove colonic polyps and for colorectal cancer screening and prevention. However, polyps are frequently missed during colonoscopy. The aim of this study was to determine the miss rates of polyps by colonoscopy and to evaluate the factors that affect the miss rates. Methods: Within sixty days after a first-time colonoscopy, consecutive polypectomies were performed in 317 patients who had one or more colon polyps. Results: The overall miss rate for polyps was 26.6%. As the withdrawal time increased, the number of polyps detected on the first colonoscopy decreased, and the miss rate decreased significantly (respectively p=0.000, p=0.028). The withdrawal time for an expert operator was shorter than the withdrawal time for a beginner operator (p=0.001). The miss rate for a beginner operator and expert operator was not different (p=0.271) due to interference with withdrawal time. The most frequent location of a polyp was the ascending colon and the most frequent size of a polyp was ≤5 mm. Conclusions: Although colonoscopy is the gold standard for colorectal polyp detection, it is imperfect even when meticulously performed. To reduce the miss rates of polyps, it is important that a careful examination with sufficient withdrawal time is performed, the colonoscopy is complete to the cecum, and that the bowel preparation is adequate. (Korean J Gastrointest Endosc 2008;36:132-137)

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The Significance of Fecal Occult Blood Testing to Screen for Colon Cancer: Jung Hyun Kwon, M.D., Myung Gyu Choi, M.D., Jung Pil Suh, M.D., Jae Hyuck Chang, M.D., Kwan Woo Nam, M.D., Ho Sung Park, M.D., Chang Nyol Paik, M.D., Jae Myung Park, M.D., Yu Kyung Cho, M.D., In Seok Lee, M.D., Sang Woo Kim, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2007;35(2):68-73. Published online August 30, 2007

Abstract PDF: Background
/Aims: We investigated the efficacy of the fecal occult blood test (FOBT) as a colon cancer screening tool in a tertiary hospital setting. Methods: This retrospective study analyzed patients who underwent routine check- ups at Kang-Nam St. Mary's Hospital Health Promotion Center from January 2004 to April 2005. All the subjects were encouraged to submit stool for a FOBT, while performing a double contrast barium enema (DCBE) was optional for those who wanted colon examination. Colonoscopy was performed if the FOBT or DCBE results were abnormal or if the patients had bowel symptoms. Results: The FOBT was performed in 8,198 of 10,182 patients (80.5%) who underwent routine check-ups. The overall positive rate of FOBT was 149 of 8,198 (1.8%) and this increased with age (p＜0.05). Colonoscopy and/or DCBE was performed in 33 of 149 patients (22.1%) in the FOBT positive group. Colon cancer and polyp were diagnosed 2 (6.1%) and 7 (21.2%) patients, respectively, in the FOBT positive group, whereas colon cancer and polyp were diagnosed in 3 (0.5%) and 102 (15.7%) patients, respectively, in the FOBT negative group. The sensitivity and specificity of the FOBT for colon cancer was 40% and 95.4%, respectively. Conclusions: Although it had low sensitivity, the FOBT was a useful screening tool for detecting colon cancer in a tertiary hospital setting.

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The Usefulness of Colonoscopy as a Colon Cancer Screening Test for Asymptomatic Adults: Hyun-Ho Cho, M.D., Seok Young Lee, M.D., Jeong Kwon Huh, M.D., Jung Hoon Kim, M.D.,Hee Hwan Lim, M.D., Hee Sun No, M.D., Jang Hyun Cho, M.D., Sung In Cho, M.D., Duck Ryung Kim, M.D., Su Cheol Park, M.D., Jin Kim, M.D., Chul Ju Han, M.D. and You Cheoul Kim; Korean J Gastrointest Endosc 2007;34(1):14-18. Published online January 30, 2007

Abstract PDF: Background
/Aims: This study evaluated the prevalence and location of colonic adenomatous polyps in asymptomatic adults. Methods: A total of 2,849 asymptomatic adults underwent colonscopic screening as a part of health evaluation from January 2003 to September 2005. Completed questionnaires as well as the colonoscopic and pathologic findings were analyzed. Results: There were 406 (14.3%) subjects with adenomatous polyps including 78 (2.7%) with advanced polyps. There was a trend toward an increased prevalence of adenomatous polyps with age. The relative risk of a proximal polyp according to the distal findings was 5.7 (95% CI 4.3∼7.4) for adenoma, 4.9 (95% CI 3.0∼7.7) for advanced adenoma compared with that for no adenomatous polyp. There were no index polyps at the distal colon in 30% of the 406 subjects. Conclusions: Though distal polyps are associated with the proximal polyps, 30% of asymptomatic adults with proximal polyps are not associated with any distal index polyps. For those without any contraindication to the procedure, colonoscopy performed by experienced colonoscopists as a screening test is feasible for detecting those patients with colorectal polyps.

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Sensitivity of Two-Time Immunochemical Fecal Occult-Blood Testing with Sigmoidoscopy for the Detection of Advanced Colon Adenoma: Ki Tae Suk, M.D., Hyun Soo Kim, M.D., Jung Kwon Kim, M.D., Jung Min Kim, M.D., Myeong Gwan Jee, M.D., Sang Won Ji, M.D., Soon Koo Baik, M.D.,Dong Ki Lee, M.D. and Sang Ok Kwon, M.D.; Korean J Gastrointest Endosc 2004;28(6):291-297. Published online June 30, 2004

Abstract PDF: Background
/Aims: Because detection and removal of colonic adenoma provided an opportunity to prevent colorectal cancer, advanced adenoma (＞10 mm, villous or high grade dysplasia) should be the major target of screening. In this study, we assessed the diagnostic sensitivity of one- or two-time immunochemical fecal occult blood test (i-FOBT), flexible sigmoidoscopy and their combination in patients with advanced adenoma or non-advanced adenoma. Methods: From January to October 2002, we performed colonoscopy with i-FOBT using latex agglutination method in 879 individuals. Among these, we diagnosed 234 polyps in 93 patients with advanced adenoma and 179 polyps in 109 patients with non-advanced adenoma. After the diagnosis of adenoma, second i-FOBT was done before polypectomy. Based on these data, we evaluated the diagnostic sensitivities of i-FOBT, flexible sigmoidoscopy and their combination for patients with advanced adenoma or non-advanced adenoma. Results: The diagnostic sensitivity of one- or two-time i-FOBT, flexible sigmoidoscopy and flexible sigmoidoscopy with two-time i-FOBT in patients with advanced adenoma vs.non-advanced adenoma were 17.2% vs. 18.3%, 28.0% vs. 29.4%, 70.1% vs. 66.1% and 81.7% vs. 78.0%. Although repeated application of i-FOBT enhanced diagnostic sensitivity for colon adenoma, this test or combination with flexible sigmoidoscopy did not differentiate advanced adenoma from non-advanced adenoma. Conclusions: Although it fails to detect one fifth of colon adenoma, combined two-time i-FOBT testing with flexible sigmoidoscopy is an effective and feasible screening modality for advanced colon adenoma. (Korean J Gastrointest Endosc 2004;28:291⁣297)

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Cost-Effectiveness Analysis of Colon Cancer Screening by Colonosopic Examination in Korea: Dong Soo Han, M.D., Joon Yong Park, M.D., Hyung Ran Yun, M.D.^†and Sang Cheol Bae, M.D.*^,†; Korean J Gastrointest Endosc 2004;28(1):1-8. Published online January 30, 2004

Abstract PDF: Background
/Aims: The mortality of colon cancer is reduced by a proper screening test. Recently, colonoscopic screening was reported more cost-effective than stool occult blood test or sigmoidoscopy in America. In this study, we performed cost-effectiveness analysis of colonoscopy as a colon cancer screening test in Korea by using Markov model. Methods: A hypothetical population of 50 years of age divided into 2 groups. Markov model was applied to those with colonoscopic screening and consecutive polypectomy or without screening. The effect of screening test to the general health was expressed as quality-adjusted life years (QALYs). The variables during the screening test and treatment were regarded carefully by sensitivity analysis. Results: The mean cost estimates for colonoscopic exam was 75,164 won and colon cancer treatment was 10,867,177 won. From the analysis using Markov model, the mean cost required for the screening group was 166,717 won and 76,938 won for non-screening group. The QALY in screening group was 18.49. The incremental cost-effectiveness was 1,097,992 won/QALY. Conclusions: Regular colonoscopic exam requires higher medical cost than non-screening group, with its property of reducing mortality from colorectal cancer, however, colonoscopy is a cost-effective means of colorectal cancer screening. (Korean J Gastrointest Endosc 2004;28:1⁣8)

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비만곡 근위부 대장암에 동반된 대장 용종의 의의 ( The Significance of Synchronous Colorectal Polyps in Colon Cancer Proximal to the Splenic Flexure ): Korean J Gastrointest Endosc 2000;20(3):177-182. Published online November 30, 1999

Abstract PDF: Background
/Aims: The aim of this study was to evaluate the characteristics of colorectal polyps, especially distal colorectal polyps and their frequency in patients with colon cancer located proximal to the splenic flexure. Methods: Among 1,250 patients with colorectal cancer, 269 patients (21.5%) had colon cancer located proximal to the splenic flexure. Of these, 183 patients were involved in this study because complete colonoscopic evaluations to the cecum or to the level of proximal colon cancer were possible. Results: 54 patients (29.5%) had one or more distal colorectal polyps, 33 patients (18.1%) had one or more adenomatous distal polyps, and 3 patients (1.6%) had synchronous distal carcinoma. The percentage of patients without distal polyps was 70.5% of 183 patients with proximal colon cancer, and 80.3% of patients without distal neoplastic lesions. The percentage of patients with advanced lesions (villous component, high-grade dysplasia, or ≥1 cm in diameter) was 40.7% of 54 patients with distal colorectal polyps. Conclusions: Flexible sigmoidoscopy is insensitive and ineffective for the detection of proximal colon cancer. Ongoing evaluation of colonoscopy as a general screening test is appropriate.

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원저 : 식도 위장관 ; 건강검진 수진자 9,137 명에 대한 위내시경적 집단 검진 소견 ( Original Articles : Esophagus , Stomach & Intestine ; Esophgogastroduodenoscopic Findings in 9,137 Healthy Subjects Examined for the Secondary Prevention ): Korean J Gastrointest Endosc 1998;18(2):161-168. Published online November 30, 1997

Abstract PDF: Background
A esophagogastroduodenoscopy is now considered to be one of the essential rnethods for diagnosis of upper gastrointestinal disease. Furthermore early detection of stomach cancer by such a mass screening techique is very important to increase the survival rate. Methods: A clinical analysis was conducted on 9,137 healthy subjects who had undergone a gastrofiberscopic examination for the secondary prevention, from January 1995 to December 1996, in Kangbuk Samsung hospital. Results: 1) Number of cases with normal finding was 764 (8.4%). 2) The most prevalent disease found was chronic gastritis (82%). The number of cases with superficial gastritis was 64.7%, erosive gastritis 9.0%, atrophic gastritis 6.4% and metaplastic gastritis 1.6%. Atrophic and metaplastic gastritis were more frequent in the older age group. 3) The prevalence of peptic ulcer was 13.9% and duodenal ulcers (8.1%) was more common than gastric ulcers (5.8%, p<0.05) with a male to female ratio of 3.7: 1, and 2.1: 1 respectively. 4) Of the 10 cases with stomach cancer (0.11%), 5 cases (0.055%) were found to be advanced stomach cancer and the other 5 cases (0.055%) were early gastric cancer. The macroscopic type of early gastric cancer was type IIc in 4 cases and type IIb in another case, and 4 cases were limited in mucosa but another was in submucosa. The size of 4 cases were below 1 cm and there was no lymph node metastasis. Conclusion: Medically screened subjects were found to have many abnormalities, and therefore, it is recommanded that regular check ups using an endoscopy would be needed for early detection of early gastric cancer regardless of clinical symptoms. (Korean J Gastrointest Endosc 18: 161-168, 1998)

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