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Surveillance for metachronous cancers after endoscopic resection of esophageal squamous cell carcinoma
Ryu Ishihara
Received October 10, 2023  Accepted December 17, 2023  Published online May 10, 2024  
DOI: https://doi.org/10.5946/ce.2023.263    [Epub ahead of print]
AbstractAbstract PDFPubReaderePub
The literature pertaining to surveillance following treatment for esophageal squamous cell carcinoma (SCC) was reviewed and summarized, encompassing the current status and future perspectives. Analysis of the standardized mortality and incidence ratios for these cancers indicates an elevated risk of cancer in the oral cavity, pharynx, larynx, and lungs among patients with esophageal SCC compared to the general population. To enhance the efficacy of surveillance for these metachronous cancers, risk stratification is needed. Various factors, including multiple Lugol-voiding lesions, multiple foci of dilated vascular areas, young age, and high mean corpuscular volume, have been identified as predictors of metachronous SCCs. Current practice involves stratifying the risk of metachronous esophageal and head/neck SCCs based on the presence of multiple Lugol-voiding lesions. Endoscopic surveillance, scheduled 6–12 months post-endoscopic resection, has demonstrated effectiveness, with over 90% of metachronous esophageal SCCs treatable through minimally invasive modalities. Narrow-band imaging emerges as the preferred surveillance method for esophageal and head/neck SCC based on comparative studies of various imaging techniques. Innovative approaches, such as artificial intelligence-assisted detection systems and radiofrequency ablation of high-risk background mucosa, may improve outcomes in patients following endoscopic resection.
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Recent advances in surveillance colonoscopy for dysplasia in inflammatory bowel disease
Soo-Young Na, Won Moon
Clin Endosc 2022;55(6):726-735.   Published online November 18, 2022
DOI: https://doi.org/10.5946/ce.2022.132
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease (IBD) has a global presence with rapidly increasing incidence and prevalence. Patients with IBD including those with ulcerative colitis and Crohn’s disease have a higher risk of developing colorectal cancer (CRC) compared to the general population. Risk factors for CRC in patients with IBD include long disease duration, extensive colitis, primary sclerosing cholangitis, family history of CRC, stricture, and prior dysplasia. Surveillance colonoscopy for CRC in patients with IBD should be tailored to individualized risk factors and requires careful monitoring every year to every five years. The current surveillance techniques are based on several guidelines. Chromoendoscopy with targeted biopsy is being recommended increasingly, and high-definition colonoscopy is gradually replacing standard-definition colonoscopy. However, it remains unclear whether chromoendoscopy, virtual chromoendoscopy, or white-light endoscopy has better efficiency when a high-definition scope is used. With the development of new endoscopic instruments and techniques, the paradigm of surveillance strategy has gradually changed. In this review, we discuss cutting-edge surveillance colonoscopy in patients with IBD including a review of literature.

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  • Inflammatory bowel disease and primary sclerosing cholangitis: One disease or two?
    Kim N. van Munster, Annika Bergquist, Cyriel Y. Ponsioen
    Journal of Hepatology.2024; 80(1): 155.     CrossRef
  • Extrachromosomal Circular DNA: An Emerging Potential Biomarker for Inflammatory Bowel Diseases?
    Valentina Petito, Federica Di Vincenzo, Lorenza Putignani, Maria T. Abreu, Birgitte Regenberg, Antonio Gasbarrini, Franco Scaldaferri
    Genes.2024; 15(4): 414.     CrossRef
  • A Review of Colonoscopy in Intestinal Diseases
    Seung Min Hong, Dong Hoon Baek
    Diagnostics.2023; 13(7): 1262.     CrossRef
  • Potential Oral Microbial Markers for Differential Diagnosis of Crohn’s Disease and Ulcerative Colitis Using Machine Learning Models
    Sang-Bum Kang, Hyeonwoo Kim, Sangsoo Kim, Jiwon Kim, Soo-Kyung Park, Chil-Woo Lee, Kyeong Ok Kim, Geom-Seog Seo, Min Suk Kim, Jae Myung Cha, Ja Seol Koo, Dong-Il Park
    Microorganisms.2023; 11(7): 1665.     CrossRef
  • Update on Endoscopic Dysplasia Surveillance in Inflammatory Bowel Disease
    Nayantara Coelho-Prabhu, James D. Lewis
    American Journal of Gastroenterology.2023; 118(10): 1748.     CrossRef
  • 3,031 View
  • 208 Download
  • 5 Web of Science
  • 5 Crossref
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Korean guidelines for postpolypectomy colonoscopic surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases
Clin Endosc 2022;55(6):703-725.   Published online October 13, 2022
DOI: https://doi.org/10.5946/ce.2022.136
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for the management of advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: (1) adenoma ≥10 mm in size; (2) 3 to 5 (or more) adenomas; (3) tubulovillous or villous adenoma; (4) adenoma containing high-grade dysplasia; (5) traditional serrated adenoma; (6) sessile serrated lesion (SSL) containing any grade of dysplasia; (7) serrated polyp of at least 10 mm in size; and (8) 3 to 5 (or more) SSLs. More studies are needed to fully comprehend the patients most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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Citations to this article as recorded by  
  • Association between Atherosclerosis and High-Risk Colorectal Adenomas based on Cardio-Ankle Vascular Index and Ankle-Brachial Index
    Jung Ho Lee, Hyunseok Cho, Sang Hoon Lee, Sung Joon Lee, Chang Don Kang, Dae Hee Choi, Jin Myung Park, Seung-Joo Nam, Tae Suk Kim, Ji Hyun Kim, Sung Chul Park
    The Korean Journal of Gastroenterology.2024; 83(4): 143.     CrossRef
  • A survey of current practices in post-polypectomy surveillance in Korea
    Jeongseok Kim, Tae-Geun Gweon, Min Seob Kwak, Su Young Kim, Seong Jung Kim, Hyun Gun Kim, Eun Ran Kim, Sung Noh Hong, Eun Sun Kim, Chang Mo Moon, Dae Seong Myung, Dong Hoon Baek, Shin Ju Oh, Hyun Jung Lee, Ji Young Lee, Yunho Jung, Jaeyoung Chun, Dong-Hoo
    Intestinal Research.2024; 22(2): 186.     CrossRef
  • Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
    Yunho Jung
    The Korean Journal of Internal Medicine.2024; 39(4): 563.     CrossRef
  • Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 Revision
    Su Young Kim
    The Korean Journal of Medicine.2023; 98(3): 102.     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
  • Understanding colorectal polyps to prevent colorectal cancer
    Dong-Hoon Yang
    Journal of the Korean Medical Association.2023; 66(11): 626.     CrossRef
  • Classification and endoscopic diagnosis of colorectal polyps
    Ji Hyun Kim, Sung Chul Park
    Journal of the Korean Medical Association.2023; 66(11): 633.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • 5,412 View
  • 518 Download
  • 8 Web of Science
  • 9 Crossref
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Post-polypectomy surveillance: the present and the future
Masau Sekiguchi, Takahisa Matsuda, Kinichi Hotta, Yutaka Saito
Clin Endosc 2022;55(4):489-495.   Published online July 11, 2022
DOI: https://doi.org/10.5946/ce.2022.097
AbstractAbstract PDFPubReaderePub
An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polypectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

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Citations to this article as recorded by  
  • Protocolo diagnóstico del seguimiento de pólipos colónicos
    S. Redondo Evangelista, M. Sierra Morales, I. Bartolomé Oterino, P. García Centeno, A. Santos Rodríguez
    Medicine - Programa de Formación Médica Continuada Acreditado.2024; 14(4): 219.     CrossRef
  • Approaches and considerations in the endoscopic treatment of T1 colorectal cancer
    Yunho Jung
    The Korean Journal of Internal Medicine.2024; 39(4): 563.     CrossRef
  • Metabolic‐associated fatty liver disease is associated with colorectal adenomas in young and older Korean adults
    Jiwon Chang, Yoosoo Chang, Yoosun Cho, Hyun‐Suk Jung, Dong‐Il Park, Soo‐Kyung Park, Soo‐Youn Ham, Sarah H. Wild, Christopher D. Byrne, Seungho Ryu
    Liver International.2023; 43(11): 2548.     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
  • Strategy for post-polypectomy colonoscopy surveillance: focus on the revised Korean guidelines
    Yong Soo Kwon, Su Young Kim
    Journal of the Korean Medical Association.2023; 66(11): 652.     CrossRef
  • Endoscopic treatment of colorectal polyps and early colorectal cancer
    Yunho Jung
    Journal of the Korean Medical Association.2023; 66(11): 642.     CrossRef
  • Understanding colorectal polyps to prevent colorectal cancer
    Dong-Hoon Yang
    Journal of the Korean Medical Association.2023; 66(11): 626.     CrossRef
  • 3,673 View
  • 256 Download
  • 5 Web of Science
  • 7 Crossref
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Systematic Review and Meta-Analysis
Contamination Rates in Duodenoscopes Reprocessed Using Enhanced Surveillance and Reprocessing Techniques: A Systematic Review and Meta-Analysis
Shivanand Bomman, Munish Ashat, Navroop Nagra, Mahendran Jayaraj, Shruti Chandra, Richard A Kozarek, Andrew Ross, Rajesh Krishnamoorthi
Clin Endosc 2022;55(1):33-40.   Published online January 3, 2022
DOI: https://doi.org/10.5946/ce.2021.212
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background
/Aims: Multiple outbreaks of multidrug-resistant organisms have been reported worldwide due to contaminated duodenoscopes. In 2015, the United States Food and Drug Administration recommended the following supplemental enhanced surveillance and reprocessing techniques (ESRT) to improve duodenoscope disinfection: (1) microbiological culture, (2) ethylene oxide sterilization, (3) liquid chemical sterilant processing system, and (4) double high-level disinfection. A systematic review and meta-analysis was performed to assess the impact of ESRT on the contamination rates.
Methods
A thorough and systematic search was performed across several databases and conference proceedings from inception until January 2021, and all studies reporting the effectiveness of various ESRTs were identified. The pooled contamination rates of post-ESRT duodenoscopes were estimated using the random effects model.
Results
A total of seven studies using various ESRTs were incorporated in the analysis, which included a total of 9,084 post-ESRT duodenoscope cultures. The pooled contamination rate of the post-ESRT duodenoscope was 5% (95% confidence interval [CI]: 2.3%–10.8%, inconsistency index [I2]=97.97%). Pooled contamination rates for high-risk organisms were 0.8% (95% CI: 0.2%–2.7%, I2=94.96).
Conclusions
While ESRT may improve the disinfection process, a post-ESRT contamination rate of 5% is not negligible. Ongoing efforts to mitigate the rate of contamination by improving disinfection techniques and innovations in duodenoscope design to improve safety are warranted.

Citations

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  • Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan
    Wei-Kuo Chang, Chen-Ling Peng, Yen-Wei Chen, Cheuk-Kay Sun, Chieh-Chang Chen, Tao-Chieh Liu, Yin-Yi Chu, I-Fang Tsai, Chen-Shuan Chung, Hsiao-Fen Lin, Fang-Yu Hsu, Wei-Chen Tai, Hsi-Chang Lee, Hsu-Heng Yen, E-Ming Wang, Shu-Hui Chen, Cheng-Hsin Chu, Ming-
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    Melinda Wang, Graham M. Snyder
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    Maria Effenberger, Ramona Al-Zoairy, Ronald Gstir, Ivo Graziadei, Hubert Schwaighofer, Herbert Tilg, Heinz Zoller
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    Harishankar Gopakumar, Neil R. Sharma
    Frontiers in Gastroenterology.2023;[Epub]     CrossRef
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    Harishankar Gopakumar, Ishaan Vohra, Neil R. Sharma, Srinivas R. Puli
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  • 3,961 View
  • 224 Download
  • 4 Web of Science
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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
AbstractAbstract PDFPubReaderePub
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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  • Predictive Significance of Promoter DNA Methylation of Cysteine Dioxygenase Type 1 (CDO1) in Metachronous Gastric Cancer
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  • Gastrointestinal Microbiota Changes in Patients With Gastric Precancerous Lesions
    Dehua Liu, Si Chen, Yawen Gou, Wenyong Yu, Hangcheng Zhou, Rutong Zhang, Jinghao Wang, Fei Ye, Yingling Liu, Baolin Sun, Kaiguang Zhang
    Frontiers in Cellular and Infection Microbiology.2021;[Epub]     CrossRef
  • Use of endoscopic assessment of gastric atrophy for gastric cancer risk stratification to reduce the need for gastric mapping
    Duc Trong Quach, Toru Hiyama, Huy Minh Le, Trung Sao Nguyen, Takuji Gotoda
    Scandinavian Journal of Gastroenterology.2020; 55(4): 402.     CrossRef
  • Influence of hypergastrinemia secondary to long-term proton pump inhibitor treatment on ECL cell tumorigenesis in human gastric mucosa
    Atsushi Tatsuguchi, Shintaro Hoshino, Noriyuki Kawami, Katya Gudis, Tsutomu Nomura, Akira Shimizu, Katsuhiko Iwakiri
    Pathology - Research and Practice.2020; 216(10): 153113.     CrossRef
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    Misaki Kanai, Ren Togo, Takahiro Ogawa, Miki Haseyama
    World Journal of Gastroenterology.2020; 26(25): 3650.     CrossRef
  • Naiv Helicobacter pylori pozitif ve negatif hastaların klinik, demografik ve endoskopik karakteristikleri: Retrospektif analiz
    Muhammet AYDIN
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  • Gastrointestinal Microbiota Changes in Patients With Gastric Precancerous Lesions
    Dehua Liu, Si Chen, Yawen Gou, Wenyong Yu, Hangcheng Zhou, Rutong Zhang, Jinghao Wang, Fei Ye, Yingling Liu, Baolin Sun, Kaiguang Zhang
    SSRN Electronic Journal .2020;[Epub]     CrossRef
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  • 34 Web of Science
  • 36 Crossref
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Metachronous Gastric Cancer Following Curative Endoscopic Resection of Early Gastric Cancer
Seiichiro Abe, Ichiro Oda, Takeyoshi Minagawa, Masau Sekiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Amit Bhatt, Yutaka Saito
Clin Endosc 2018;51(3):253-259.   Published online September 18, 2017
DOI: https://doi.org/10.5946/ce.2017.104
AbstractAbstract PDFPubReaderePub
This review article summarizes knowledge about metachronous gastric cancer (MGC) occurring after curative endoscopic resection (ER) of early gastric cancer (EGC), treatment outcomes of patients who developed MGC, and efficacy of Helicobacter pylori eradication to prevent MGC. The incidence of MGC following curative ER increases over time and is higher than in patients undergoing gastrectomy. Increasing age and multifocal EGC are independent risk factors for developing MGC. An MGC following curative ER is usually a small (<20 mm) and differentiated intramucosal cancer. Most MGC lesions are found at an early stage on semiannual or annual surveillance endoscopy and are successfully treated by further ER, with excellent long-term outcomes. Eradication of H. pylori may reduce the risk of MGC following ER of EGC, but further prospective studies with long-term outcomes are required. Surveillance endoscopy following gastric ER should be continued indefinitely, due to the risk of MGC even after successful H. pylori eradication. Risk stratification and tailored endoscopic surveillance schedules need to be developed.

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Optimal Colonoscopy Surveillance Interval after Polypectomy
Tae Oh Kim
Clin Endosc 2016;49(4):359-363.   Published online July 29, 2016
DOI: https://doi.org/10.5946/ce.2016.080
AbstractAbstract PDFPubReaderePub
The detection and removal of adenomatous polyps and postpolypectomy surveillance are considered important for the control of colorectal cancer (CRC). Surveillance using colonoscopy is an effective tool for preventing CRC after colorectal polypectomy, especially if compliance is good. In current practice, the intervals between colonoscopies after polypectomy are variable. Different recommendations for recognizing at risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published. However, high-grade dysplasia and the number and size of adenomas are known major cancer predictors. Based on this, a subgroup of patients that may benefit from intensive surveillance colonoscopy can be identified.

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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancers
Colon Cancer Screening and Surveillance in Inflammatory Bowel Disease
Song I Bae, You Sun Kim
Clin Endosc 2014;47(6):509-515.   Published online November 30, 2014
DOI: https://doi.org/10.5946/ce.2014.47.6.509
AbstractAbstract PDFPubReaderePub

Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Accordingly, the duration and anatomic extent of the disease have been known to affect the development of IBD-related CRC. When CRC occurs in patients with IBD, unlike in sporadic CRC, it is difficult to detect the lesions because of mucosal changes caused by inflammation. In addition, the tumor types vary with ill-circumscribed lesions, and the cancer is difficult to diagnose and remedy at an early stage. For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter. The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD. A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected. Currently, pharmacotherapies are being extensively studied as a way to prevent IBD-related CRC.

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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
AbstractAbstract PDFPubReaderePub

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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Original Article
The Effect of the Bowel Preparation Status on the Risk of Missing Polyp and Adenoma during Screening Colonoscopy: A Tandem Colonoscopic Study
Sung Noh Hong, In Kyung Sung, Jeong Hwan Kim, Won Hyeok Choe, Byung Kook Kim, Soon Young Ko, Jung Hyun Lee, Dong Choon Seol, Su Young Ahn, Sun-Young Lee, Hyung Seok Park, Chan Sup Shim
Clin Endosc 2012;45(4):404-411.   Published online November 30, 2012
DOI: https://doi.org/10.5946/ce.2012.45.4.404
AbstractAbstract PDFPubReaderePub
Background/Aims

Although a small amount of fecal material can obscure significant colorectal lesions, it has not been well documented whether bowel preparation status affects the missing risk of colorectal polyps and adenomas during a colonoscopy.

Methods

We prospectively enrolled patients with one to nine colorectal polyps and at least one adenoma of >5 mm in size at the screening colonoscopy. Tandem colonoscopy with polypectomy was carried out within 3 months.

Results

A total of 277 patients with 942 polyps and 714 adenomas completed index and tandem examinations. At the index colonoscopy, 187 polyps (19.9%) and 127 adenomas (17.8%) were missed. The per-patient miss rate of polyps and adenomas increased significantly as the bowel cleansing rate declined from excellent to poor/inadequate on the Aronchick scale (polyps, p=0.024; adenomas, p=0.040). The patients with poor/inadequate bowel preparation were independently associated with an increased risk of having missed polyps (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.13 to 9.15) or missed adenomas (OR, 3.04; 95% CI, 1.04 to 8.88) compared to the patients with excellent bowel preparation.

Conclusions

The risk of missing polyps and adenomas during screening colonoscopy is significantly affected by bowel preparation status. It seems appropriate to shorten the colonoscopy follow-up interval for patients with suboptimal bowel preparation.

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Special Issue Articles of IDEN 2012
Colonoscopic Cancer Surveillance in Inflammatory Bowel Disease: What's New Beyond Random Biopsy?
James E. East
Clin Endosc 2012;45(3):274-277.   Published online August 22, 2012
DOI: https://doi.org/10.5946/ce.2012.45.3.274
AbstractAbstract PDFPubReaderePub

Colonoscopy based colitis surveillance is widely accepted to try to prevent development of and ensure early detection of colitis-associated colorectal cancer. Traditionally this has been performed with quadrantic random biopsies throughout the colon. Chromoendoscopy "dye-spray" with targeted biopsies only has been shown to increase dysplasia detection 4 to 5 fold on a per lesion basis. It has therefore been suggested that random biopsies should be abandoned as they do not increase dysplasia detection nor change patient clinical course. Recent British guidelines for colitis surveillance have strongly endorsed chromoendoscopy. This short review summarizes current international guidelines and looks at how to optimize white light colonoscopy in colitis considering: bowel preparation, withdrawal time, high definition, and structure enhancement. Data for advanced imaging techniques are reviewed including positive evidence in favor of chromoendoscopy, and limited data suggesting autofluoresence imaging may be promising. Narrow band imaging does not increase dysplasia detection in colitis. Confocal endomicroscopy might potentially reduce biopsies beyond that of chromoendoscopy but does not offer a clear detection advantage. Pan-colonic chromoendoscopy with targeted biopsies increases dysplasia detection and is the standard of care in the United Kingdom. It is likely that the use of chromoendoscopy for colitis surveillance will become widely accepted internationally.

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Review
Korean Guidelines for Postpolypectomy Colonoscopy Surveillance
Dong-Hoon Yang, Sung Noh Hong, Young-Ho Kim, Sung Pil Hong, Sung Jae Shin, Seong-Eun Kim, Bo In Lee, Suck-Ho Lee, Dong Il Park, Hyun-Soo Kim, Suk-Kyun Yang, Hyo Jong Kim, Se Hyung Kim, Hyun Jung Kim, Multi-Society Task Force for Development of Guidelines for Colorectal Polyp Screening, Surveillance and Management
Clin Endosc 2012;45(1):44-61.   Published online March 31, 2012
DOI: https://doi.org/10.5946/ce.2012.45.1.44
AbstractAbstract PDFSupplementary MaterialPubReaderePub

Postpolypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. In this report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy and we elucidated the high risk findings of the index colonoscopy as follows: 3 or more adenomas, any adenoma larger than 10 mm, any tubulovillous or villous adenoma, any adenoma with high-grade dysplasia, and any serrated polyps larger than 10 mm. Surveillance colonoscopy should be performed five years after the index colonoscopy for those without any high-risk findings and three years after the index colonoscopy for those with one or more high risk findings. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polypectomy, the patient's general condition, and family and medical history.

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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
AbstractAbstract 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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Barrett's Esophagus - With Emphasis on Endoscopic Disgnosis
Jun Haeng Lee, M.D.
Korean J Gastrointest Endosc 2009;39(4):185-198.   Published online October 30, 2009
AbstractAbstract PDF
Barrett's esophagus is a metaplastic change of the esophageal mucosa, such that the normal squamous epithelium is replaced by specialized columnar epithelium. During the last decades, there has been a significant change in the definition, endoscopic diagnosis, pathologic diagnosis, surveillance and management of Barrett's esophagus. Because of the rising prevalence of gastroesophgeal reflux disease in Korea, problems related to Barrett's esophagus are expected to be much more common in the near future. In this review, methods of endoscopic diagnosis of Barrett's esophagus are discussed in detail. Management strategies in the context of Korean epidemiology are also suggested. (Korean J Gastrointest Endosc 2009; 39:185-198)
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A Survey on the Interval of Post-polypectomy Surveillance Colonoscopy
Mun Su Kang, M.D., Dong Il Park, M.D., Jung Ho Park, M.D., Hong Joo Kim, M.D., Yong Kyun Cho, M.D., Chong Il Sohn, M.D., Woo Kyu Jeon, M.D. and Byung Ik Kim, M.D.
Korean J Gastrointest Endosc 2006;33(6):339-345.   Published online December 30, 2006
AbstractAbstract PDF
Background
/Aims: Colonoscopy is the golden standard used as a surveillance test and screen for colon cancer, and the current demand for colonoscopy exceeds its availability. This study is an assessment of the colonoscopic surveillance intervals currently practiced. Methods: A multiple choice survey of the colonoscopic surveillance interval used in six case scenarios [hyperplastic polyp; two 0.5 cm tubular adenomas (TAs); a 1.5 cm TA; 0.8 cm triple TAs; a 1.5 cm TA with high grade dysplasia; current normal exam after polypectomy of a <1 cm sized TA 3 years ago] was sent via e-mail to members of the KASID. Results: A total of 131 colonoscopists (104 men, 27 women) replied, and the mean age of the respondents was 36 years (range 28∼58). All respondents were board- certified in their respective specialties (internal medicine 75, general surgery 3, and GI subspecialty 53). When compared with the AGA guidelines, 90.1∼99.2% of the respondents performed the first post-polypectomy surveillance colonoscopy prematurely, and 75.6% of respondents performed the second surveillance prematurely. Conclusions: Most post-polypectomy surveillance colonoscopies were performed prematurely. It is quite possible that unnecessary surveillance may account for a significant portion of the demand for colonoscopy. (Korean J Gastrointest Endosc 2006;33:339⁣345)
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원저 : 식도 위장관 ; 융모성 종양의 특성과 대책 ( Original Articles : Esophagus , Stomach & Intestine ; Tubulovillous and Villous Adenomas of the Colon and Rectum - Endoscopic Characteristics and Management - )
Korean J Gastrointest Endosc 1998;18(4):506-519.   Published online November 30, 1997
AbstractAbstract PDF
Background
/Aims: A villous tumor, histologically villous or tubulovillous adenoma, is a clinical challenge because of its higher potential for malignancy and higher recurrence rate. However, information and experience with these tumors in the Korean people is still lacking. For that reason, we designed this study to review and analyze the colonoscopic features, the potential for malignancy, and the treatiment with respect to the confirmation of guidelines for the accurate diagnosis and reasonable management of such tumors in the Korean population. Materials and Methods: We performed 753 polypectomies, including 4 transanal excisions and several bowel resections, from January 1996 to May 1997 at Song-Do Colorectal Hospital in Seoul, Among them, 447 cases (59.4%) were adenomas, comprising 405 (53.8%) tubular adenomas, 31 (4.1%) tubulovillous adenomas, and 11 (1.5%) villous adenomas. We analyzed the 42 (5.6%) tubulovillous and villous adenomas. (Korean J Gastraintest Endosc 18: 506-519, 1998) (continue)
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