Pub Date : 2025-01-01Epub Date: 2024-08-30DOI: 10.1053/j.gastro.2024.08.022
Beatriz Carvalho, Willemijn de Klaver, Francine van Wifferen, Meta C J van Lanschot, Alouisa J P van Wetering, Quirine E W van der Zander, Margriet Lemmens, Anne S Bolijn, Marianne Tijssen, Pien Delis-van Diemen, Nikkie Buekers, Kathleen Daenen, Jaleesa van der Meer, Pauline G van Mulligen, Brenda S Hijmans, Sander de Ridder, Lana Meiqari, Mariska Bierkens, René W M van der Hulst, Johan P H Kuyvenhoven, Annemarie M van Berkel, Annekatrien C T M Depla, Monique E van Leerdam, Jeroen M Jansen, Caroline A Wientjes, Jan W A Straathof, Eric T P Keulen, Dewkoemar Ramsoekh, Leon M G Moons, Michael Zacherl, Ad A M Masclee, Meike de Wit, Marjolein J E Greuter, Manon van Engeland, Evelien Dekker, Veerle M H Coupé, Gerrit A Meijer
Background & aims: Colonoscopy-based surveillance to prevent colorectal cancer (CRC) causes substantial burden for patients and health care. Stool tests may help to reduce surveillance colonoscopies by limiting colonoscopies to individuals at increased risk of advanced neoplasia.
Methods: This cross-sectional observational study included individuals aged 50-75 years with surveillance indication. Before bowel preparation, participants collected samples for a multitarget stool DNA test and 2 fecal immunochemical tests (FITs). Test accuracy was calculated for all surveillance indications. For the post-polypectomy indication only, which is the most common and is associated with a relatively low CRC risk, long-term impact of stool-based surveillance was evaluated with the Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA) model. Stool-based strategies were simulated to tune each test's positivity threshold to obtain strategies at least as effective as colonoscopy surveillance.
Results: There were 3453 individuals with results for all stool tests and colonoscopy; 2226 had previous polypectomy, 1003 had previous CRC, and 224 had a familial risk. Areas under the receiver operating characteristic curve for advanced neoplasia were 0.72 (95% CI, 0.69-0.75) for the multitarget stool DNA test, 0.61 (95% CI, 0.58-0.64) for the FIT OC-SENSOR (Eiken Chemical Co, Tokyo, Japan) and 0.59 (95% CI, 0.56-0.61) for the FIT FOB-Gold (Sentinel, Milan, Italy). Stool-based post-polypectomy surveillance strategies at least as effective as colonoscopy surveillance reduced the number of colonoscopies by 15%-41% and required 5.6-9.5 stool tests over a person's lifetime. Multitarget stool DNA-based surveillance was more costly than colonoscopy surveillance, whereas FIT-based surveillance saved costs.
Conclusions: This study found that stool-based post-polypectomy surveillance strategies can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.
{"title":"Stool-Based Testing for Post-Polypectomy Colorectal Cancer Surveillance Safely Reduces Colonoscopies: The MOCCAS Study.","authors":"Beatriz Carvalho, Willemijn de Klaver, Francine van Wifferen, Meta C J van Lanschot, Alouisa J P van Wetering, Quirine E W van der Zander, Margriet Lemmens, Anne S Bolijn, Marianne Tijssen, Pien Delis-van Diemen, Nikkie Buekers, Kathleen Daenen, Jaleesa van der Meer, Pauline G van Mulligen, Brenda S Hijmans, Sander de Ridder, Lana Meiqari, Mariska Bierkens, René W M van der Hulst, Johan P H Kuyvenhoven, Annemarie M van Berkel, Annekatrien C T M Depla, Monique E van Leerdam, Jeroen M Jansen, Caroline A Wientjes, Jan W A Straathof, Eric T P Keulen, Dewkoemar Ramsoekh, Leon M G Moons, Michael Zacherl, Ad A M Masclee, Meike de Wit, Marjolein J E Greuter, Manon van Engeland, Evelien Dekker, Veerle M H Coupé, Gerrit A Meijer","doi":"10.1053/j.gastro.2024.08.022","DOIUrl":"10.1053/j.gastro.2024.08.022","url":null,"abstract":"<p><strong>Background & aims: </strong>Colonoscopy-based surveillance to prevent colorectal cancer (CRC) causes substantial burden for patients and health care. Stool tests may help to reduce surveillance colonoscopies by limiting colonoscopies to individuals at increased risk of advanced neoplasia.</p><p><strong>Methods: </strong>This cross-sectional observational study included individuals aged 50-75 years with surveillance indication. Before bowel preparation, participants collected samples for a multitarget stool DNA test and 2 fecal immunochemical tests (FITs). Test accuracy was calculated for all surveillance indications. For the post-polypectomy indication only, which is the most common and is associated with a relatively low CRC risk, long-term impact of stool-based surveillance was evaluated with the Adenoma and Serrated Pathway to Colorectal Cancer (ASCCA) model. Stool-based strategies were simulated to tune each test's positivity threshold to obtain strategies at least as effective as colonoscopy surveillance.</p><p><strong>Results: </strong>There were 3453 individuals with results for all stool tests and colonoscopy; 2226 had previous polypectomy, 1003 had previous CRC, and 224 had a familial risk. Areas under the receiver operating characteristic curve for advanced neoplasia were 0.72 (95% CI, 0.69-0.75) for the multitarget stool DNA test, 0.61 (95% CI, 0.58-0.64) for the FIT OC-SENSOR (Eiken Chemical Co, Tokyo, Japan) and 0.59 (95% CI, 0.56-0.61) for the FIT FOB-Gold (Sentinel, Milan, Italy). Stool-based post-polypectomy surveillance strategies at least as effective as colonoscopy surveillance reduced the number of colonoscopies by 15%-41% and required 5.6-9.5 stool tests over a person's lifetime. Multitarget stool DNA-based surveillance was more costly than colonoscopy surveillance, whereas FIT-based surveillance saved costs.</p><p><strong>Conclusions: </strong>This study found that stool-based post-polypectomy surveillance strategies can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.</p><p><strong>Clinicaltrials: </strong>gov, Number: NCT02715141.</p>","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"121-135.e16"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142106459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-07DOI: 10.1053/j.gastro.2024.08.037
Mahsa Taghiakbari, Douglas K Rex, Heiko Pohl, Roupen Djinbachian, Felix Huang, Cesare Hassan, Daniel von Renteln
{"title":"Pragmatic Resect and Discard Implementation Using Computer-Assisted Optical Polyp Diagnosis.","authors":"Mahsa Taghiakbari, Douglas K Rex, Heiko Pohl, Roupen Djinbachian, Felix Huang, Cesare Hassan, Daniel von Renteln","doi":"10.1053/j.gastro.2024.08.037","DOIUrl":"10.1053/j.gastro.2024.08.037","url":null,"abstract":"","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"154-156.e2"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-11-16DOI: 10.1053/j.gastro.2024.10.008
Michael J Bourke, Simon K Lo, Ross C D Buerlein, Koushik K Das
<p><strong>Description: </strong>Nonampullary duodenal polyps are found in up to 5% of all upper endoscopies; the vast majority are identified incidentally in asymptomatic patients. Although most are benign, adenomas are estimated to account for 10%-20% of these lesions. Most international guidelines recommend that all duodenal adenomas should be considered for endoscopic resection; this may be associated with a near 15% adverse event rate (predominantly bleeding and perforation) in prospective studies, with substantial local recurrence on surveillance. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review was to describe how individuals should be evaluated and risk-stratified for duodenal polyps, the best approaches to endoscopic resection and surveillance, and management of complications, highlighting opportunities for future research to fill gaps in the existing literature.</p><p><strong>Methods: </strong>This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Non-neoplastic duodenal lesions (eg, metaplastic foveolar epithelium and gastric heterotopia) may mimic neoplastic adenomatous pathology. Careful optical evaluation and pathologic correlation may be necessary to exclude dysplasia. Nondysplastic lesions do not require endoscopic resection unless they are symptomatic or bleeding. BEST PRACTICE ADVICE 2: Ideal duodenal endoscopic inspection includes identification of the major and minor papilla with photodocumentation to ensure no involvement by the lesion. Adding a clear distal attachment device to a forward-viewing gastroscope improves visualization of the papilla and the medial wall. A side-viewing duodenoscope should be used when the major and minor papilla are not visible with the gastroscope and for most lesions on the medial wall of the duodenum within 5 cm of the ampulla. BEST PRACTICE ADVICE 3: All duodenal polyps should be described according to their size, Paris morphology, suspected histologic layer of origin (mucosal lesion or subepithelial lesion), duodenal location (D1-4) and orientation (anterior, posterior, medial, or lateral wall), and proximity/relationship to the major papilla to facilitate therapeutic planning and subsequent surveillance. BEST PRACTICE ADVICE 4: Given the high frequency of concomitant c
{"title":"AGA Clinical Practice Update on Nonampullary Duodenal Lesions: Expert Review.","authors":"Michael J Bourke, Simon K Lo, Ross C D Buerlein, Koushik K Das","doi":"10.1053/j.gastro.2024.10.008","DOIUrl":"10.1053/j.gastro.2024.10.008","url":null,"abstract":"<p><strong>Description: </strong>Nonampullary duodenal polyps are found in up to 5% of all upper endoscopies; the vast majority are identified incidentally in asymptomatic patients. Although most are benign, adenomas are estimated to account for 10%-20% of these lesions. Most international guidelines recommend that all duodenal adenomas should be considered for endoscopic resection; this may be associated with a near 15% adverse event rate (predominantly bleeding and perforation) in prospective studies, with substantial local recurrence on surveillance. The aim of this American Gastroenterological Association (AGA) Clinical Practice Update Expert Review was to describe how individuals should be evaluated and risk-stratified for duodenal polyps, the best approaches to endoscopic resection and surveillance, and management of complications, highlighting opportunities for future research to fill gaps in the existing literature.</p><p><strong>Methods: </strong>This expert review was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership, and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Gastroenterology. These Best Practice Advice statements were drawn from a review of the published literature and from expert opinion. Because systematic reviews were not performed, these Best Practice Advice statements do not carry formal ratings regarding the quality of evidence or strength of the presented considerations. Best Practice Advice Statements BEST PRACTICE ADVICE 1: Non-neoplastic duodenal lesions (eg, metaplastic foveolar epithelium and gastric heterotopia) may mimic neoplastic adenomatous pathology. Careful optical evaluation and pathologic correlation may be necessary to exclude dysplasia. Nondysplastic lesions do not require endoscopic resection unless they are symptomatic or bleeding. BEST PRACTICE ADVICE 2: Ideal duodenal endoscopic inspection includes identification of the major and minor papilla with photodocumentation to ensure no involvement by the lesion. Adding a clear distal attachment device to a forward-viewing gastroscope improves visualization of the papilla and the medial wall. A side-viewing duodenoscope should be used when the major and minor papilla are not visible with the gastroscope and for most lesions on the medial wall of the duodenum within 5 cm of the ampulla. BEST PRACTICE ADVICE 3: All duodenal polyps should be described according to their size, Paris morphology, suspected histologic layer of origin (mucosal lesion or subepithelial lesion), duodenal location (D1-4) and orientation (anterior, posterior, medial, or lateral wall), and proximity/relationship to the major papilla to facilitate therapeutic planning and subsequent surveillance. BEST PRACTICE ADVICE 4: Given the high frequency of concomitant c","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"169-175"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-06-28DOI: 10.1053/j.gastro.2024.05.036
Arno R Bourgonje, Ryan C Ungaro, Saurabh Mehandru, Jean-Frédéric Colombel
Interleukin (IL) 23, a member of the IL12 family of cytokines, maintains intestinal homeostasis, but is also implicated in the pathogenesis of inflammatory bowel diseases (IBDs). IL23 is a heterodimer composed of disulfide-linked p19 and p40 subunits. Humanized monoclonal antibodies selectively targeting the p19 subunit of IL23 are poised to become prominent drugs in IBDs. In this review, we discuss the pharmacodynamic and pharmacokinetic properties of the currently available IL23p19 inhibitors and discuss the mechanistic underpinnings of their therapeutic effects, including the mechanism of action, epitope affinity, potency, and downstream signaling. Furthermore, we address available data on the efficacy, safety, and tolerability of IL23p19 inhibitors in the treatment of IBDs and discuss important studies performed in other immune-mediated inflammatory diseases. Finally, we evaluate the potential for combining classes of biological therapies and provide future directions on the development of precision medicine-guided positioning of IL23p19 inhibitors in IBD.
{"title":"Targeting the Interleukin 23 Pathway in Inflammatory Bowel Disease.","authors":"Arno R Bourgonje, Ryan C Ungaro, Saurabh Mehandru, Jean-Frédéric Colombel","doi":"10.1053/j.gastro.2024.05.036","DOIUrl":"10.1053/j.gastro.2024.05.036","url":null,"abstract":"<p><p>Interleukin (IL) 23, a member of the IL12 family of cytokines, maintains intestinal homeostasis, but is also implicated in the pathogenesis of inflammatory bowel diseases (IBDs). IL23 is a heterodimer composed of disulfide-linked p19 and p40 subunits. Humanized monoclonal antibodies selectively targeting the p19 subunit of IL23 are poised to become prominent drugs in IBDs. In this review, we discuss the pharmacodynamic and pharmacokinetic properties of the currently available IL23p19 inhibitors and discuss the mechanistic underpinnings of their therapeutic effects, including the mechanism of action, epitope affinity, potency, and downstream signaling. Furthermore, we address available data on the efficacy, safety, and tolerability of IL23p19 inhibitors in the treatment of IBDs and discuss important studies performed in other immune-mediated inflammatory diseases. Finally, we evaluate the potential for combining classes of biological therapies and provide future directions on the development of precision medicine-guided positioning of IL23p19 inhibitors in IBD.</p>","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"29-52.e3"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-07-20DOI: 10.1053/j.gastro.2024.07.015
Jack Shembrey, Carl Cosgrave, Neel Heerasing
{"title":"An Unexpected Case of Per-rectal Bleeding.","authors":"Jack Shembrey, Carl Cosgrave, Neel Heerasing","doi":"10.1053/j.gastro.2024.07.015","DOIUrl":"10.1053/j.gastro.2024.07.015","url":null,"abstract":"","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"13-16"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-14DOI: 10.1053/j.gastro.2024.09.016
Lin Y Hung, Kara Gross Margolis
{"title":"The Brain and the Immune System: A Dynamic Duo in Detecting and Defending.","authors":"Lin Y Hung, Kara Gross Margolis","doi":"10.1053/j.gastro.2024.09.016","DOIUrl":"10.1053/j.gastro.2024.09.016","url":null,"abstract":"","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"178-179"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-09-12DOI: 10.1053/j.gastro.2024.09.006
Kevin J Monahan
{"title":"Where Do Noninvasive Colorectal Cancer Tools \"FIT\" Alongside Colonoscopy in the Surveillance of High-Risk Patients?","authors":"Kevin J Monahan","doi":"10.1053/j.gastro.2024.09.006","DOIUrl":"10.1053/j.gastro.2024.09.006","url":null,"abstract":"","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"10-12"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142283946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01Epub Date: 2024-07-20DOI: 10.1053/j.gastro.2024.07.018
Mark Hanscom
{"title":"Treating Chronic Pancreatitis Pain With the Use of Extracorporeal Shock-Wave Lithotripsy and Endoscopy.","authors":"Mark Hanscom","doi":"10.1053/j.gastro.2024.07.018","DOIUrl":"10.1053/j.gastro.2024.07.018","url":null,"abstract":"","PeriodicalId":12590,"journal":{"name":"Gastroenterology","volume":" ","pages":"176-177"},"PeriodicalIF":25.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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