Endoscopic management of patients with high-risk colorectal colitis-associated neoplasia: a Delphi study.

Humans Delphi Technique Inflammatory Bowel Diseases / pathology Colorectal Neoplasms / complications Colitis Endoscopy, Gastrointestinal

Journal

Gastrointestinal endoscopy
ISSN: 1097-6779
Titre abrégé: Gastrointest Endosc
Pays: United States
ID NLM: 0010505

Informations de publication

Date de publication:
04 2023
Historique:
received: 07 10 2022
revised: 23 11 2022
accepted: 02 12 2022
pubmed: 13 12 2022
medline: 28 3 2023
entrez: 12 12 2022
Statut: ppublish

Résumé

Current guidelines recommend endoscopic resection of visible and endoscopically resectable colorectal colitis-associated neoplasia (CAN) in patients with inflammatory bowel disease (IBD). However, patients with high-risk CAN (HR-CAN) are often not amenable to conventional resection techniques, and a consensus approach for the endoscopic management of these lesions is presently lacking. This Delphi study aims to reach consensus among experts on the endoscopic management of these lesions. A 3-round modified Delphi process was conducted to reach consensus among worldwide IBD and/or endoscopy experts (n = 18) from 3 continents. Consensus was considered if ≥75% agreed or disagreed. Quality of evidence was assessed by the criteria of the Cochrane Collaboration group. Consensus was reached on all statements (n = 14). Experts agreed on a definition for CAN and HR-CAN. Consensus was reached on the examination of the colon with enhanced endoscopic imaging before resection, the endoscopic resectability of an HR-CAN lesion, and endoscopic assessment and standard report of CAN lesions. In addition, experts agreed on type of resections of HR-CAN (< 20 mm, >20 mm, with or without good lifting), endoscopic success (technical success and outcomes), histologic assessment, and follow-up in HR-CAN. This is the first step in developing international consensus-based recommendations for endoscopic management of CAN and HR-CAN. Although the quality of available evidence was considered low, consensus was reached on several aspects of the management of CAN and HR-CAN. The present work and proposed standardization might benefit future studies.

Sections du résumé

BACKGROUND AND AIMS
Current guidelines recommend endoscopic resection of visible and endoscopically resectable colorectal colitis-associated neoplasia (CAN) in patients with inflammatory bowel disease (IBD). However, patients with high-risk CAN (HR-CAN) are often not amenable to conventional resection techniques, and a consensus approach for the endoscopic management of these lesions is presently lacking. This Delphi study aims to reach consensus among experts on the endoscopic management of these lesions.
METHODS
A 3-round modified Delphi process was conducted to reach consensus among worldwide IBD and/or endoscopy experts (n = 18) from 3 continents. Consensus was considered if ≥75% agreed or disagreed. Quality of evidence was assessed by the criteria of the Cochrane Collaboration group.
RESULTS
Consensus was reached on all statements (n = 14). Experts agreed on a definition for CAN and HR-CAN. Consensus was reached on the examination of the colon with enhanced endoscopic imaging before resection, the endoscopic resectability of an HR-CAN lesion, and endoscopic assessment and standard report of CAN lesions. In addition, experts agreed on type of resections of HR-CAN (< 20 mm, >20 mm, with or without good lifting), endoscopic success (technical success and outcomes), histologic assessment, and follow-up in HR-CAN.
CONCLUSIONS
This is the first step in developing international consensus-based recommendations for endoscopic management of CAN and HR-CAN. Although the quality of available evidence was considered low, consensus was reached on several aspects of the management of CAN and HR-CAN. The present work and proposed standardization might benefit future studies.

Identifiants

DOI: 10.1016/j.gie.2022.12.005 PMID: 36509111
pubmed: 36509111
pii: S0016-5107(22)02206-4
doi: 10.1016/j.gie.2022.12.005
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

767-779.e6

Informations de copyright

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Auteurs

Michiel T J Bak (MTJ)

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.

Eduardo Albéniz (E)

Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra Navarrabiomed, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain.

James E East (JE)

Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK.

Nayantara Coelho-Prabhu (N)

Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Noriko Suzuki (N)

Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, UK.

Yutaka Saito (Y)

Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.

Takayuki Matsumoto (T)

Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan.

Rupa Banerjee (R)

Inflammatory Bowel Disease Center, Asian Institute of Gastroenterology, Hyderabad, India.

Michal F Kaminski (MF)

Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.

Ralf Kiesslich (R)

Department of Internal Medicine and Gastroenterology, Helios Clinic Wiesbaden, Wiesbaden, Germany.

Emmanuel Coron (E)

Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland.

Annemarie C de Vries (AC)

Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.

C Janneke van der Woude (CJ)

Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.

Raf Bisschops (R)

Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Belgium.

Ailsa L Hart (AL)

Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK.

Steven H Itzkowitz (SH)

Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Mathieu Pioche (M)

Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.

Leon M G Moons (LMG)

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.

Bas Oldenburg (B)

Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Endoscopic management of patients with...
questionsmedicales.fr › Sciences de l'information › Analyse des systèmes › Méthode Delphi › Endoscopic management of patients with...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies inflammatoires intestinales › Endoscopic management of patients with...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du rectum › Tumeurs colorectales › Endoscopic management of patients with...
questionsmedicales.fr › Maladies de l'appareil digestif › Maladies gastro-intestinales › Maladies intestinales › Maladies du côlon › Colite › Endoscopic management of patients with...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Endoscopie › Endoscopie digestive › Endoscopie gastrointestinale › Endoscopic management of patients with...