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An overview of deep learning algorithms and water exchange in colonoscopy in improving adenoma detection.
Hsieh, YH, Leung, FW
Expert review of gastroenterology & hepatology. 2019;(12):1153-1160
Abstract
Introduction: Among the Gastrointestinal (GI) Endoscopy Editorial Board top 10 topics in advances in endoscopy in 2018, water exchange colonoscopy and artificial intelligence were both considered important advances. Artificial intelligence holds the potential to increase and water exchange significantly increases adenoma detection.Areas covered: The authors searched MEDLINE (1998-2019) using the following medical subject terms: water-aided, water-assisted and water exchange colonoscopy, adenoma, artificial intelligence, deep learning, computer-assisted detection, and neural networks. Additional related studies were manually searched from the reference lists of publications. Only fully published journal articles in English were reviewed. The latest date of the search was Aug10, 2019. Artificial intelligence, machine learning, and deep learning contribute to the promise of real-time computer-aided detection diagnosis. By emphasizing near-complete suction of infused water during insertion, water exchange provides salvage cleaning and decreases cleaning-related multi-tasking distractions during withdrawal, increasing adenoma detection. The review will address how artificial intelligence and water exchange can complement each other in improving adenoma detection during colonoscopy.Expert opinion: In 5 years, research on artificial intelligence will likely achieve real-time application and evaluation of factors contributing to quality colonoscopy. Better understanding and more widespread use of water exchange will be possible.
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An FP's guide to AI-enabled clinical decision support.
Halamka, J, Cerrato, P
The Journal of family practice. 2019;(9):486;488;490;492
Abstract
To better understand the capabilities and challenges of artificial intelligence and machine learning, we look at the role they can play in screening for retinopathy and colon cancer.
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Optimal Management of Malignant Polyps, From Endoscopic Assessment and Resection to Decisions About Surgery.
Rex, DK, Shaukat, A, Wallace, MB
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 2019;(8):1428-1437
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Colorectal cancer is defined clinically as invasion of dysplastic cells into the submucosa. Lesions with submucosal invasion but without invasion into the muscularis propria are generally called malignant polyps. A stepwise approach produces optimal management of malignant polyps (including polypoid and flat/depressed lesions). The first step is to avoid endoscopic resection of non-pedunculated lesions with endoscopic features that predict deep submucosal invasion. Lesions without such features are candidates for endoscopic resection. The second step is to assess candidates for endoscopic resection for features that predict an increased risk of superficial submucosal invasion. Such lesions should be considered for en bloc endoscopic excision if feasible. The third step is giving patients with endoscopically resected malignant polyps good advice regarding whether to undergo adjuvant therapy, usually surgery. We review the endoscopic and histologic criteria that guide clinicians through these steps.
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What Do We Need to Know About Colonic Polypoid Ganglioneuroma? A Case Report and A Comprehensive Review.
Abdelfatah, M, Sangah, G, Harvin, G
Journal of gastrointestinal cancer. 2018;(3):327-332
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Dietary fiber intake and risks of proximal and distal colon cancers: A meta-analysis.
Ma, Y, Hu, M, Zhou, L, Ling, S, Li, Y, Kong, B, Huang, P
Medicine. 2018;(36):e11678
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Abstract
The purpose of this study was to conduct a systematic review and meta-analysis of studies investigating the relationship between dietary fiber intake and subsite-specific colon cancer.The PubMed database was searched to identify relevant cohort studies published from inception to August 2016 in order to examine individually the association between dietary fiber intake and the risk of proximal colon cancer (PCC), and that between dietary fiber intake and the risk of distal colon cancer (DCC). We searched the reference lists of the studies included in our analysis as well as those listed in the published meta-analyses. A random-effects model was used to compute summary risk estimates. Heterogeneity was assessed using I and Q statistics. Publication bias was assessed with the Egger's and Begg's tests, with a P value of P < .10 indicating publication bias. All statistical tests were 2-sided.We identified and included 11 prospective cohort studies in the final meta-analysis. The risks of PCC and DCC among individuals in the highest dietary fiber intake quartile/quintile were 14% (relative risk [RR] = 0.86, 95% confidence interval [CI] = 0.78-0.95) and 21% (RR = 0.79, 95% CI = 0.71-0.87) lower, respectively, than those among individuals with the lowest dietary fiber intake. In a subgroup analysis, the inverse association observed in the sex-based subgroup was apparent only for men with PCC. Dietary fiber intake was inversely associated with DCC for both men and women. In addition, dietary fiber intake appeared to be inversely associated with PCC only in European countries, whereas this association was observed for DCC in both European countries and the United States.Our findings reveal that dietary fiber intake is associated inversely with the risk of both PCC and DCCs.
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Laparoscopic Versus Open Transverse Colectomy: A Systematic Review and Meta-Analysis.
Gavriilidis, P, Katsanos, K
World journal of surgery. 2018;(9):3008-3014
Abstract
OBJECTIVES The survival benefits, oncological adequacy, effectiveness, and safety of laparoscopic transverse colectomy (LTC) were compared with that of open transverse colectomy (OTC) using a meta-analysis. METHODS EMBASE, Medline, Cochrane library, and Google scholar databases were searched for the last 20 years. Meta-analyses were performed using both fixed-effects and random-effects models. Five-year disease-free survival and overall survival were estimated using the inverse variance hazard ratio method. RESULTS No survival benefits were detected between the two LTC and OTC cohorts. OTC showed shorter operative time by 38 min compared to LTC [mean difference (MD) = 38(15.23-60.77), p = 0.001]. However, LTC was associated with earlier postoperative recovery. The time to flatus and time to oral intake for LTC were MD = -1.12(-1.68 to -0.55, p = 0.001) and MD = -1.57(-2.38 to -0.76, p = 0.001), respectively. In addition, LTC was associated with a shorter hospital stay by 4.5 days [MD = -4.64(-7.52 to -1.75), p = 0.002]. CONCLUSIONS Compared to OTC, LTC provides similar survival benefits, earlier postoperative recovery, and shorter hospital stay by 4.5 days.
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Surgical Treatment of Colon Cancer of the Splenic Flexure: A Systematic Review and Meta-analysis.
Martínez-Pérez, A, Brunetti, F, Vitali, GC, Abdalla, S, Ris, F, de'Angelis, N
Surgical laparoscopy, endoscopy & percutaneous techniques. 2017;(5):318-327
Abstract
This is a systematic review and meta-analysis on the surgical treatments of splenic flexure carcinomas (SFCs). Medline, EMBASE, and Scopus were searched from January 1990 to May 2016. Studies of at least 5 patients comparing extended right colectomy (ERC) versus left colectomy (LC) and/or laparoscopy versus open surgery for SFCs were retrieved and analyzed. Overall, 12 retrospective studies were selected, including 569 patients. ERC was performed in 23.2% of patients, whereas LC in 76.8%. Pooled data suggested that ERC and LC had similar oncologic quality of resection and postoperative outcomes. Laparoscopy was used in 50.6% of patients (conversion rate: 2.5%) and it was associated with significantly shorter time to oral diet, fewer postoperative complications, and shorter hospital stay than open surgery. In conclusion, the optimal extent of SFC surgical resection, that is, ERC or LC remains under debate. However, laparoscopy provides better postoperative outcomes and fewer postoperative complications than open surgery.
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Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis.
Mahmood, S, MacInnis, RJ, English, DR, Karahalios, A, Lynch, BM
International journal of epidemiology. 2017;(6):1797-1813
Abstract
BACKGROUND Physical activity is associated with reduced risk of colorectal cancer, but most epidemiological studies have focused on occupational and recreational physical activity. The evidence for other domains of activity, and for sedentary behaviour, is limited. METHODS Medline, Embase and Web of Science were searched from inception to December 2015 for studies examining domain-specific physical activity or sedentary behaviour and the risk of colon and/or rectal cancer. We extracted maximally adjusted relative risks (RRs) except when RRs not adjusted for body mass index, were also presented. We used random-effects meta-analysis to compute pooled RRs comparing the highest versus the lowest level of exposure. We used meta-regression to assess sources of heterogeneity in estimates. RESULTS We identified 17 cohort and 21 case-control studies, of which 17 had occupational data, 23 had recreational data, three each had data on transport and household physical activity domains, and 6 studies had data on occupational sedentary behaviour. The pooled relative risks (RRs) for colon cancer were 0.74 (95% confidence interval (CI): 0.67, 0.82) for occupational activity, 0.80 (95% CI: 0.71, 0.89) for recreational activity, 0.66 (95% CI: 0.45, 0.98) for transport-related physical activity, 0.85 (95% CI: 0.71, 1.02) for household physical activity, and 1.44 (95% CI: 1.28, 1.62) for occupational sedentary behaviour. For rectal cancer, the pooled RRs were 0.88 (95% CI: 0.79, 0.98) for occupational activity, 0.87 (95% CI: 0.75, 1.01) for recreational activity, 0.88 (95% CI: 0.70, 1.12) for transport-related physical activity, 1.01 (95% CI: 0.80, 1.27) for household physical activity, and 1.02 (95% CI: 0.82, 1.28) for occupational sedentary behaviour. CONCLUSIONS In addition to increasing occupational and recreational physical activity, promoting physical activity during transport and reducing sedentary behaviour in the workplace may also be useful colorectal cancer prevention strategies.
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Laparoscopic Colectomy Versus Open Colectomy for Treatment of Transverse Colon Cancer: A Systematic Review and Meta-Analysis.
Wu, Q, Wei, M, Ye, Z, Bi, L, Zheng, E, Hu, T, Gu, C, Wang, Z
Journal of laparoendoscopic & advanced surgical techniques. Part A. 2017;(10):1038-1050
Abstract
BACKGROUND The surgical management of transverse colon cancer (TCC) is still not standardized. The aim of this meta-analysis was to evaluate the effect of laparoscopic colectomy (LC) for treatment of TCC in terms of short-term and long-term outcomes compared with open colectomy. METHOD A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on September 15, 2016. The short-term outcomes included intraoperative outcomes, postoperative outcomes, and oncological surgical quality. The long-term outcomes included overall survival (OS) and disease-free survival (DFS). RESULTS Thirteen articles and one conference abstract published between 2010 and 2016 with a total of 1728 patients were enrolled in this meta-analysis. LC was associated with significant less estimated blood loss, fewer total postoperative complications, and shorter time to first flatus, time to liquid diet, length of hospital stay, and length of postoperative hospital stay. However, longer operative time was needed in LC. There was no statistically significant difference between the groups concerning the intraoperative complications, mortality, ileus, anastomotic leakage, bleeding, wound infection, abdominal infection, lymph nodes harvested, proximal resection margin, distal resection margin, OS, or DFS. CONCLUSION Our meta-analysis suggests that LC is a safe and feasible technique for TCC associated with less estimated blood loss, fewer total postoperative complications, quicker recovery of intestinal function, shorter length of hospital stay, and equivalent long-term outcomes. Furthermore, a large-scaled, prospective randomized controlled study is warranted to verify those results.
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Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013.
Kyu, HH, Bachman, VF, Alexander, LT, Mumford, JE, Afshin, A, Estep, K, Veerman, JL, Delwiche, K, Iannarone, ML, Moyer, ML, et al
BMJ (Clinical research ed.). 2016;:i3857
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Abstract
OBJECTIVE To quantify the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events. DESIGN Systematic review and Bayesian dose-response meta-analysis. DATA SOURCES PubMed and Embase from 1980 to 27 February 2016, and references from relevant systematic reviews. Data from the Study on Global AGEing and Adult Health conducted in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010 and the US National Health and Nutrition Examination Surveys from 1999 to 2011 were used to map domain specific physical activity (reported in included studies) to total activity. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective cohort studies examining the associations between physical activity (any domain) and at least one of the five diseases studied. RESULTS 174 articles were identified: 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke (some articles included multiple outcomes). Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The same amount of increase yielded much smaller returns at higher levels of activity: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6%. Compared with insufficiently active individuals (total activity <600 MET minutes/week), the risk reduction for those in the highly active category (≥8000 MET minutes/week) was 14% (relative risk 0.863, 95% uncertainty interval 0.829 to 0.900) for breast cancer; 21% (0.789, 0.735 to 0.850) for colon cancer; 28% (0.722, 0.678 to 0.768) for diabetes; 25% (0.754, 0.704 to 0.809) for ischemic heart disease; and 26% (0.736, 0.659 to 0.811) for ischemic stroke. CONCLUSIONS People who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. More studies with detailed quantification of total physical activity will help to find more precise relative risk estimates for different levels of activity.