Deepthi S. Rao

Higher adenoma detection rates with cap-assisted colonoscopy: a randomised controlled trial

Objective Cap-assisted colonoscopy (CAC) uses a small plastic transparent cap attached to the tip of the colonoscope that can depress and flatten colonic folds and thus improve visualisation of their proximal aspects. The aim of this study was to compare CAC with standard colonoscopy (SC; high-definition white light) for adenoma detection rates. Design This is a prospective randomised controlled trial. Setting The study was performed in a tertiary-care Veterans Affairs Medical Center in the USA. Patients Subjects undergoing screening or surveillance colonoscopy were enrolled. Interventions Subjects were randomised to undergo either CAC or SC. Main outcome measures The outcome measures were the proportion of subjects with at least one adenoma, the number of adenomas detected per subject, insertion time, caecal intubation rates and complications. Results 420 subjects were enrolled and included in the study (210 in each group). The proportion of subjects with at least one adenoma was higher with CAC compared to SC (69% vs 56%, p=0.009). CAC also detected a higher number of adenomas per subject (2.3 vs 1.4, p<0.001). The caecal intubation time was shorter with CAC (3.29 min vs 3.98 min, p<0.001). The caecal intubation rates were similar in the two groups (99% vs 98%, p=0.37). There were no complications associated with CAC or SC. Conclusions CAC detected a 13% higher number of subjects with at least one adenoma and 59% higher adenomas per subject. CAC is a safe, effective and practical means to improve adenoma detection rates. Clinical Trial Registration NCT 01211132.

Accuracy of in vivo optical diagnosis of colon polyp histology by narrow-band imaging in predicting colonoscopy surveillance intervals

BACKGROUND The American Society for Gastrointestinal Endoscopy (ASGE) recently developed thresholds for the performance characteristics of technologies for real-time assessment of histology of diminutive (≤ 5 mm) colon polyps. Narrow-band imaging (NBI) has been shown to predict polyp histology with moderate to high accuracy in several studies. OBJECTIVE To determine whether in vivo optical diagnosis of polyp histology by using NBI can reach the 2 benchmarks set forth by the ASGE. DESIGN Retrospective analysis of data from 3 prospective clinical trials. SETTING Two tertiary referral centers. PATIENTS Subjects undergoing screening or surveillance colonoscopy. INTERVENTIONS In vivo optical diagnosis of polyp histology by using NBI. MAIN OUTCOME MEASUREMENT Accuracy in predicting colonoscopy surveillance intervals, negative predictive value (NPV) for diagnosing adenomatous histology in the rectosigmoid. RESULTS A total of 410 patients met the inclusion/exclusion criteria and had at least 1 polyp seen and resected during colonoscopy. Using in vivo optical diagnosis instead of histopathology for all diminutive polyps predicted the correct colonoscopy surveillance interval in 86% to 94% patients. When optical diagnosis was limited to diminutive polyps in the rectosigmoid only, the NPV for diagnosing adenomatous histology with NBI was 95%. LIMITATIONS Retrospective analysis from tertiary referral centers. CONCLUSIONS The threshold NPV for diagnosing adenomatous histology in diminutive rectosigmoid polyps recently set forth by the ASGE can be achieved by using NBI. The threshold accuracy rate for predicting surveillance interval recommendations can be reached by using NBI, but only if patients with 1 to 2 small adenomas without advanced features have a repeat colonoscopy in 10 years.

A new tool for sharing and querying of clinical documents modeled using HL7 Version 3 standard

We present a new software tool called CDN (Collaborative Data Network) for sharing and querying of clinical documents modeled using HL7 v3 standard (e.g., Clinical Document Architecture (CDA), Continuity of Care Document (CCD)). Similar to the caBIG initiative, CDN aims to foster innovations in cancer treatment and diagnosis through large-scale, sharing of clinical data. We focus on cancer because it is the second leading cause of deaths in the US. CDN is based on the synergistic combination of peer-to-peer technology and the extensible markup language XML and XQuery. Using CDN, a user can pose both structured queries and keyword queries on the HL7 v3 documents hosted by data providers. CDN is unique in its design--it supports location oblivious queries in a large-scale, network wherein a user does not explicitly provide the location of the data for a query. A location service in CDN discovers data of interest in the network at query time. CDN uses standard cryptographic techniques to provide security to data providers and protect the privacy of patients. Using CDN, a user can pose clinical queries pertaining to cancer containing aggregations and joins across data hosted by multiple data providers. CDN is implemented with open-source software for web application development and XML query processing. We ran CDN in a distributed environment using Amazon EC2 as a testbed. We report its performance on real and synthetic datasets of discharge summaries. We show that CDN can achieve good performance in a setup with large number of data providers and documents.

A prototype of a novel cell phone application for tracking the vaccination coverage of children in rural communities

Immunization saves millions of lives against vaccine-preventable diseases. Yet, 24 million children born every year do not receive proper immunization during their first year. UNICEF and WHO have emphasized the need to strengthen the immunization surveillance and monitoring in developing countries to reduce childhood deaths. In this regard, we present a software application called Jeev to track the vaccination coverage of children in rural communities. Jeev synergistically combines the power of smartphones and the ubiquity of cellular infrastructure, QR codes, and national identification cards. We present the design of Jeev and highlight its unique features along with a detailed evaluation of its performance and power consumption using the National Immunization Survey datasets. We are in discussion with a non-profit organization in Haiti to pilot test Jeev in order to study its effectiveness and identify socio-cultural issues that may arise in a large-scale deployment.

Community gastroenterologists can learn diminutive colon polyp histology characterization with narrow band imaging by a computer-based teaching module

The aim of the present study was to evaluate the impact of a computer‐based teaching module on the performance of community gastroenterologists for characterization of diminutive polyps (≤5 mm) using narrow band imaging video clips.

Trainee participation and adenoma detection rates during screening colonoscopies.

Goal: To evaluate whether participation of a gastroenterology trainee had an impact on adenoma detection rate (ADR) during screening colonoscopies performed with standard-definition colonoscopes (SD-C) versus high-definition colonoscopes (HD-C). Background: ADR is an established quality indicator of colonoscopy and efforts to improve ADR have led to technological advancements including HD-C that have a greater angle of view and produce an image with higher pixel density compared with SD-C. Moreover, other factors like trainee participation have been shown to improve adenoma detection. Methods: This is a retrospective review of screening colonoscopies performed during 2 different time periods by 4 experienced endoscopists with or without trainee participation. There are 2 arms of this study, based on whether screening colonoscopy was performed using SD-C or HD-C. Detailed review of endoscopy and histopathologic reports was conducted. Statistical analysis was performed and odds ratio and incidence rate ratios were calculated to adjust for numerous factors. Results: No significant differences were seen with trainee participation in the SD-C arm of the study. In the HD-C arm, the total number, and the proportion of subjects with: adenomas, diminutive adenomas, and right-sided adenomas were significantly higher with trainee participation. Conclusions: Trainee participation significantly improved the overall adenoma detection, specifically diminutive adenoma and right-sided adenoma detection, but only when colonoscopies were performed with HD-C. The improved image quality and resolution provided by HD-C, coupled with enhanced visual scanning an additional pair of eyes provides, may account for the differential impact of trainee participation on ADR.

Jeev: A Low-Cost Cell Phone Application for Tracking the Vaccination Coverage of Children in Rural Communities

Immunization saves millions of lives against vaccine-preventable diseases. Yet, 24 million children born every year do not receive proper immunization during their first year. UNICEF and WHO have emphasized the need to strengthen the immunization surveillance and monitoring in developing countries to reduce childhood deaths. In this regard, we present a software application called Jeev to track the vaccination coverage of children in rural communities. Jeev synergistically combines the power of smart phones and the ubiquity of cellular infrastructure, QR codes, and national identification cards. We present the design of Jeev and highlight its unique features along with a preliminary evaluation of its performance. We plan to pilot test Jeev in a rural population to study its effectiveness and identify socio-cultural issues that may arise in a large-scale deployment.

Presence or absence of intestinal metaplasia but not its burden is associated with prevalent high-grade dysplasia and cancer in Barrett's esophagus.

Universal agreement on the inclusion of intestinal metaplasia to diagnose Barretts esophagus (BE) is lacking. Our aim was to determine the association of intestinal metaplasia and its density with the prevalence of dysplasia/cancer in columnar lined esophagus (CLE). Patients with CLE but no intestinal metaplasia (CLE-no IM) were identified by querying the clinical pathology database using SNOMED codes for distal esophageal biopsies. CLE-IM patients were identified from a prospectively maintained database of BE patients. Subsequently, relative risks for prevalent dysplasia and cancer were calculated. Since patients with CLE-no IM are not usually enrolled in surveillance, only prevalent dysplasia/cancer on index endoscopy was analyzed. Goblet cell density and percent intestinal metaplasia were estimated. All biopsy slides were reviewed for dysplasia by two experienced gastrointestinal pathologists. Two hundred sixty-two CLE-IM and 260 CLE-no IM patients were included (age 64±12 vs. 60±11 years, P=0.001; whites 92% vs. 82%, P=0.001; males 99.7% vs. 99.3%, P=NS; CLE length 3.4±3.2 vears 1.4±0.4 cm, P=0.001 and hiatus hernia 64% vs. 56%, P=0.013). The odds of finding low-grade dysplasia and of high-grade dysplasia (HGD)/cancer were 12.5-fold (2.9-53.8, P=0.007) and 4.2-fold (95% CI 1.4-13, P=0.01) higher, respectively, in the CLE-IM group. Reanalysis after controlling for important variables of age, race, and length did not significantly alter the overall results. In CLE-IM group, when patients with high (>50/LPF) versus low goblet cell density (<50/LPF) and <10% versus >10% intestinal metaplasia were compared, the odds of HGD/cancer, OR 1.5 (0.5-4.9, P=0.5) and 1.97 (0.54-7.22), respectively, were not significantly higher. Demonstration of intestinal metaplasia continues to be an essential element in the definition of BE, but its quantification may not be useful for risk stratification of HGD/cancer in BE.

787 Higher Detection of Serrated Polyps With CAP Assisted Colonoscopy - Results From a Prospective, Randomized Controlled Trial

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Tu1186 Trainee Participation Increases Adenoma Detection Rates During Screening Colonoscopies Performed With High-Definition Colonoscopes but Not With Standard-Definition Colonoscopes

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