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CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2313-4996
Original article

Training in optical diagnosis in community hospitals is associated with improved recognition and treatment of T1 CRC: a prospective multicenter intervention study (OPTICAL II).

Lonne W.T. Meulen 
1   Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands (Ringgold ID: RIN199236)
2   The Netherlands GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands (Ringgold ID: RIN5211)
,
Krijn Jan Cornelis Haasnoot 
3   Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
Marije S. Vlug
4   Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, Netherlands (Ringgold ID: RIN3956)
,
Frank H.J. Wolfhagen
5   Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, Netherlands (Ringgold ID: RIN2998)
,
Martine A.M.C. Baven-Pronk
6   Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, Netherlands (Ringgold ID: RIN3573)
,
Michael P.J.A. van der Voorn
7   Department of Gastroenterology and Hepatology, Haga Hospital, Den Haag, Netherlands (Ringgold ID: RIN37134)
,
M. P. Schwartz
8   Gastroenterology, Meander Medical Centre, Amersfoort, Netherlands (Ringgold ID: RIN1170)
,
Lauran Vogelaar
9   Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht Zeist Doorn, Utrecht, Netherlands (Ringgold ID: RIN8118)
,
Wouter H de Vos tot Nederveen Cappel
10   Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, Netherlands (Ringgold ID: RIN8772)
,
Tom C.J. Seerden
11   Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, Netherlands (Ringgold ID: RIN89411)
,
W.L. Hazen
12   Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, Netherlands (Ringgold ID: RIN7898)
,
R W.M. Schrauwen
13   Department of Gastroenterology and Hepatology, Bernhoven Hospital Location Uden, Uden, Netherlands (Ringgold ID: RIN97772)
,
Lorenza Alvarez Herrero
14   Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, Netherlands (Ringgold ID: RIN6028)
,
Ramon Michel Schreuder
15   Division of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, Netherlands (Ringgold ID: RIN3168)
,
Annick B van Nunen
16   Department of Gastroenterology and Hepatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands (Ringgold ID: RIN3802)
,
Esther Stoop
17   Department of Gastroenterology and Hepatology, Medical Centre Haaglanden, Den Haag, Netherlands (Ringgold ID: RIN2901)
,
Gijs J de Bruin
18   Department of Gastroenterology and Hepatology, Tergooi Medical Centre, Hilversum, Netherlands (Ringgold ID: RIN3913)
,
Philip Bos
19   Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, Netherlands (Ringgold ID: RIN3096)
,
Willem A. Marsman
20   Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, Netherlands (Ringgold ID: RIN3670)
,
Edith Kuiper
21   Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, Netherlands (Ringgold ID: RIN7000)
,
Marc de Bièvre
22   Department of Gastroenterology and Hepatology,, VieCuri Medical Centre, Venlo, Netherlands (Ringgold ID: RIN8187)
,
Robert Roomer
23   Department of Gastroenterology and Hepatology, Franciscus Gasthuis, Rotterdam, Netherlands (Ringgold ID: RIN6992)
,
John Groen
24   Department of Gastroenterology and Hepatology, Ziekenhuis Sint Jansdal, Harderwijk, Netherlands (Ringgold ID: RIN72496)
,
Marloes Bigirwamungu-Bargeman
25   Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, Netherlands
,
Peter D. Siersema
26   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
,
Sjoerd G. Elias
27   Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
,
Ad Masclee
1   Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands (Ringgold ID: RIN199236)
,
Leon MG Moons
3   Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands (Ringgold ID: RIN8124)
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Background and study aims: Recognition of T1 colorectal cancer (CRC) is difficult, with sensitivities of 35-60% in Western countries. We evaluated the real-life effects of the implementation of the OPTICAL model, a recently developed structured and validated prediction model, in Dutch community hospitals. Patients and methods: In this prospective multicenter study, 383 endoscopists from 40 hospitals were invited to follow an e-learning on the OPTICAL-model, to increase sensitivity for detecting T1CRC in non-pedunculated polyps. Next, real-life recognition of T1CRC was evaluated in 25 hospitals. Endoscopic and pathologic reports of T1CRCs detected during the next year were collected retrospectively while endoscopists were unaware of this evaluation. Sensitivity for recognition of T1CRC, R0 resection rate, and treatment modality were compared for trained vs. untrained endoscopists and for recognised vs. unrecognised T1CRCs. Results: Within 1 year after the e-learning 251 endoscopists detected 528 non-pedunculated T1CRCs, 118 (47%) of the endoscopist were trained. T1CRCs had a median size of 20mm and were mainly located in the distal colorectum (66%). Trained endoscopists recognised T1CRCs more frequently than untrained endoscopists (sensitivity 74% vs. 62%; mixed model analysis OR 2.90; 95%CI 1.54-5.45. A higher rate of R0 resection was seen for T1CRCs detected by trained endoscopists (69% vs. 56%, OR 1.73; 95%CI 1.03-2.91). Conclusion: Training in optical recognition of T1CRCs in community hospitals was associated with an increase in sensitivity for T1CRCs. Recognition led to a higher rate of en bloc local excision, resulting in higher R0-resection rates. This may be an important step towards more organ-preserving strategies.



Publikationsverlauf

Eingereicht: 07. April 2023

Angenommen nach Revision: 24. April 2024

Accepted Manuscript online:
24. April 2024

© . The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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