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CC BY 4.0 · Endoscopy 2024; 56(10): 770-779
DOI: 10.1055/a-2313-4996
Original article

Effect of optical diagnosis training on recognition and treatment of submucosal invasive colorectal cancer in community hospitals: a prospective multicenter intervention study

Lonne W.T. Meulen 
1   Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
2   GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
,
Krijn J.C. Haasnoot 
3   Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
,
Marije S. Vlug
4   Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands
,
Frank H.J. Wolfhagen
5   Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
,
Martine A.M.C. Baven-Pronk
6   Department of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands
,
Michael P.J.A. van der Voorn
7   Department of Gastroenterology and Hepatology, Haga Hospital, Den Haag, The Netherlands
,
Matthijs P. Schwartz
 8   Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
,
Lauran Vogelaar
 9   Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands
,
Wouter H de Vos tot Nederveen Cappel
10   Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands
,
Tom C.J. Seerden
11   Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
,
Wouter L. Hazen
12   Department of Gastroenterology and Hepatology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
,
Ruud W.M. Schrauwen
13   Department of Gastroenterology and Hepatology, Bernhoven, Uden, The Netherlands
,
Lorenza Alvarez-Herrero
14   Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
,
Ramon-Michel Schreuder
15   Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
,
Annick B. van Nunen
16   Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
,
Esther Stoop
17   Department of Gastroenterology and Hepatology, Haaglanden Medical Center, Den Haag, The Netherlands
,
Gijs J. de Bruin
18   Department of Gastroenterology and Hepatology, Tergooi Hospital, Hilversum, The Netherlands
,
Philip Bos
19   Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
,
Willem A. Marsman
20   Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
,
Edith Kuiper
21   Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
,
Marc de Bièvre
22   Department of Gastroenterology and Hepatology, Viecuri Medical Center, Venlo, The Netherlands
,
Yasser A. Alderlieste
23   Department of Gastroenterology and Hepatology, Rivas, Gorinchem, The Netherlands
,
Robert Roomer
24   Department of Gastroenterology and Hepatology, Franciscus Gasthuis, Rotterdam, The Netherlands
,
John Groen
25   Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands
,
Marloes Bigirwamungu-Bargeman
26   Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
,
Peter D. Siersema
27   Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
,
Sjoerd G. Elias
28   Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
,
Ad A.M. Masclee
1   Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Leon M.G. Moons
3   Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
,
on behalf of the OPTICAL-STAR study team and the Dutch T1 CRC Working Group › Author Affiliations
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Abstract

Background Recognition of submucosal invasive colorectal cancer (T1 CRC) is difficult, with sensitivities of 35 %–60 % in Western countries. We evaluated the real-life effects of training in the OPTICAL model, a recently developed structured and validated prediction model, in Dutch community hospitals.

Methods In this prospective multicenter study (OPTICAL II), 383 endoscopists from 40 hospitals were invited to follow an e-learning program on the OPTICAL model, to increase sensitivity in detecting T1 CRC in nonpedunculated polyps. Real-life recognition of T1 CRC was then evaluated in 25 hospitals. Endoscopic and pathologic reports of T1 CRCs detected during the next year were collected retrospectively, with endoscopists unaware of this evaluation. Sensitivity for T1 CRC recognition, R0 resection rate, and treatment modality were compared for trained vs. untrained endoscopists.

Results 1 year after e-learning, 528 nonpedunculated T1 CRCs were recorded for endoscopies performed by 251 endoscopists (118 [47 %] trained). Median T1 CRC size was 20 mm. Lesions were mainly located in the distal colorectum (66 %). Trained endoscopists recognized T1 CRCs more frequently than untrained endoscopists (sensitivity 74 % vs. 62 %; mixed model analysis odds ratio [OR] 2.90, 95 %CI 1.54–5.45). R0 resection rate was higher for T1 CRCs detected by trained endoscopists (69 % vs. 56 %; OR 1.73, 95 %CI 1.03–2.91).

Conclusion Training in optical recognition of T1 CRCs in community hospitals was associated with increased recognition of T1 CRCs, leading to higher en bloc and R0 resection rates. This may be an important step toward more organ-preserving strategies.

Supplementary Material



Publication History

Received: 07 April 2023

Accepted: 24 April 2024

Accepted Manuscript online:
24 April 2024

Article published online:
11 June 2024

© 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/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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