Publications

BACKGROUND AND STUDY AIMS

 Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment.

METHODS

 We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95 % confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes.

RESULTS

 We identified 2949 studies, of which 48 were included. Overall, 8.5 % (95 %CI 6.5 % - 10.5 %) of LSTs contained SMI. The risk of SMI differed among the LST subtypes: 31.6 % in non-granular pseudodepressed LSTs (95 %CI 19.8 % - 43.4 %), 10.5 % in granular nodular mixed LSTs (95 %CI 5.9 % - 15.1 %), 4.9 % in non-granular flat elevated LSTs (95 %CI 2.1 % - 7.8 %), and 0.5 % in granular homogenous LSTs (95 %CI 0.1 % - 1.0 %). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95 %CI 1.24 - 5.02). The proportion of SMI increased with lesion size (10 - 19 mm, 4.6 %; 20 - 29 mm, 9.2 %; ≥ 30 mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8 % (95 %CI 0.6 % - 1.1 %).

CONCLUSION

 The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the preferred therapy.

OBJECTIVE

We undertook this study of echocardiographic classification of diastolic function by three different algorithms to determine: (1) how frequently each algorithm classified patients and (2) how well the results agreed with one another.

BACKGROUND

Several algorithms exist to grade diastolic function (DF), the Mayo Clinic scheme of Redfield et al (Mayo 2003) and the 2 ASE guideline documents of 2009 and 2016 (ASE 2009 and ASE 2016).

METHODS

A total of 200 consecutive echocardiograms were retrospectively analyzed; mean age of patients 60.3 ± 3.5 years, 45% male. Echocardiograms were performed using Intersocietal Accreditation Commission guidelines. Diastolic function was assessed by Mayo 2003 and ASE 2009 and 2016. Coexisting conditions affecting DF analysis, such as mitral annular calcification (MAC), were tabulated. Data were compared using a paired t-test. Concordance between algorithms was assessed using the Kappa statistic.

RESULTS

A total of 117 of 200 studies (58.5%) were excluded for the presence of coexisting conditions (51.5%), poor image quality (2.5%), or incomplete data (4.5%). Thirty-three of the remaining 83 studies (40%) received the same grade of DF based on assessments made using the Mayo 2003 and ASE 2016 algorithms; the Kappa statistic was 0.20. 36 of the 83 studies (43%) received the same grade of DF based on assessments made using the ASE 2009 and ASE 2016 algorithms; the Kappa statistic was 0.25.

CONCLUSION

Assessment of diastolic function via echocardiography cannot be reliably accomplished in approximately 50% of patients using current guidelines. Further, when studies are suitable for assessment, widely used guidelines yield discordant results.