Endoscopic Techniques for the Detection, Characterisation and Treatment of Gastrointestinal Neoplasia

  • Sreedhari Thayalasekaran

Student thesis: Doctoral Thesis

Abstract

GI endoscopy is an important tool in the Gastroenterologists’ armamentarium in the detection and management of colorectal cancer. Prognosis from colorectal cancer is predominantly related to the stage of cancer at the time of diagnosis. Early diagnosis and treatment of pre-cancerous lesions is crucial to facilitate improved outcomes. The introduction reviews data on the techniques and technologies that influence the detection and management of dysplasia at colonoscopy. The aim of the thesis is to evaluate technologies that assist with detection of colonic neoplasia and endoscopic techniques for the management of neoplasia.

Endoscopy is rapidly changing with the advent of more advanced technology and novel techniques that improve the detection of pre-cancerous lesions. The widespread use of polypectomy has reduced the occurrence of colonic neoplasia. In recent years, the development of techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has seen an increase in the resection of more advanced colonic polyps.

Chapter 4 describes the use of a distal attachment device, the EndoRings for polyp detection in a large multi-centre randomized controlled trial in the United Kingdom. The study showed that the EndoRings device showed an improvement in polyp detection, compared to standard colonoscopy.

Chapter 5 describes a meta-analysis of the existing trials that compared EndoRings colonoscopy to standard colonoscopy. This meta-analysis did not show a significant benefit with the EndoRings device over standard colonoscopy.

Chapter 6 describes a meta-analysis of all colonoscopy assisted technology in the detection of colorectal adenoma in a cohort with a positive faecal occult blood test. This population are enriched with colorectal adenoma and would benefit the most if improved technology assists in the diagnosis and prevention of colorectal adenoma. This meta-analysis showed that no technologies improve adenoma detection.

Chapter 7 describes the use of a modified Delphi process by a series of experts to produce a series of recommendations on the use of I-Scan technology for colonic polyp detection and characterization.

Chapter 8 describes a retrospective study looking at the resection of colonic dysplasia in patients with inflammatory bowel disease (IBD). This study evaluated the difference in outcomes using the two endoscopic resection modalities; EMR and ESD. This study showed that both EMR and ESD are feasible options for the endoscopic resection of dysplasia in IBD.
Date of Award4 Aug 2022
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorJames Brown (Supervisor) & Pradeep Bhandari (Supervisor)

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