Prospective Study of a Novel Diagnostic Algorithm for Investigating and Managing Gastrointestinal Disease Through The Appropriate Use of Biomarkers and Wireless Based Capsule Endoscopy
Citation:
Mohd Syafiq Ismail, 'Prospective Study of a Novel Diagnostic Algorithm for Investigating and Managing Gastrointestinal Disease Through The Appropriate Use of Biomarkers and Wireless Based Capsule Endoscopy', Trinity College Dublin.School of Medicine, 2022Download Item:
Abstract:
This chapter gives a general outline of the thesis for better understanding of issues surrounding research areas and studies that have been performed. Lower Gastrointestinal (GI) Symptoms are common and often warrant further investigations which may include colonoscopy. Currently the demand for colonoscopy far exceeds the capacity to perform them. This results in prolonged waiting lists and unfortunately delays in diagnosis. Possible strategies for patient triaging would include symptoms based triaging systems, use of biomarkers and minimally-invasive colonoscopy which includes Colon Capsule Endoscopy (CCE) and CTC (Computed Tomography Colonography). The use of CCE for investigating the symptomatic lower GI patient is still under investigation and we wish to explore this further in this thesis.
Chapter 2 highlights the current literature review on the topic of the symptomatic lower gastrointestinal (GI) patient. This is a common problem and warrants further investigations. We outline in this chapter the current strategies that has been employed to select and triage patient for further investigations which includes the need for colonoscopy. This chapter also explores the role of symptoms based triaging systems, biomarker use and minimally-invasive colonoscopy, which we have divided into CT Colonography (CTC) and Colon Capsule Endoscopy (CCE) in the diagnosis of the symptomatic patient.
Chapter 3 is a retrospective study performed to assess the value of symptoms in picking up Clinically Significant Disease (CSD). We compared the diagnostic yield of each lower GI symptoms and the likelihood of picking up CSD based on symptoms. We than applied the National Institute for Health and Care Excellence (NICE) guidelines for Colorectal Cancer (CRC) and Inflammatory Bowel Disease (IBD) as a means of classifying these patients into low risk versus high risk to assess whether fulfilling the criteria will increase diagnostic yield. This study has been published in BMJ Open Gastroenterol. 2020 Mar 31;7(1): e000221. DOI: 10.1136/bmjgast-2018-000221 [1]. The study has also been presented at the 26th United European Gastroenterology Week (UEGW) which was held on October 20-24, 2018, in Vienna, Austria as a poster presentation.
Chapter 4 outlines the use of biomarkers in assessing GI related disease.
The first subchapter outlines the role of different types of faecal and urine biomarkers in diagnosis and management of small bowel diseases. This subchapter has been published as a review article in Curr Opin Gastroenterol. 2021 May 1;37(3):284-294. doi: 10.1097/MOG.0000000000000730 [2].
The second subchapter is a study that we have performed to investigate the use of C-Reactive Protein (CRP), Faecal Immunochemical Test for Haemoglobin (FIT) and Faecal Calprotectin (FC) to assess for mucosal healing and disease activity in patients with Inflammatory Bowel Disease (IBD). We correlate the diagnostic accuracy of biomarkers with findings on endoscopy of IBD patients. The results of this study were presented at the 15th Congress of ECCO, 12-15 February 2020and published as an abstract publication in Journal of Crohn's and Colitis, Volume 14, Issue Supplement_1, January 2020, Page S240, https://doi.org/10.1093/ecco-jcc/jjz203.332 [3]. A full journal article has been written and has been planned for submission for peer-review in the Irish Medical Journal.
Chapter 5 explores the use of CCE in the symptomatic patient and also some other aspects of CCE.
• The first subchapter is a pilot study that investigates the use of biomarkers and CCE in low to moderate risk patients complaining of lower GI symptoms. The study outlines the diagnostic accuracy of biomarkers and CCE compared to colonoscopy. This subchapter has been published as an original research in Endosc Int Open. 2021 Jun;9(6):E965-E970. doi: 10.1055/a-1401-9528. Epub 2021 May 27 [4]. Colon capsule endoscopy is a viable alternative to colonoscopy for the investigation of intermediate- and low-risk patients with gastrointestinal symptoms: results of a pilot study. Ismail MS, Semenov S, Sihag S, Manoharan T, Douglas AR, Reill P, Kelly M, Boran G, O'Connor A, Breslin N, O'Donnell S, Ryan B, McNamara D. This study has also been presented as an oral e-poster podium presentation at ESGE Days 2019 meeting in Prague.
• The second subchapter explores the different bowel preparation regimens that are used for CCE and the effect on bowel cleansing and capsule excretion. The first part describes the change from a 4 litre Polyethylene Glycol (PEG) (KleanPrep) based bowel preparation to a 2 litre Polyethylene Glycol + Ascorbic acid (AA) (Moviprep). This study has been presented as an e-poster at the Virtual UEGW 2020 meeting and has been published as abstract form in Endoscopy 2020; 52(S 01): S274. DOI: 10.1055/s-0040-1704865 [5]. Improving Quality in Colon Capsule Endoscopy; Effects of Different Bowel Preparation Regimens. M Syafiq Ismail, S Semenov, S Sihag, N Breslin, A O’Connor, B Ryan, D McNamara. The second part of this subchapter explores the addition of castor oil to the CCE booster medications and effects on bowel cleansing and capsule excretion. This study has been published in World J Gastrointest Pharmacol Ther. 2021 Nov 5;12(6):103-112. DOI: 10.4292/wjgpt.v12.i6.103, Semenov S, Ismail MS, O'Hara F, Sihag S, Ryan B, O'Connor A, O'Donnell S, McNamara D. Addition of castor oil as a booster in colon capsule regimens significantly improves completion rates and polyp detection [6]. It was also presented at the Virtual UEGW 2020 meeting as a e-poster.
• The third subchapter explores the patient preference between colonoscopy and CCE. We assess patients’ comfort, satisfaction, and preference between CCE and colonoscopy. The patients from this subchapter were recruited from the study conducted in subchapter 5.1. This subchapter has been published in BMC Gastroenterol. 2022 Jan 24;22(1):31. DOI: 10.1186/s12876-021-02081-0, Ismail MS, Murphy G, Semenov S, McNamara D. Comparing Colon Capsule Endoscopy to colonoscopy; a symptomatic patient's perspective [7]. This study has also been presented as a e-poster at the ESGE Days 2019 meeting in Prague.
Chapter 6 explores the potential role of CCE as a response to the Covid-19 Pandemic.
• The first subchapter introduces the effects of the pandemic to endoscopy waiting lists in general and how CCE will be able to help reduce the waiting list. This subchapter has been submitted as a correspondence letter to Endoscopy International Open and is awaiting editor decision.
• The second subchapter outlines the impact of the Covid-19 pandemic to Colorectal Cancer Screening. This subchapter has been published as correspondence letter in Lancet Gastroenterol Hepatol. 2021 Jun;6(6):426. doi: 10.1016/S2468-1253(21)00136-9. Semenov S*, Ismail MS*, McNamara D. Impairment of colorectal cancer screening during the COVID-19 pandemic [8]. Ismail MS and Semenov S are co-first authors to this paper.
Chapter 7 is our conclusion to the thesis, which outlines summaries of studies presented and published. This chapter also outlines possible future directions for CCE and triaging systems of patients with lower GI symptoms.
Author: Ismail, Mohd Syafiq
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McNamara, DeirdreQualification name:
Doctor in Medicine (MD)Type of material:
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