Papers by Ernst J Kuipers
American Journal of Gastroenterology, 2011
The risk for inflammatory bowel disease (IBD)-related colorectal cancer (CRC) remains a matter of... more The risk for inflammatory bowel disease (IBD)-related colorectal cancer (CRC) remains a matter of debate. Initial reports mainly originate from tertiary referral centers, and conflict with more recent studies. Overall, epidemiology of IBD-related CRC is relevant to strengthen the basis of surveillance guidelines. We performed a nationwide nested case-control study to assess the risk for IBD-related CRC and associated prognostic factors in general hospitals. IBD patients diagnosed with CRC between January 1990 and July 2006 in 78 Dutch general hospitals were identified as cases, using a nationwide automated pathology database. Control IBD patients without CRC were randomly selected. Clinical data were collected from detailed chart review. Poisson regression analysis was used for univariable and multivariable analyses. A total of 173 cases were identified through pathology and chart review and compared with 393 controls. The incidence rate of IBD-related CRC was 0.04%. Risk factors for IBD-related CRC were older age, concomitant primary sclerosing cholangitis (PSC, relative ratio (RR) per year duration 1.05; 95% confidence interval (CI) 1.01-1.10), pseudopolyps (RR 1.92; 95% CI 1.28-2.88), and duration of IBD (RR per year 1.04; 95% CI 1.02-1.05). Using immunosuppressive therapy (odds ratio (OR) 0.3; 95% CI 0.16-0.56, P<0.001) or anti-tumor necrosis factor (TNF) (OR 0.09; 95% CI 0.01-0.68, P<0.02) was protective. We found a limited risk for developing IBD-related CRC in The Netherlands. Age, duration of PSC and IBD, concomitant pseudopolyps, and use immunosuppressives or anti-TNF were strong prognostic factors in general hospitals.
BMC Surgery, 2007
Background: Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, pa... more Background: Surgery in patients with obstructive jaundice caused by a periampullary (pancreas, papilla, distal bile duct) tumor is associated with a higher risk of postoperative complications than in non-jaundiced patients. Preoperative biliary drainage was introduced in an attempt to improve
Scandinavian Journal of Gastroenterology, 2012
Background and aims. Atrophic gastritis (AG) results most often from Helicobacter pylori (H. pylo... more Background and aims. Atrophic gastritis (AG) results most often from Helicobacter pylori (H. pylori) infection. AG is the most important single risk condition for gastric cancer that often leads to an acid-free or hypochlorhydric stomach. In the present paper, we suggest a rationale for noninvasive screening of AG with stomach-specific biomarkers. Methods. The paper summarizes a set of data on application of the biomarkers and describes how the test results could be interpreted in practice. Results. In AG of the gastric corpus and fundus, the plasma levels of pepsinogen I and/or the pepsinogen I/pepsinogen II ratio are always low. The fasting level of gastrin-17 is high in AG limited to the corpus and fundus, but low or non-elevated if the AG occurs in both antrum and corpus. A low fasting level of G-17 is a sign of antral AG or indicates high intragastric acidity. Differentiation between antral AG and high intragastric acidity can be done by assaying the plasma G-17 before and after protein stimulation, or before and after administration of the proton pump inhibitors (PPI). Amidated G-17 will rise if the antral mucosa is normal in structure. H. pylori antibodies are a reliable indicator of helicobacter infection, even in patients with AG and hypochlorhydria. Conclusions. Stomach-specific biomarkers provide information about the stomach health and about the function of stomach mucosa and are a noninvasive tool for diagnosis and screening of AG and acid-free stomach.
JNCI Journal of the National Cancer Institute, 1996
Gastrointestinal Endoscopy, 2011
Gastrointestinal Endoscopy, 2011
International Journal of Cancer, 2013
Differences in the risk of a false negative or a false positive fecal immunochemical test (FIT) a... more Differences in the risk of a false negative or a false positive fecal immunochemical test (FIT) across subgroups may affect optimal screening strategies. We evaluate whether subgroups are at increased risk of a false positive or a false negative FIT result, whether such variability in risk is related to differences in FIT sensitivity and specificity or to differences in prior CRC risk. Randomly selected, asymptomatic individuals were invited to undergo colonoscopy. Participants were asked to undergo one sample FIT and to complete a risk questionnaire. We identified patient characteristics associated with a false negative and false positive FIT results using logistic regression. We focused on statistically significant differences as well as on variables influencing the false positive or negative risk for which the odds ratio exceeded 1.25. Of the 1,426 screening participants, 1,112 (78%) completed FIT and the questionnaire; 101 (9.1%) had advanced neoplasia. 102 Individuals were FIT positive, 65 (64%) had a false negative FIT result and 66 (65%) a false positive FIT result. Participants at higher age and smokers had a significantly higher risk of a false negative FIT result. Males were at increased risk of a false positive result, so were smokers and regular NSAID users. FIT sensitivity was lower in females. Specificity was lower for males, smokers and regular NSAID users. FIT sensitivity was lower in women. FIT specificity was lower in males, smokers and regular NSAID users. Our results can be used for further evidence based individualization of screening strategies.
Cancer Epidemiology, 2013
Several risk factors for colorectal cancer (CRC) have been identified. If individuals with risk f... more Several risk factors for colorectal cancer (CRC) have been identified. If individuals with risk factors are more likely to harbor cancer or it precursors screening programs should be targeted toward this population. We evaluated the predictive value of colorectal cancer risk factors for the detection of advanced colorectal adenoma in a population based CRC colonoscopy screening program. Data were collected in a multicenter trial conducted in the Netherlands, in which 6600 asymptomatic men and women between 50 and 75 years were randomly selected from a population registry. They were invited to undergo a screening colonoscopy. Based on a review of the literature CRC risk factors were selected. Information on risk factors was obtained from screening attendees through a questionnaire. For each CRC risk factor, we estimated its odds ratio (OR) relative to the presence of advanced neoplasia as detected at colonoscopy. Of the 1426 screening participants who underwent a colonoscopy, 1236 (86%) completed the risk questionnaire. 110 participants (8.9%) had advanced neoplasia. The following risk factors were significantly associated with advanced neoplasia detected by colonoscopy: age (OR: 1.06 per year; 95% CI: 1.03-1.10), calcium intake (OR: 0.99 per mg; 95% CI: 0.99-1.00), positive CRC family history (OR: 1.55 per first degree family member; 95%CI: 1.11-2.16) and smoking (OR: 1.75; 95%CI: 1.09-2.82). Elderly screening participants, participants with lower calcium intake, a CRC family history, and smokers are at increased risk of harboring detectable advanced colorectal neoplasia at screening colonoscopy.
Cancer Epidemiology, 2014
American Journal of Roentgenology, 2006
MR enteroclysis has been introduced in the workup of small-bowel diseases. The major advantage of... more MR enteroclysis has been introduced in the workup of small-bowel diseases. The major advantage of this technique over others is the combined visualization of luminal, mural, and extramural abnormalities. In this article we propose an MR enteroclysis protocol, present a stepwise approach for evaluation of these examinations, and discuss the different inflammatory conditions that can be detected. MR enteroclysis can be considered the current first-line imaging technique for inflammatory small-bowel disorders.
Gastrointestinal Endoscopy, 2010
Gastrointestinal Endoscopy, 2010
Gut, Jan 13, 2015
To determine adherence to recommended surveillance intervals in clinical practice. 2997 successiv... more To determine adherence to recommended surveillance intervals in clinical practice. 2997 successive patients with a first adenoma diagnosis (57% male, mean age 59 years) from 10 hospitals, who underwent colonoscopy between 1998 and 2002, were identified via Pathologisch Anatomisch Landelijk Geautomatiseerd Archief: Dutch Pathology Registry. Their medical records were reviewed until 1 December 2008. Time to and findings at first surveillance colonoscopy were assessed. A surveillance colonoscopy occurring within ±3 months of a 1-year recommended interval and ±6 months of a recommended interval of 2 years or longer was considered appropriate. The analysis was stratified by period per change in guideline (before 2002: 2-3 years for patients with 1 adenoma, annually otherwise; in 2002: 6 years for 1-2 adenomas, 3 years otherwise). We also assessed differences in adenoma and colorectal cancer recurrence rates by surveillance timing. Surveillance was inappropriate in 76% and 89% of patients...
Background Surveillance of adenoma patients aims to prevent colorectal cancer (CRC) by removing r... more Background Surveillance of adenoma patients aims to prevent colorectal cancer (CRC) by removing recurrent adenomas. Adenoma removal and subsequent surveillance can reduce CRC incidence by 76-90%. Colonoscopy is however scarce, expensive and potentially harmful. To ensure efficient use of resources, surveillance colonoscopy should be targeted at patients who will benefit most from the procedure. Current surveillance guidelines use advanced morphology or multiplicity as criteria for surveillance interval. However, none of the guidelines have separate recommendations for patients with both multiple and advanced adenomas. Aim To assess the relative risks of advanced and multiple (≥3) adenomas separately and combined on metachronous advanced colorectal neoplasia in a representative cohort of adenoma patients. Methods We collected prospective data on adenoma patients from 10 hospitals throughout the Netherlands, using a nationwide histopathology registry to select newly diagnosed adenoma patients from 1988 to 2002. Patients with CRC history or CRC at index colonoscopy, hereditary cancer syndromes or IBD were excluded. Electronic medical records were reviewed until December 1, 2008 for follow-up. Index colonoscopy was defined as colonoscopy with first adenoma diagnosis. Presence of advanced (≥10 mm, a villous histology or high-grade dysplasia) or multiple (≥3) adenomas and the combination at index colonoscopy were considered as potential risk factors for metachronous advanced colorectal neoplasia (advanced adenoma or CRC) at first follow-up endoscopy. To assess hazard ratios (HR) for the relative risk we performed a Cox-regression analysis, adjusted for age and gender. Results 3,041 adenoma patients (55% male, mean age 61 yrs (range 40 -88)) were analyzed, of whom 1,351 (44%) patients had advanced adenomas at index endoscopy, and 161 (6%) ≥3 non-advanced adenomas. Median interval (interquartile range) to first surveillance endoscopy was 21 months (12-39); 15 months (11-35) for patients with advanced and/or ≥3 adenomas, and 27 months (13-45) for patients with 1-2 non-advanced adenomas at index endoscopy (p<0.01). At follow-up, 831 patients had any colorectal neoplasia (adenoma or CRC), of whom 182 patients had advanced colorectal neoplasia, including 26 CRC cases. Relative risks for metachronous advanced colorectal neoplasia are given in . Conclusion Advanced adenomas and ≥3 adenomas at index colonoscopy are equally important risk factors for metachronous advanced colorectal neoplasia, resulting in a 3-fold increased risk of developing advanced colorectal neoplasia during follow-up. However, having both risk factors results in a 6-fold increased risk. The results suggest that advanced morphology and multiplicity should be used to tailor surveillance guidelines with a separate recommendation for adenoma patients that have both these risk factors. Table 1. Relative risk of advanced and multiple (≥3) adenomas on metachronous advanced colorectal neoplasia NAA = Non-advanced adenomas, AA = Advanced adenomas, *Adjusted for age and gender S-183 AGA Abstracts 1093 Decreased Risk of Developing Colorectal Cancer Following a Colonoscopy Among Older Patients in the United States: A Population-Based Analysis of the SEER-Medicare Linked Database, 1998-2005 Yize R. Wang, John R. Cangemi, Michael F. Picco Background: Previous studies found decreased risk of developing colorectal cancer following a colonoscopy but the benefits were limited to the left colon. Medicare coverage of screening colonoscopy for high-risk patients began on 01/01/1998 and was expanded to average-risk patients on 07/01/2001. Objective: To determine if the risk of developing colorectal cancer decreased following a colonoscopy among older Medicare patients. Data and Methods: All patients in the Medicare 5% random sample of the Surveillance, Epidemiology and End Results Medicare (SEER-Medicare) linked database who were 67 years or older at the time of their first colonoscopy between 01/01/1998 and 12/31/2002 were identified. We excluded Medicare HMO enrollees or those without Part B coverage in the 24 months prior to colonoscopy.
Gastrointestinal Endoscopy, 2011
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Papers by Ernst J Kuipers