Effect of real-time computer-aided detection of colorectal adenoma in routine colonoscopy (COLO-GENIUS): a single-centre randomised controlled trial.

BACKGROUND: Artificial intelligence systems have been developed to improve polyp detection. We aimed to evaluate the effect of real-time computer-aided detection (CADe) on the adenoma detection rate (ADR) in routine colonoscopy. METHODS: This single-centre randomised controlled trial (COLO-GENIUS) was done at the Digestive Endoscopy Unit, Pôle Digestif Paris-Bercy, Clinique Paris-Bercy, Charenton-le-Pont, France. All consecutive individuals aged 18 years or older who were scheduled for a total colonoscopy and had an American Society of Anesthesiologists score of 1-3 were screened for inclusion. After the caecum was reached and the colonic preparation was appropriate, eligible participants were randomly assigned (1:1; computer-generated random numbers list) to either standard colonoscopy or CADe-assisted colonoscopy (GI Genius 2.0.2; Medtronic). Participants and cytopathologists were masked to study assignment, whereas endoscopists were not. The primary outcome was ADR, which was assessed in the modified intention-to-treat population (all randomly assigned participants except those with misplaced consent forms). Safety was analysed in all included patients. According to statistical calculations, 20 endoscopists from the Clinique Paris-Bercy had to include approximately 2100 participants with 1:1 randomisation. The trial is complete and registered with ClinicalTrials.gov, NCT04440865. FINDINGS: Between May 1, 2021, and May 1, 2022, 2592 participants were assessed for eligibility, of whom 2039 were randomly assigned to standard colonoscopy (n=1026) or CADe-assisted colonoscopy (n=1013). 14 participants in the standard group and ten participants in the CADe group were then excluded due to misplaced consent forms, leaving 2015 participants (979 [48·6%] men and 1036 [51·4%] women) in the modified intention-to-treat analysis. ADR was 33·7% (341 of 1012 colonoscopies) in the standard group and 37·5% (376 of 1003 colonoscopies) in the CADe group (estimated mean absolute difference 4·1 percentage points [95% CI 0·0-8·1]; p=0·051). One bleeding event without deglobulisation occurred in the CADe group after a large (>2 cm) polyp resection and resolved after a haemostasis clip was placed during a second colonoscopy. INTERPRETATION: Our findings support the benefits of CADe, even in a non-academic centre. Systematic use of CADe in routine colonoscopy should be considered. FUNDING: None.

Long-term pollution by chlordecone of tropical volcanic soils in the French West Indies: New insights and improvement of previous predictions.

Chlordecone (CLD), was widely applied in banana fields in the French West Indies from 1972 to 1993. The WISORCH model was constructed to assess soil contamination by CLD and estimated that it lasts from 100 to 600 years, depending on leaching intensity and assuming no degradation. However, recent studies demonstrated that CLD is degraded in the environment, hence questioning the reliability of previous estimations. This paper shows how to improve the model and provides insights into the long-term dissipation of CLD. In-situ observations were made in nearly 2545 plots between 2001 and 2020, and 17 plots were sampled at two dates. Results of soil analyses showed an unexpected 4-fold decrease in CLD concentrations in the soil, in contrast to simulations made using the first version of WISORCH at the time. Neither erosion, nor CLD leaching explained these discrepancies. In a top-down modeling approach, these new observations of CLD concentrations led us to implement a new dissipation process in the WISORCH model that corresponds to a DT50 dissipation half-life of 5 years. The new version of the improved model allowed us to update the prediction of the persistence of soil pollution, with soil decontamination estimated for the 2070s. This development calls for re-evaluation of soil pollution status. Further validation of the new version of WISORCH is needed so it can contribute to crop management on contaminated soil.

Analysis of surface water reveals land pesticide contamination: an application for the determination of chlordecone-polluted areas in Guadeloupe, French West Indies.

In Guadeloupe, the use between 1972 and 1993 of chlordecone, an organochlorine insecticide, has permanently contaminated the island's soil, thus contaminating the food chain at its very beginning. There is today a strong societal requirement for an improved mapping of the contaminated zones. Given the extent of the areas to be covered, carrying out soil tests on each plot of the territory would be a long and expensive process. In this article, we explore a method of demarcating polluted areas. The approach adopted consists in carrying out, using surface water analyses, a hydrological delimitation that makes it possible to distinguish contaminated watersheds from uncontaminated ones. The selection of sampling points was based on the spatial analysis of the actual and potential contamination data existing at the beginning of the study. The approach was validated by soil analyses, after having compared the contamination data of the watersheds with the soil contamination data of the plots within them. The study thus made it possible to highlight new contaminated areas and also those at risk of contamination and to identify the plots to be targeted as a priority during future analysis campaigns by State services.

Adenoma detection by Endocuff-assisted versus standard colonoscopy in routine practice: a cluster-randomised crossover trial.

OBJECTIVE: Endocuff Vision (ECV) is the second generation of a device designed to improve polyp detection. The aim of this study was to evaluate its impact on adenoma detection rate (ADR) in routine colonoscopy. DESIGN: This cluster-randomised crossover trial compared Endocuff-assisted (ECV+) with standard (ECV-) colonoscopy. Two teams of 11 endoscopists each with prior ECV experience, balanced in terms of basal ADR, gender and case volume were compared. In randomised fashion, the teams started with ECV+ or ECV- and switched group after inclusion of half of the cases. The main outcome criterion was ADR difference between ECV+ and ECV-. Subgroup analysis was done for physicians with low and high ADR (< or ≥ 25%). RESULTS: During two periods of 20 and 21 weeks, respectively, the 22 endoscopists included 2058 patients (1032 ECV- vs 1026 ECV+, both groups being comparable). Overall ADR for both groups taken together was higher with ECV (39.2%) than without (29.4%; p<0.001) irrespective of the sequence of use (ECV+ or ECV- first), but mostly in adenomas <1 cm. In the physician subgroup analysis, only high detectors showed a significant ADR increase (from 31% to 41%, p<0.001), while the increase in the low detectors was not significant (from 24% to 30%, p=0.11). ECV had a positive impact in all colonic locations, except for the rectum. No ECV- related complication was reported. CONCLUSION: We observed a significant ADR difference of approximately 10% by the use of ECV. By subgroup analysis, this increase was significant only in physicians classified as high detectors. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT03344055).

Physical limitation of pesticides (chlordecone) decontamination in volcanic soils: fractal approach and numerical simulation.

In the French West Indies, the chlordecone (organochloride pesticide) pollution is now diffuse becoming new contamination source for crops and environment (water, trophic chain). Decontamination by bioremediation and chemical degradation are still under development but the physical limitations of these approaches are generally not taken into account. These physical limitations are related to the poor physical accessibility to the pesticides in soils because of the peculiar structural properties of the contaminated clays (pore volume, transport properties, permeability, and diffusion). Some volcanic soils (andosols), which represent the half of the contaminated soils in Martinique, contain nanoclay (allophane) with a unique structure and porous properties. Andosols are characterized by pore size distribution in the mesoporous range, a high specific surface area, a large pore volume, and a fractal structure. Our hypothesis is that the clay microstructure characteristics are crucial physico-chemical factors strongly limiting the remediation of the pesticide. Our results show that allophane microstructure (small pore size, hierarchical microstructure, and tortuosity) favors accumulation of chlordecone, in andosols. Moreover, the clay microporosity limits the accessibility of microorganisms and chemical species able to decontaminate because of poor transport properties (permeability and diffusion). We model the transport properties by two approaches: (1) we use a numerical model to simulate the structure of allophane aggregates. The algorithm is based on a cluster-cluster aggregation model. From the simulated data, we derived the pore volume, specific surface area, tortuosity, permeability, and diffusion. We show that transport properties strongly decrease because of the presence of allophane. (2) The fractal approach. We characterize the fractal features (size of the fractal aggregate, fractal dimension, tortuosity inside allophane aggregates) and we calculate that transport properties decrease of several order ranges inside the clay aggregates. These poor transport properties are important parameters to explain the poor accessibility to pollutants in volcanic soils and should be taken into account by future decontamination process. We conclude that for andosols, this inaccessibility could render inefficient some of the methods proposed in the literature.

Spatio-temporal variability of water pollution by chlordecone at the watershed scale: what insights for the management of polluted territories?

Chlordecone, applied on soils until 1993 to control banana weevil, has polluted water resources in the French West Indies for more than 40 years. At the watershed scale, chlordecone applications were not homogenous, generating a spatial heterogeneity of the pollution. The roles of climate, hydrology, soil, agronomy, and geology on watershed functioning generate a temporal heterogeneity of the pollution. This study questions the interactions between practices and the environment that induce such variability. We analyzed hydrological and water pollution datasets from a 2-year monitoring program on the Galion watershed in Martinique (French West Indies). We conjointly analyzed (i) weekly chlordecone (CLD) concentration monitored on 3 river sampling sites, (ii) aquifer piezometric dynamics and pollutions, and (iii) agricultural practices on polluted soils. Our results showed that chlordecone pollution in surface waters are characterized by annual trends and infra-annual variations. Aquifers showed CLD concentration 10 times higher than surface water, with CLD concentration peaks during recharge events. We showed strong interactions between rainfall events and practices on CLD pollution requiring a systemic management approach, in particular during post-cyclonic periods. Small sub-watershed with high CLD pollution appeared to be a substantial contributor to CLD mass transfers to the marine environment via rivers and should therefore receive priority management. We suggest increasing stable organic matter return to soil as well as external input of organic matter to reduce CLD transfers to water. We identified hydrological conditions-notably drying periods-and tillage as the most influential factors on CLD leaching. In particular, tillage acts on 3 processes that increases CLD leaching: organic matter degradation, modification of water paths in soil, and allophane clay degradation.

Difference in Physician- and Patient-Dependent Factors Contributing to Adenoma Detection Rate and Serrated Polyp Detection Rate.

BACKGROUND: Adenoma detection rate (ADR) is correlated with the risk of interval colorectal cancer and is considered as a quality benchmark for colonoscopy. Serrated polyp detection rate (SPDR) might be a more stringent indicator of quality in polyp detection. AIMS: To evaluate in a 2-year monocentric observational study patient-dependent and endoscopist-dependent factors influencing ADR and SPDR in daily practice. METHODS: We determined ADR and SPDR. We collected patient-dependent factors and endoscopist-dependent factors. Links between these data and detection rates were assessed by uni- and multivariate analysis. RESULTS: A total of 11682 colonoscopies were performed (female: 54.3%; male: 45.7%; median age 58) by 30 endoscopists (female: 9; male: 21). ADR and SPDR were 29.2% and 8%, respectively. In multivariate analysis, ADR was associated with patient-dependent factors: age (OR 1.044, CI 95% 1.040-1.048), male gender (OR 1.7, CI 95% 1.56-1.85), personal history of polyp/cancer (OR 1.53, CI 95% 1.3-1.9), and positive fecal immunochemical test (OR 2.47, CI 95% 2.0-3.1). In multivariate analysis, SPDR was associated with withdrawal time (OR 1.25, CI 95% 1.17-1.32), low volume activity (OR 1.3, CI 95% 1.1-1.52), and personal history of polyp/cancer (OR 1.61, CI 95% 1.15-2.25). CONCLUSION: In this large series of routine colonoscopies, we found that ADR was mainly driven by patient-dependent conditions, i.e., age, male gender, colonoscopy indication for positive FIT, and a personal history of polyp or cancer. In contrast, SPDR was mainly related to endoscopist-dependent factor, i.e., withdrawal time and low volume activity.

Adenoma and advanced neoplasia detection rates increase from 45 years of age.

BACKGROUND: Colonoscopy is considered a valid primary screening tool for colorectal cancer (CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate (ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years. AIM: To compare the ADR and advanced neoplasia detection rate (ANDR) according to age in a large series of patients during routine colonoscopy. METHODS: All consecutive patients who were scheduled for colonoscopy were included. Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy (for stent insertion or stenosis dilation). Colonoscopies were performed in our unit by a team of 30 gastroenterologists in 2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC (excluding patients with personal or family history of advanced adenoma or cancer). RESULTS: 6027 colonoscopies were performed in patients with a median age of 57 years (range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44 (n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49 (P < 0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years (P < 0.03). With regard to patients aged 50-54 (n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years. CONCLUSION: This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.

Linking current river pollution to historical pesticide use: Insights for territorial management?

Persistent organic pollutants like organochlorine pesticides continue to contaminate large areas worldwide raising questions concerning their management. We designed and tested a method to link soil and water pollution in the watershed of the Galion River in Martinique. We first estimated the risk of soil contamination by chlordecone by referring to past use of land for banana cultivation and took 27 soil samples. We then sampled surface waters at 39 points and groundwater at 16 points. We tested three hypotheses linked to the source of chlordecone pollution at the watershed scale: (i) soils close to the river, (ii) soils close to the sampling point, (iii) throughout the sub-watershed generated at the sampling point. Graphical and statistical analysis showed that contamination of the river increased when it passed through an area with contaminated plots and decreased when it passed through area not contaminated by chlordecone. Modeling showed that the entire surface area of the watershed contributed to river pollution, suggesting that the river was mainly being contaminated by the aquifers and groundwater flows. Our method proved to be a reliable way to identify areas polluted by chlordecone at the watershed scale and should help stakeholders focus their management actions on both hot spots and the whole watershed.

Comparative fate of an organochlorine, chlordecone, and a related compound, chlordecone-5b-hydro, in soils and plants.

We address the problem of the comparative environmental fate of a pesticide, chlordecone (CLD), and a related compound, chlordecone-5b-hydro (CLD-5b-hydro). We used a large database including data from two types of contaminated volcanic soils, andosol and nitisol, and thirteen crops grown in the French West Indies in historically polluted soils. We performed in-depth statistical analysis of the effect of different parameters (soil type, crop, organ, etc.) on the ratio of CLD-5b-hydro to CLD in both soils and plants. The environmental fate of the two compounds differed depending on the type of soil. Proportionally, more CLD-5b-hydro than CLD was measured in nitisols than in andosols. Compared to CLD, we also found a preferential transfer of CLD-5b-hydro from the soil to the plant. Finally, mobilization of the two compounds differed according to the species of crop but also within the plant, with increasing ratios from the roots to the top of the plant. The properties of the compound played a key role in the underlying processes. Because CLD-5b-hydro is more soluble in water and has a lower K(ow) than CLD, CLD-5b-hydro (1) was more easily absorbed from soils by plants, (2) was less adsorbed onto plant tissues and (3) was transported in greater quantities through the transpiration stream. Due to the amounts of CLD-5b-hydro we measured in some plant parts such as cucurbit fruits, an assessment of the toxicity of this CLD monodechlorinated product is recommended.

Decision support tool for soil sampling of heterogeneous pesticide (chlordecone) pollution.

When field pollution is heterogeneous due to localized pesticide application, as is the case of chlordecone (CLD), the mean level of pollution is difficult to assess. Our objective was to design a decision support tool to optimize soil sampling. We analyzed the CLD heterogeneity of soil content at 0-30- and 30-60-cm depth. This was done within and between nine plots (0.4 to 1.8 ha) on andosol and ferralsol. We determined that 20 pooled subsamples per plot were a satisfactory compromise with respect to both cost and accuracy. Globally, CLD content was greater for andosols and the upper soil horizon (0-30 cm). Soil organic carbon cannot account for CLD intra-field variability. Cropping systems and tillage practices influence the CLD content and distribution; that is CLD pollution was higher under intensive banana cropping systems and, while upper soil horizon was more polluted than the lower one with shallow tillage (<40 cm), deeper tillage led to a homogenization and a dilution of the pollution in the soil profile. The decision tool we proposed compiles and organizes these results to better assess CLD soil pollution in terms of sampling depth, distance, and unit at field scale. It accounts for sampling objectives, farming practices (cropping system, tillage), type of soil, and topographical characteristics (slope) to design a relevant sampling plan. This decision support tool is also adaptable to other types of heterogeneous agricultural pollution at field level.

Transport of a nematicide in surface and groundwaters in a tropical volcanic catchment.

The aim of this article is to determine how the nematicide cadusafos [S,S-di-sec-butyl O-ethyl phosphorodithioate] contaminates water and soils at two scales, subcatchment and catchment. The study site was a small banana (Musa spp.)-growing catchment on the tropical volcanic island of Guadeloupe in the Caribbean. Two application campaigns were conducted, one in 2003 on 40% of the catchment and one in 2006 on 12%. The study involved monitoring for 100 d the surface water and groundwater flows and the cadusafos concentrations in the soil and in surface and groundwaters in a 2400 m(2) subcatchment and a 17.8 ha catchment. The results show that at the subcatchment scale the high retention in the A horizon of the soil limits the transport of cadusafos by runoff, whereas the lower retention of the molecule in the B horizon favors percolation toward the shallow groundwater. Comparing the losses of cadusafos at the subcatchment and at the catchment scales revealed that the nematicide re-infiltrated in the hydrographic network. Two successive phases of stream water contamination were observed, corresponding to two distinct contamination mechanisms: an event-dominated contamination phase (of <30 d) when transport was linked to overland flow during precipitation shortly after application, and a stabilized contamination phase when transport originated mainly from the drainage of the shallow aquifer. Lastly, comparing the losses of the two phases during 2003 and 2006 showed that shallow groundwater, which is promoted in such permeable soils under abundant tropical rainfalls, seems to be the main contributor to stream contamination.

Efficiency of a bagasse substrate in a biological bed system for the degradation of glyphosate, malathion and lambda-cyhalothrin under tropical climate conditions.

BACKGROUND: After the rinsing of spray equipment, the rinsing water contains polluting products. One way to avoid pollution is to bring the rinsing water over a purification system, a biological bed. The system consists of an impermeable tub filled with a biomix substrate that facilitates biodegradation of pesticides. Usually, straw is one component of the biomix. The objective of this study was to assess the efficiency of an unusual substrate, bagasse, a residue of sugar cane, for the degradation of three pesticides, glyphosate, malathion and lambda-cyhalothrin. RESULTS: Results showed that more than 99% of malathion and glyphosate were degraded in 6 months. In the biological bed, the DT(50) value for malathion was 17 days, for glyphosate 33 days and for lambda-cyhalothrin 43 days. The degradation rate of aminomethylphosphonic acid (AMPA) residues from the degradation of glyphosate was slower than that of the other pesticides (DT(50) 69 days). Finally, the innocuousness of the biomix after 6 months of degradation was confirmed by biological tests. CONCLUSIONS: Although the degradation rates of the three pesticides in the present bagasse-based system were similar to those under temperate conditions, the degradation conditions were improved by comparison with those in soil under the given tropical conditions. Further benefits of this system are pesticide confinement, to avoid their dispersion in the environment by liquids or solids, and a lower overall cost. Finally, possibilities for optimising the bagasse-based system (e.g. management of the water content and nature of the biomix) are discussed.

[Inflammatory colitis and chronic granulomatous disease, a steroid-dependent case report]. / Colite inflammatoire et granulomatose septique, à propos d'un cas de cortico-dépendance.

Chronic granulomatous disease may lead to inflammatory bowel disease with endoscopic and histological aspects similar to that observed in patients with Crohn's disease. Inflammatory symptoms are generally controlled by steroids, but resistant forms may need total colectomy. Therapeutic strategy in steroid-dependent cases is not yet established. We report here the case of a patient with chronic granulomatous enteritis dependent on steroids at a daily dose of 20 mg. Azathioprine made it possible to withdraw steroid therapy without relapse over twenty Months and without infectious complication during the follow up.

[Chronic abdominal pain due to bowel ischemia in a patient with Leiden factor V mutation]. / Douleurs abdominales chroniques par ischémie mésentérique liée à une mutation du facteur V Leiden.

Leiden Factor V mutation, associated with resistance to activated protein C, is a prothrombotic state found in 20% of the patients with a first episode of deep-vein thrombosis. We report the case of a 30-Year-old woman with a history of intermittent abdominal pain who developed small bowel infarction requiring extensive small bowel resection. Biological search for prothrombotic disorder showed resistance to activated protein C due to homozygosity for the factor V Leiden mutation. Long-term anticoagulant therapy was initiated. Unexplained abdominal pain may be due to venous mesenteric ischemia, which can be associated with factor V Leiden mutation.