Evelien Dekker

Academisch Medisch Centrum Universiteit van Amsterdam, Amsterdamo, North Holland, Netherlands

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Publications (219)1467.56 Total impact

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    ABSTRACT: Current guidelines recommend routine follow-up colonoscopy after acute diverticulitis to confirm the diagnosis and exclude malignancy. Its value, however, has recently been questioned because of contradictory study results. Our objective was to compare the colonoscopic detection rate of advanced colonic neoplasia (ACN), comprising colorectal cancer (CRC) and advanced adenoma (AA), in patients after a CT-proven primary episode of uncomplicated acute diverticulitis with average risk participants in a primary colonoscopy CRC screening program. A retrospective comparison was performed of prospectively collected data from cohorts derived from two multicenter randomized clinical trials executed in the Netherlands between 2009 and 2013. 401 uncomplicated diverticulitis patients and 1,426 CRC screening participants underwent colonic evaluation by colonoscopy. Main outcome was the diagnostic yield for ACN, calculated as number of diverticulitis patients and screening participants with ACN relative to their totals, with differences expressed as odds ratios (OR). The histopathology outcome of removed lesions during colonoscopy was used as definitive diagnosis. AA detection was similar [5.5 vs. 8.7 %; OR 0.62 (95 % CI 0.38-1.01); P = 0.053]. CRC was detected in 1.2 % (5/401) of diverticulitis patients versus 0.6 % (9/1,426) of screening participants [OR 1.30 (95 % CI 0.39-4.36); P = 0.673]. ACN was diagnosed in 6.7 % (27/401) of diverticulitis patients versus 9.1 % (130/1,426) of screening participants [OR 0.71 (95 % CI 0.45-1.11); P = 0.134]. ORs were adjusted for age, family history of CRC, smoking, BMI, and cecal intubation rate. ACN detection does not differ significantly between patients with recent uncomplicated diverticulitis and average risk screening participants. Routine follow-up colonoscopy after primary CT-proven uncomplicated left-sided acute diverticulitis can be omitted; these patients can participate in CRC screening programs. Follow-up colonoscopy may be beneficial when targeted at high-risk patients, but such an approach first needs prospective evaluation.
    Surgical endoscopy. 12/2014;
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    ABSTRACT: Colonoscopy is the gold standard for the detection of colorectal cancer and its precursors. Nevertheless multiple studies have demonstrated a significant miss-rate for polyps and, more importantly, demonstrated the occurrence of interval cancers in the years after colonoscopy. This imperfect protection against colorectal cancer can be explained by multiple factors related to both the endoscopist and the equipment. To ensure the quality of colonoscopy, several quality indicators have been described. These include bowel preparation, cecal intubation rate, withdrawal time, adenoma detection rate and complication rate. Measurement of these quality indicators, followed by awareness, benchmarking and additional training will hopefully optimize daily practice. If these basic quality parameters are well taken care of, advanced colonoscopic techniques will aim at further increasing the detection and differentiation of colonic lesions. In this review, the authors discuss the literature on quality indicators for colonoscopy and give a comprehensive overview of the advanced colonoscopic techniques currently available.
    Expert review of gastroenterology & hepatology. 12/2014;
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    ABSTRACT: Endoscopic mucosal resection (EMR) of large rectal adenomas is largely being centralized. We assessed the safety and effectiveness of EMR in the rectum in a collaboration of 15 Dutch hospitals. Prospective, observational study of patients with rectal adenomas >3 cm, resected by piecemeal EMR. Endoscopic treatment of adenoma remnants at 3 months was considered part of the intervention strategy. Outcomes included recurrence after 6, 12 and 24 months and morbidity. Sixty-four patients (50% male, age 69 ± 11, 96% ASA 1/2) presented with 65 adenomas (diameter 46 ± 17 mm, distance ab ano 4.5 cm (IQR 1-8), 6% recurrent lesion). Sixty-two procedures (97%) were technically successful. Histopathology revealed invasive carcinoma in three patients (5%), who were excluded from effectiveness analyses. At 3 months' follow-up, 10 patients showed adenoma remnants. Recurrence was diagnosed in 16 patients during follow-up (recurrence rate 25%). Fifteen of 64 patients (23%) experienced 17 postprocedural complications. In a multicenter collaboration, EMR was feasible in 97% of patients. Recurrence and postprocedural morbidity rates were 25% and 23%. Our results demonstrate the outcomes of EMR in the absence of tertiary referral centers.
    United European gastroenterology journal. 12/2014; 2(6):497-504.
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    ABSTRACT: Background:Constitutive Wnt activation is essential for colorectal cancer (CRC) initiation but also underlies the cancer stem cell phenotype, metastasis and chemosensitivity. Importantly Wnt activity is still modulated as evidenced by higher Wnt activity at the invasive front of clonal tumours termed the β-catenin paradox. SMAD4 and p53 mutation status and the bone morphogenetic protein (BMP) pathway are known to affect Wnt activity. The combination of SMAD4 loss, p53 mutations and BMP signalling may integrate to influence Wnt signalling and explain the β-catenin paradox.Methods:We analysed the expression patterns of SMAD4, p53 and β-catenin at the invasive front of CRCs using immunohistochemistry. We activated BMP signalling in CRC cells in vitro and measured BMP/Wnt activity using luciferase reporters. MTT assays were performed to study the effect of BMP signalling on CRC chemosensitivity.Results:Eighty-four percent of CRCs with high nuclear β-catenin staining are SMAD4 negative and/or p53 aberrant. BMP signalling inhibits Wnt signalling in CRC only when p53 and SMAD4 are unaffected. In the absence of SMAD4, BMP signalling activates Wnt signalling. When p53 is lost or mutated, BMP signalling no longer influences Wnt signalling. The cytotoxic effects of 5-FU are influenced in a similar manner.Conclusions:The BMP signalling pathway differentially modulates Wnt signalling dependent on the SMAD4 and p53 status. The use of BMPs in cancer therapy, as has been proposed by previous studies, should be targeted to individual cancers based on the mutational status of p53 and SMAD4.British Journal of Cancer advance online publication, 13 November 2014; doi:10.1038/bjc.2014.560 www.bjcancer.com.
    British journal of cancer. 11/2014;
  • Value in Health 11/2014; 17(7):A323. · 2.19 Impact Factor
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    ABSTRACT: Objectives To evaluate patient burden and preferences for MR colonography with a limited bowel preparation and automated carbon dioxide insufflation in comparison to conventional colonoscopy. Methods Symptomatic patients were consecutively recruited to undergo MR colonography with automated carbon dioxide insufflation and a limited bowel preparation followed within four weeks by colonoscopy with a standard bowel cleansing preparation. Four questionnaires regarding burden (on a five-point scale) and preferences (on a seven-point scale) were addressed after MR colonography and colonoscopy and five weeks after colonoscopy. Results Ninety-nine patients (47 men, 52 women; mean age 62.3, SD 8.7) were included. None of the patients experienced severe or extreme burden from the MR colonography bowel preparation compared to 31.5% of the patients for the colonoscopy bowel preparation. Colonoscopy was rated more burdensome (25.6% severe or extreme burden) compared to MR colonography (5.2% severe or extreme burden) (P < 0.0001). When discarding the bowel preparations, the examinations were rated equally burdensome (P = 0.35). The majority of patients (61.4%) preferred MR colonography compared to colonoscopy (29.5%) immediately after the examinations and five weeks later (57.0% versus 39.5%). Conclusion MR colonography with a limited bowel preparation and automated carbon dioxide insufflation demonstrated less burden compared to colonoscopy. The majority of patients preferred MR colonography over colonoscopy.
    European Journal of Radiology. 10/2014;
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    ABSTRACT: OBJECTIVES:The Paris classification is an international classification system for describing polyp morphology. Thus far, the validity and reproducibility of this classification have not been assessed. We aimed to determine the interobserver agreement for the Paris classification among seven Western expert endoscopists.METHODS:A total of 85 short endoscopic video clips depicting polyps were created and assessed by seven expert endoscopists according to the Paris classification. After a digital training module, the same 85 polyps were assessed again. We calculated the interobserver agreement with a Fleiss kappa and as the proportion of pairwise agreement.RESULTS:The interobserver agreement of the Paris classification among seven experts was moderate with a Fleiss kappa of 0.42 and a mean pairwise agreement of 67%. The proportion of lesions assessed as "flat" by the experts ranged between 13 and 40% (P<0.001). After the digital training, the interobserver agreement did not change (kappa 0.38, pairwise agreement 60%).CONCLUSIONS:Our study is the first to validate the Paris classification for polyp morphology. We demonstrated only a moderate interobserver agreement among international Western experts for this classification system. Our data suggest that, in its current version, the use of this classification system in daily practice is questionable and it is unsuitable for comparative endoscopic research. We therefore suggest introduction of a simplification of the classification system.Am J Gastroenterol advance online publication, 21 October 2014; doi:10.1038/ajg.2014.326.
    The American Journal of Gastroenterology 10/2014; · 9.21 Impact Factor
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    ABSTRACT: Background and study aims: Endoscopic optical diagnosis can potentially replace histopathological evaluation of small colorectal lesions. The aim of this study was to evaluate diagnostic performance of WavSTAT, a novel system for automatic optical diagnosis based on laser-induced autofluorescence spectroscopy. Patients and methods: Consecutive patients who were scheduled for colonoscopy were included in the study. Each detected lesion with a size of ≤ 9 mm was differentiated using high resolution endoscopy (HRE) by the endoscopist, who then reported this as a low or high confidence call. Thereafter, all lesions were analyzed using WavSTAT. Histopathology was used as the reference standard. The primary outcome measures were the accuracy of WavSTAT to differentiate between adenomatous and nonadenomatous lesions, and the accuracy of an algorithm combining HRE (lesions differentiated with high confidence) and WavSTAT (all remaining lesions). The secondary outcome measure was the accuracy of on-site recommended surveillance intervals. Results: At total of 87 patients with 207 small colorectal lesions were evaluated. Accuracy and negative predictive value of WavSTAT were 74.4 % and 73.5 %, respectively. The corresponding figures for the algorithm were 79.2 % and 73.9 %, respectively. Accuracy of on-site recommended surveillance interval was 73.7 % for WavSTAT alone and 77.2 % for the algorithm of HRE and WavSTAT. Conclusions: Both accuracy of WavSTAT alone and the algorithm combining HRE with WavSTAT proved to be insufficient for the in vivo differentiation of small colorectal lesions, and do not fulfill American Society for Gastrointestinal Endoscopy performance thresholds for assessment of diminutive lesions. Future studies should assess whether combining WavSTAT with more advanced imaging techniques could result in a higher accuracy.Netherlands Trial Registry (NTR 3235).
    Endoscopy 09/2014; · 5.74 Impact Factor
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    ABSTRACT: The aim was to determine the prevalence of small-bowel neoplasia in asymptomatic patients with Lynch syndrome (LS) by video capsule endoscopy (VCE).
    Gastroenterology 09/2014; 144(5):S-25–S-26. · 12.82 Impact Factor
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    ABSTRACT: Interval colorectal cancers (interval CRCs), that is, cancers occurring after a negative screening test or examination, are an important indicator of the quality and effectiveness of CRC screening and surveillance. In order to compare incidence rates of interval CRCs across screening programmes, a standardised definition is required. Our goal was to develop an internationally applicable definition and taxonomy for reporting on interval CRCs.
    Gut 09/2014; · 10.73 Impact Factor
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    ABSTRACT: Serrated polyposis syndrome (SPS) is characterized by the presence of multiple serrated polyps spread throughout the colon. Patients with SPS are considered to be at risk of colorectal cancer and are advised to undergo endoscopic surveillance. Narrow-band imaging (NBI) may improve the detection of polyps during these surveillance colonoscopies.
    Gastrointestinal endoscopy 08/2014; · 6.71 Impact Factor
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    ABSTRACT: Patients with serrated polyposis syndrome (SPS) are advised to undergo endoscopic surveillance for early detection of polyps and prevention of colorectal cancer (CRC). The optimal surveillance and treatment regimen is however unknown. We performed a prospective study to evaluate a standardized endoscopic treatment protocol in a large cohort of patients with SPS. We followed a cohort of patients with SPS who received annual endoscopic surveillance at the Academic Medical Centre in Amsterdam, the Netherlands from January 2007 through December 2012. All patients underwent clearing colonoscopy with removal of all polyps ≥3 mm. After clearance, subsequent follow-up colonoscopies were scheduled annually. The primary outcome measure was the incidence of CRC and polyps. Secondary outcomes were the incidence of complications and the rate of preventive surgery. Successful endoscopic clearance of all polyps ≥ 3 mm was achieved in 41/50 (82%) patients. During subsequent annual surveillance with a median follow-up time of 3.1 y (inter-quartile range, 1.5-4.3 y), CRC was not detected. The cumulative risks of detecting CRC, advanced adenomas, or large (≥ 10 mm) serrated polyps after 3 surveillance colonoscopies were 0%, 9%, 34%, respectively. Twelve patients (24 %) were referred for preventive surgery; 9 at initial colonoscopy and 3 during surveillance. Perforations or severe bleedings did not occur. Annual surveillance with complete removal of all polyps ≥3 mm with timely referral of selected high-risk patients for prophylactic surgery prevents the development of CRC in SPS patients without significant morbidity. Considering the substantial risk of polyp recurrence, close endoscopic surveillance in SPS seems warranted. www.trialregister.nl NTR2757.
    Gastroenterology 03/2014; · 12.82 Impact Factor
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    ABSTRACT: This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia. Main recommendations 1 ESGE suggests the routine use of high definition white-light endoscopy systems for detecting colorectal neoplasia in average risk populations (weak recommendation, moderate quality evidence). 2 ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (narrow band imaging [NBI], i-SCAN) chromoendoscopy in patients with known or suspected Lynch syndrome (strong recommendation, low quality evidence). 2b ESGE recommends the routine use of high definition systems and pancolonic conventional or virtual (NBI) chromoendoscopy in patients with known or suspected serrated polyposis syndrome (strong recommendation, low quality evidence). 3 ESGE recommends the routine use of 0.1 % methylene blue or 0.1 % - 0.5 % indigo carmine pancolonic chromoendoscopy with targeted biopsies for neoplasia surveillance in patients with long-standing colitis. In appropriately trained hands, in the situation of quiescent disease activity and adequate bowel preparation, nontargeted, four-quadrant biopsies can be abandoned (strong recommendation, high quality evidence). 4 ESGE suggests that virtual chromoendoscopy (NBI, FICE, i-SCAN) and conventional chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps to replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained and audited (weak recommendation, high quality evidence). 5 ESGE suggests the use of conventional or virtual (NBI) magnified chromoendoscopy to predict the risk of invasive cancer and deep submucosal invasion in lesions such as those with a depressed component (0-IIc according to the Paris classification) or nongranular or mixed-type laterally spreading tumors (weak recommendation, moderate quality evidence). Conclusion Advanced imaging techniques will need to be applied in specific patient groups in routine clinical practice and to be taught in endoscopic training programs.
    Endoscopy 03/2014; · 5.74 Impact Factor
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    ABSTRACT: Background and study aims: Sessile serrated adenomas/polyps (SSA/Ps) are precursors of colorectal cancer (CRC), but their endoscopic detection can be difficult. We therefore examined the endoscopic characteristics of SSA/Ps with and without dysplasia in a cross-sectional study. Patients and methods: We reviewed clinical, endoscopic, and histopathologic data from patients undergoing colonoscopy between February 2008 and February 2012. We categorized colorectal polyps according to anatomic site, size, and shape, and classified serrated polyps using the World Health Organization (WHO) classification. Multiple logistic regression analyses examined potential differences regarding site, size, and shape between SSA/Ps and colorectal adenomas (overall and advanced only). Results: We examined 7433 patients (mean age 59 years, 45.9 % men) with 5968 colorectal polyps. In total, we found 170 SSA/Ps (170/5968, 2.9 %), including 63 SSA/Ps with dysplasia (1.1 %) and 107 SSA/Ps without dysplasia (1.8 %). Compared with SSA/Ps with dysplasia, SSA/Ps without dysplasia were more often proximally located (odds ratio [OR] 3.3, 95 % confidence interval [95 %CI] 1.7 - 6.4), but less often < 6 mm in size (OR 0.6, 95 %CI 0.3 - 1.1). No significant differences were found regarding location between SSA/Ps with dysplasia and advanced adenomas (proximal colon, 47.6 % vs. 40.1 %). However, SSA/Ps with dysplasia were more often < 6 mm in size than advanced adenomas (OR 0.3, 95 %CI 0.2 - 0.5). Of the 63 dysplastic SSA/Ps, 6 (9.5 %) contained high grade dysplasia, but none invasive carcinoma. Conclusions: SSA/Ps with dysplasia are frequently < 6 mm in size, located throughout the colon and 9.5 % of them contain high grade dysplasia. These findings underscore the importance of high quality colonoscopic examination to maximize protection against CRC.
    Endoscopy 03/2014; 46(3):225-35. · 5.74 Impact Factor
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    ABSTRACT: AimMost international post polypectomy surveillance guidelines do not recommend surveillance for serrated polyps, In the present study the additional impact of serrated polyps on surveillance intervals from international adenoma surveillance guidelines was investigated.Method: Endoscopic and pathology records were audited of participants in the NHS Bowel Cancer Screening programme (guaiac FOBT) in 2011. Surveillance intervals were calculated for current guidelines and also for serrated polyps based on previously deccribed aggressive and conservative strategies. Results389 patients were included of whom141(36.2%) were high risk (advanced adenoma: adenoma ≥10 mm; villous elements; high grade dysplasia (HGD), or adenoma ≥3 in number) needing surveillance at ≤3 years. Thirty three (8.5%) had significant serrated polyps, of whom 18 (4.6% of the total) had significant serrated lesions and simultaneous advanced adenoma. Adopting an aggressive surveillance strategy, the mean overall absolute additional proportion of all such patients in the surveillance group at three or less years was 4.0% (3.9–4.1%; [4.2% female; 3.8% male]. These proportions varied according to endoscopist from 2.3 to 4.7%. For more conservative strategies the increase was only 1%. Conclusion The impact of including serrated polyps in current guidelines would result in a small increase in surveillance intervals for FOBT-based bowel cancer screening. About half of those who might need surveillance for serrated polyps would already receive surveillance for being in a high risk adenoma group.This article is protected by copyright. All rights reserved.
    Colorectal Disease 03/2014; · 2.08 Impact Factor
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    ABSTRACT: We aimed to evaluate the diagnostic yield of screening colonoscopies in first-degree relatives (FDRs) of patients with serrated polyposis syndrome (SPS). Patients with SPS are at an increased risk for colorectal cancer. Although inheritance patterns are unknown, FDRs of these patients have an increased risk for both colorectal cancer and SPS. Prospective studies evaluating the yield of screening colonoscopies in this group are however scarce. This information would be useful to evaluate a possible mode of inheritance and to investigate whether screening colonoscopies are justified in this group. FDR of patients with SPS were invited to undergo colonoscopy. The diagnostic yield was expressed by the number of FDRs with at least 1 significant polyp relative to the total number of included FDRs. Significant polyps were defined adenomas, traditional serrated adenomas, sessile serrated adenoma/polyp, or proximal hyperplastic polyp. Tissue specimens were reviewed by one expert pathologist. Seventy-seven FDRs underwent colonoscopy (median age 52 y; interquartile range, 41 to 60). Colorectal cancer was not diagnosed. One or more significant polyps were detected in 43% of FDRs. No differences based on age, sex, or familial relationship were observed in the detection of polyps. Seven first-degree (9%) relatives had multiple polyps (≥5). Eleven (14%) FDRs fulfilled SPS WHO-criterion 2, of whom 1 sibling also met SPS WHO-criterion 3. The yield of a single screening colonoscopy in FDRs of patients with serrated polyposis is substantial, warranting a colonoscopy screening program for these individuals.
    Journal of clinical gastroenterology 02/2014; · 2.21 Impact Factor
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    ABSTRACT: Background and study aims: The quality of colonoscopy can only be measured if colonoscopy reports include all key quality indicators. In daily practice, reporting is often incomplete and not standardized. This study describes a novel, structured colonoscopy reporting system, which aims to generate standardized and complete reports and to facilitate the automatic analysis of colonoscopy quality indicators. Methods: A new colonoscopy reporting system (EndoALPHA) was developed. The system reports all colonoscopy quality indicators, as well as pathological findings, in a systematic manner using structured terminology. All essential items carry specific codes, which enables statistical analysis and the automatic generation of reports of all quality indicators. The EndoALPHA reporting system was tested with regard to completeness of reporting and evaluation of quality indicators both for individual endoscopists and the endoscopy unit. Results: In 2012, all 810 colonoscopies performed at one colonoscopy center were documented using EndoALPHA. Overall, 94 % of performed colonoscopies were reported completely using the encoded terminology. Individual unadjusted cecal intubation rates were above 90 % for all endoscopists (mean 96.7 %), and the adenoma detection rate was above 20 % for all endoscopists (35.4 % for the unit). Conclusion: The novel EndoALPHA reporting system enables automatic quality assessment on two levels: the completeness of reporting can be evaluated, and if this is adequate, the quality of the colonoscopies can also be assessed. Integrated with feedback, benchmarking and training, the reporting system may facilitate quality improvement for colonoscopy services.
    Endoscopy 02/2014; · 5.74 Impact Factor
  • Gastrointestinal endoscopy 01/2014; · 6.71 Impact Factor
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    ABSTRACT: - Colorectal cancer is one of the most common cancers in the Netherlands; in both men and women it is the third most common type of cancer. - Yearly more than 13,000 patients are diagnosed with colorectal cancer and over 5000 patients die of this disease. The incidence has increased gradually over time, whereas mortality has decreased. - At time of diagnosis, almost half of patients have lymph node metastases or distant metastases. - Relative 5-year survival is about 60%, but greatly depends on the stage of the disease at diagnosis. - A nationwide colorectal cancer screening programme started in January 2014. All men and women aged 55-75 years will receive biennially an invitation to participate.- Introduction of the screening programme will have an effect on the incidence, stage distribution, treatment and mortality of colorectal cancer.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7699.
  • Article: Response.
    Yark Hazewinkel, James E East, Evelien Dekker
    Gastrointestinal endoscopy 01/2014; 79(1):184. · 6.71 Impact Factor

Publication Stats

2k Citations
1,467.56 Total Impact Points


  • 2005–2014
    • Academisch Medisch Centrum Universiteit van Amsterdam
      • • Department of Gastroenterology and Hepatology
      • • Department of Radiology
      • • Department of Clinical Epidemiology and Biostatistics
      Amsterdamo, North Holland, Netherlands
  • 2004–2014
    • University of Amsterdam
      • • Department of Gastroenterology and Hepatology
      • • Faculty of Medicine AMC
      Amsterdamo, North Holland, Netherlands
  • 2013
    • Oxford University Hospitals NHS Trust
      Oxford, England, United Kingdom
    • University of Oxford
      • Nuffield Department of Clinical Medicine
      Oxford, ENG, United Kingdom
    • Slotervaartziekenhuis
      Amsterdamo, North Holland, Netherlands
    • AMC Health
      New York City, New York, United States
    • NDDO Institute for Prevention and Early Diagnostics (NIPED)
      Amsterdamo, North Holland, Netherlands
  • 2009–2013
    • Academic Medical Center (AMC)
      Amsterdamo, North Holland, Netherlands
  • 2012
    • IJsselland Ziekenhuis
      Kapelle, South Holland, Netherlands
  • 2008–2012
    • Radboud University Nijmegen
      • Department of Gastroenterology and Hepatology
      Nijmegen, Provincie Gelderland, Netherlands
  • 2011
    • Erasmus MC
      • Research Group for Public Health
      Rotterdam, South Holland, Netherlands
    • Erasmus Universiteit Rotterdam
      • Department of Gastroenterology and Hepatology
      Rotterdam, South Holland, Netherlands