Research
Population screening and surveillance for colorectal cancer
Led by Prof. Dr. E. Dekker and Dr. M. van der Vlugt
Colorectal cancer (CRC) is one of the most common types of cancer with a high cancer associated mortality. CRC is frequently diagnosed at an advanced stage, due to the lack of symptoms at an early stage. To address this, the Dutch national colorectal cancer screening program as launched in 2014. Its primary aim is early detection of colorectal cancer and identification and removal of advanced precursor lesions, such as advanced adenomas and advanced serrated lesions.
Several techniques are available for early detection. Colonoscopy is an effective, yet invasive method, typically used for individuals at elevated risk. In the national Dutch CRC screening program, the fecal immunochemical test (FIT) is used as a non-invasive test to triage for colonoscopy.
Since 2005, our research group has played a central role in pilot studies leading up to the implementation of the screening program and remains actively involved in its ongoing evaluation and optimization. Our current focus areas include: Personalized screening strategies based on individual risk factors (Tim Kortlever: Algorithms in colorectal cancer screening), development and validation of new non-invasive diagnostic tests (PhD research by Willemijn de Klaver and Roza Opperman), implementation of the screening program in Curaçao (Shacara Blake), optimization of the national CRC screening program (Bart Homan). We also are the lead for the Dutch participation in the European Polyp Surveillance (EPoS) study, a large-scale, long-term study investigating optimal surveillance intervals following polypectomy (More information), subsidized by KWF.
In collaboration with:
- Amsterdam UMC: Prof. Dr. P.M.M. Bossuyt and Prof. Dr. V.M.H. Coupe (Epidemiology & Data Science (EDS)).
- Amsterdam UMC: Dr. M.P. Franssen (Public and Occupational Health and Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands).
- Erasmus MC: Prof. Dr. M.C.W. Spaander (Gastroenterology and Hepatology), Prof. Dr. I. Lansdorp-Vogelaar and dr. E. Toes-Zoutendijk (Department of Public Health)
- NKI/AvL: Prof. Dr. M.E. van Leerdam and Dr. J.E.G. IJspeert (Gastroenterology and Hepatology)
- Landelijke evaluatie van het bevolkingsonderzoek darmkanker (LECO), Prof. Dr. G. Meijer, Dr. B. Carvalho, Dr. M. de Wit
- Het Rijksinstituut voor Volksgezondheid en Milieu (RIVM)
- Bevolkingsonderzoek Nederland (BVO NL)
- WEO CRC Screening committee (Prof. Dr. E. Dekker is Global Chair)
- Nordic-European Initiative on Colorectal Cancer (NORDICC)-study group
- Scientific committee: Hans-Olov Adami, Michael Bretthauer, Michal F. Kaminski, Geir Hoff, Mette Kalager, Paulina Wieszczy, Ann G. Zauber, Miguel A. Hernán, Jaroslaw Regula, Ernst J. Kuipers, Evelien Dekker, Marek Bugajski, Magnus Løberg, Maciej Rupinski, Manon Spaander, Kjetil Garborg.
- EPoS
- Participating Dutch centers: Amsterdam UMC, Antoni van Leeuwenhoek/Nederlands Kanker Instituut, Erasmus MC, Maastricht UMC+, Medisch Spectrum Twente, Martini Ziekenhuis, Jeroen Bosch Ziekenhuis, Noordwest Ziekenhuisgroep, Deventer Ziekenhuis.
Quality and new techniques in colonoscopy
Led by Prof. Dr. E. Dekker and Dr. M. van der Vlugt
Since the start of the research-group in 2005 by Prof. Dr. Dekker, research focuses on optimizing the quality of colonoscopy. We perform clinical studies evaluating new imaging techniques and artificial intelligence solutions to optimize detection and characterization of lesions in the colon. Besides, we focus on optimizing colonoscopy quality metrics, reporting and auditing (as developed in Procolo/Bergman and used in the national population screening program). This is important as colonoscopy quality in terms of quality indicators is known to be directly related to the effectiveness, efficiency and, ultimately, clinical outcomes of performed colonoscopies. Lastly, we concentrate on improving colonoscopy by studying approaches to minimize colonoscopy-related complications and enhancing the patient’s colonoscopy experience. Detection and removal of serrated polyps, reflected by the proximal serrated polyp detection rate (PSPDR), is a key marker of high-quality endoscopy. A higher PSPDR is inversely associated with the risk of developing post-colonoscopy colorectal cancer (PCCRC) (More information).
In collaboration with:
- Dutch Institute for Clinical Auditing (DICA)
- Bergman Inwendige Zorg Amsterdam/Stichting Procolo
- Eindhoven University of Technology
Serrated polyps and post-colonoscopy colorectal cancer (PCCRC)
Led by Prof. Dr. E. Dekker and Dr. J.E.G. Ijspeert
Over the past decade, it has become widely recognized that serrated polyps are responsible for up to 30% of colorectal cancers (CRC). Due to their flat appearance combined with indistinct borders, serrated polyps are easily overlooked and incompletely resected during colonoscopy.
Our research group has been working on these serrated polyps for many years, unraveling the molecular biology of the serrated neoplasia pathway and improving the detection of serrated polyps. A key contribution has been the development of the WASP (Workgroup serrated polypS and Polyposis) classification system. Additionally, we have shown that an endoscopist’s proximal serrated polyp detection rate (PSPDR) is inversely associated with the chance of his/her patient having a post-colonoscopy colorectal cancer (PCCRC). This underscores the importance of endoscopists being skilled not only in detecting adenomas, but also in detecting serrated polyps to optimize the quality of colonoscopy.
PCCRCs primarily result from missed or incompletely resected polyps during colonoscopy. Given the challenges in detecting and resecting serrated polyps, we hypothesize that a substantial proportion of PCCRCs can be attributed to serrated polyps. To test this hypothesis, we are currently conducting a large-scale study within the Dutch CRC screening program. Our aim is to better understand the molecular origins and causes of each PCCRC within the program, ultimately reducing PCCRC incidence and improving the effectiveness of the Dutch CRC screening program.
In collaboration with:
- Erasmus MC: Prof. Dr. M.C.W. Spaander (Gastroenterology and Hepatology)
- NKI/AvL: Dr. J.E.G. IJspeert (Gastroenterology and Hepatology)
- The Dutch Screening Organization (BVO NL)
- The Dutch Cancer Registry (IKNL)
- PALGA, the Dutch nationwide pathology database
Hereditary Colorectal Cancer and Polyposis Syndromes
Led by Prof. Dr. E. Dekker, Drs. B. A. J. Bastiaansen, Dr. D. Ramsoekh, Dr. A. S. Aelvoet
Since the start of the hereditary colorectal cancer outpatient clinic in 2004, our team has performed scientific research on different hereditary polyposis syndromes. Early efforts focused mainly on serrated polyposis and has since expanded to include familial adenomatous polyposis (FAP), Lynch syndrome and Peutz-Jeghers syndrome.
Our research spans from translational studies investigating how environmental factors and the tumor microenvironment influence polyp development and targeted prevention of polyp development (The CHAMP-study), to clinical research focused optimization of surveillance guidelines and clinical management. We conduct investigator initiated and industry sponsored trials and actively contribute to national and international guideline development.
Since 2020, we have been part of a large European consortium of FAP expert centers. Within this collaboration, we conduct clinical studies aimed at improving endoscopic surveillance strategies for FAP patients. This includes addressing current limitations in existing guidelines for both lower and upper GI-tract surveillance. We have developed personalized surveillance and intervention protocols, which are currently being evaluated in a prospective registry study.
In a randomized controlled trial, we investigate what the preferred endoscopic imaging technique is for surveillance of the pouch in patients who underwent proctocolectomy and ileal pouch-anal anastomosis (Read more). In parallel, we are responding to the increasing number of gastric cancer cases that we have observed in FAP patients. To address this, we are exploring underlying risk factors, with the aim of improving surveillance strategies and deepening our understanding of gastric cancer development in this population. The main goal of this new strategy is to prevent development of cancer. However, an important secondary goal is to prevent overtreatment and thereby we aim to improve the quality of life of our patients.
In collaboration with:
Diagnosis and treatment of early-stage colorectal cancers and large polyps
Led by Drs. B. A. J. Bastiaansen and Prof. Dr. E. Dekker
Our research into the diagnosis and endoscopic treatment of early-stage colorectal cancer and large polyps began in 2015 with the introduction of the endoscopic full-thickness resection (eFTR) technique. Since then, we have been working to refine patient selection for organ preservation following diagnostic local excision.
The widespread introduction of colorectal cancer screening programs has led to an increased detection of early-stage cancers. As a result, there is a growing need for less invasive treatment options. For carefully selected patients with a low risk of lymph node metastasis and cancer recurrence, local excision followed by surveillance can be a safe and effective alternative to oncological surgery, helping to reduce treatment-related morbidity and improve quality of life.
At Amsterdam UMC, we aim to further develop this approach by improving risk stratification, optimizing endoscopic resection techniques such as eFTR and endoscopic intermuscular dissection (EID), and evaluating novel imaging methods to enhance diagnostic accuracy. To support this research and contribute to evidence-based treatment strategies, we work closely with the Dutch eFTR Working Group and the Dutch T1 CRC Working Group.
In collaboration with: