Preventing GI Cancers by  Optimising Endoscopy

Dr James East is a Consultant Gastroenterologist and Endoscopist, and an Associate Professor at the Translational Gastroenterology Unit (Nuffield Department of Medicine and NHS OUH Foundation Trust John Radcliffe Hospital). James is Clinical Lead for Endoscopy and the Director for the Bowel Cancer Screening Programme in Oxfordshire. He trained in Edinburgh, Cambridge and North London and wrote an MD(Res) with Imperial College London looking at “Dysplasia detection at colonoscopy” using advanced imaging. Currently, James is a BRC sub-theme lead for Molecular Diagnostics, on “Predicting progression of mild to severe disease”.

Approximately 2% of the population are endoscoped per year for both symptoms and screening for gastrointestinal cancers (GI cancers), and many patients will be offered repeated surveillance endoscopies. Endoscopy is invasive and expensive and a limited resource; however risk of GI cancer is not evenly distributed across the population. Therefore we aim to direct endoscopy to those at highest risk: “Precision endoscopy”. This would focus the powerful cancer preventative effect of limited endoscopy resources to maximum benefit and avoid endoscopy for those at low risk.

James and his team are researching ways to optimise endoscopy resources for GI cancer prevention. This ranges from risk stratifying patients using molecular techniques in high risk groups e.g. copy number alterations in colitis associated dysplasia (more information here), via testing advanced imaging techniques head-to head in clinical trial e.g. Chromoendoscopy versus Autofluorescence imaging (AFI) in colonoscopy (more information here), to considering broader questions through meta-analysis such as does endoscopic surveillance in patients with inflammatory bowel disease prevent colorectal cancer and death from colorectal cancer (more information here).

Within Oxford James collaborates with Dr Adam Bailey, Prof Barbara Braden, Dr Elizabeth Bird-Lieberman  and Prof Simon Travis (Translational Gastroenterology Unit), Prof Clare Verrill (Nuffield Department of Surgical Sciences), Prof Jens Rittscher (Target Discovery Unit), Dr David Wedge (Big Data Institute), Dr David Church, Prof Simon Leedham (Wellcome Centre for Human Genetics), and Prof Sarah Wordsworth (Nuffield Department of Population Health).
Further Collaborators are Prof Trevor Graham (Queen Mary University of London), Prof Ian Tomlinson (University of Birmingham), Prof Vipul Jairath (Western University Ontario, Canada), and Prof Evelien Dekker (University of Amsterdam).

James’ research is funded by the Oxford NIHR Biomedical Research Centre and CRUK (Early Detection grant to investigate and validate risk markers for colitis associated colorectal cancer).

Find out more about James’ research for the BRC:

Watch James explaining the benefits of Bowel Cancer Screening with FIT (faecal immunochemical testing):

View James’ BSG (British Society of Gastroenterology) vlog on the serrated pathway to colorectal cancer: