Senior Scientist, Consultant Physician and Member of congregation
Clinical and Translational Endoscopic Research
James East is a Consultant Gastroenterologist & Endoscopist and Honorary Senior Clinical Lecturer specializing in advanced luminal GI endoscopy. He is the Endoscopy Research Lead for the Translational Gastroenterology Unit, Clinical Lead for Endoscopy at the John Radcliffe Hospital, and Clinical Director for Bowel Cancer Screening Oxfordshire.
Gastrointestinal cancer cancer prevention is his core research focus, primarily though improving endoscopic strategies to halt development of pre-malignant lesions, through clinical and translational studies.
Early detection and differentiation of colonic pre-malignant lesions
Current population based strategies to prevent bowel cancer rely on low efficacy screening test (faecal occult blood testing) and sigmoidoscopy or colonoscopy. We need to improve screening tests through development of better biomarkers and patient risk stratification, and the detection, characterisation [http://www.ncbi.nlm.nih.gov/pubmed/24239209], and effective resection of pre-malignant lesions (advanced endoscopic imaging). Surveillance strategies also need to be made more clinically and cost effective with stratification based on molecular markers.
Serrated pathway to colorectal cancer
Rare familial syndromes can give insights into some specific problems faced at a population level, particularly for the new "serrated pathways" to colorectal cancer, such as hereditary mixed polyposis syndrome and its gene GREM-1 [http://www.ncbi.nlm.nih.gov/pubmed/22561515]. Serrated polyps, and the associated Serrated Polyposis Syndrome, are now newly recognised as important pre-malignant lesions, distinct from the adenoma-carcinoma sequence, but their biology is poorly understood, and detection and safe resection are challenging. [http://www.nature.com/nrgastro/journal/v10/n2/pdf/nrgastro.2012.245.pdf]
Colitis (inflammation driven) associated colorectal cancer
Inflammation and cancer are also increasingly seen as linked. Colonoscopic surveillance for colitis associated cancer (CAC) is a particular clinical challenge where molecularly targeted endoscopic imaging could yield significant clinical benefit in the short term, as well as lead to insights into use the safe of immunosuppressants in the context of dysplasia. There is an inherent tension between inflammation driving dysplasia and cancer, where stopping inflammation can reverse dysplasia [IL-22 axis; http://jem.rupress.org/content/210/5/917.full.pdf+html]; conversely use of immunosuppressive agents (anti-TNFs) may lead to dangerous loss of immune surveillance against tumour growth.
Fundamentally we aim to translate advances in immunology and molecular genetics into cl
Combining faecal immunochemical testing with blood test results for colorectal cancer risk stratification: a consecutive cohort of 16,604 patients presenting to primary care
Withrow DR. et al, (2022), BMC Medicine, 20
Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG).
Monahan KJ. et al, (2022), Gut
Serrated lesions and adenomas in colonoscopic surveillance: additive or exponential?
East JE., (2021), Gut
Deep learning for detection and segmentation of artefact and disease instances in gastrointestinal endoscopy.
Ali S. et al, (2021), Medical image analysis, 70
Faecal immunochemical testing (FIT): sources of result variation based on three years of routine testing of symptomatic patients in English primary care.
James T. et al, (2021), British journal of biomedical science, 1 - 7