James East

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.

Key themes

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.

Summary

Fundamentally we aim to translate advances in immunology and molecular genetics into cl