ArticleLiterature Review

Epidemiology of colorectal polyps

January 2005
Techniques in Coloproctology 8 Suppl 2(2):s243-7

Source
PubMed

Authors:

Azienda Ospedaliera Universitaria San Martino di Genova

The prevalence of colorectal adenomatous polyps varies widely from country to country. Among asymptomatic, average-risk patients, adenoma prevalence averages approximately 10% in sigmoidoscopy studies and more than 25% in colonoscopy studies, whereas the prevalence of colorectal cancer among these patients is less than 1%. These data may change in the future due to the advent of new technological approaches and, in particular, chromo- and magnifying endoscopy as well as confocal laser endoscopy. The cumulative incidence of new adenomas within 3 years after normal endoscopy averages about 7% by flexible sigmoidoscopy and 27% by colonoscopy. As far as risk factors for colorectal adenomas are concerned, several data are now available on the potential role of various diet items. Tobacco smoking may be important in the early stages of adenoma formation, but not necessarily in the later stages. Alcohol consumption elevates the risk of adenomatous colorectal polyps and this seems increased by ADH3 polymorphism. Another gene-environment relationship of interest in colorectal tumorigenesis may be based on folate's effects on K-ras mutations.

Juvenile Polyp in Adults

Article

Full-text available

Aug 2022
ACTA CLIN CROAT

Milan Popović

Colorectal juvenile polyp as a pathologic entity was first described by Verse. These non-neoplastic lesions are most commonly found in children and infants, while in older children after the age of 14 and adults are a rare phenomenon. A 75-year-old female underwent colonoscopy. There was a pedunculated polyp in the transverse colon. Complete endoscopic electroresection of this polyp was performed and the polyp was sent for histopathologic analysis. Macroscopically, the polyp was described as a fragment of irregular round shape, size of about 2.5x2x1 cm, with fine-grained, reddish surface, showing dark red color on serial sections. Histologic examination of the polyp showed some irregularly distributed glands, some of which were cystically dilated. All glandular formations were coated with normal intestinal epithelium. The surface of the polyp was partially eroded and replaced by non-specific cellular granulation tissue. There were some signs of hemorrhagic infarction in the stroma of the polyp. Histopathologic examination indicated that histopathologic characteristics of this polyp corresponded to juvenile polyp. Juvenile polyps are very rarely found in adults. Therefore, we describe a case of this patient in her eighties with juvenile polyp localized in the transverse colon.

Characteristics of adenomatous colorectal polyps among a Saudi population

Article

Full-text available

Jan 2023

Objectives Colorectal cancer is a common cause of cancer-related mortality in KSA with a rising incidence. Although adenomatous polyps are well-recognized as precursors of colorectal cancer, local data are scarce. Therefore, in this study, we aimed to evaluate the characteristics of adenomatous colon polyps in the Saudi population. Methods We retrospectively reviewed the electronic databases of all patients who underwent colonoscopy for any indication between January 2015 and December 2019 at a tertiary care hospital. This study included adult patients who were found to have colorectal polyps with identified histopathology reports. We collected clinical and pathological data, including patient age, sex, and histopathological polyp characteristics. A p-value <0.05 was considered significant for descriptive and analytical statistics. Results A total of 184 patients with colorectal polyps with identified histopathology reports were included in the analysis. Of these, 130 (70.6%) patients were aged 50 years or older, and 135 (73.3%) were male. Among all polyps, 127 (69%) were adenomatous, 31 (16.8%) were hyperplastic, and 24 (13%) were inflammatory. For adenomatous polyps, 31 (24.4%) were observed in patients younger than 50 years, and high-grade dysplasia was observed in 23 (18%) polyps. Among patients with adenomatous polyps, the anatomical location was as follows: 27 (23%) in the cecum/ascending colon, 12 (9%) in the transverse colon, 45 (35%) in the descending/sigmoid colon, 25 (19%) in the rectum, and 18 (14%) at multiple sites. Age >50 years was significantly associated with adenomatous polyps (P = 0.03). Conclusion Approximately one-third of adenomatous polyps were detected proximal to the splenic flexure. Although adenomatous polyps were significantly associated with increasing age, 24% were observed in patients younger than 50 years of age. This finding supports the current recommendation to start screening at the age of 45.

Towards computer-assisted diagnosis of precursor colorectal lesions

Thesis

Jan 2019

Claudia Dach

Colorectal cancer (CRC) is the fourth most common cancer in men worldwide (International Agency of Research on Cancer 2008). In many countries, regular colonoscopy screening is established as a crucial strategy for CRC prevention. During colonoscopy screening, detected precursor lesions such as adenomas and serrated polyps can be removed, thus reducing CRC incidence and mortality. After such a polypectomy, histological diagnosis is fundamental. With continuously rising numbers of participants in screening programs as well as removed polyps, an increased demand exists for an automated pre-screening and classification of colorectal lesions in digitized histological slides. Hence, in this study, initial experiments were conducted to evaluate which approaches are suitable for an automated pre-screening and classification of colorectal polyps into the known entities with different risk profiles. According to the latest WHO classification, key factors for distinguishing precursor lesions are serration, distribution of serration and cytological dysplasia. In this study, we investigate a learning scheme based on decision trees to identify image features, which precisely describe these key factors. It is shown that shape factors and histogram-based features extracted from digitized histological slides are suitable for computer-assisted pre-screening and classification of precursor colorectal lesions.

Association between Dyslipidemia and the Prevalence of Colon Polyps Based on a Health Evaluation of Subjects at a Hospital

Article

Full-text available

May 2014

Background Colonic neoplasm is associated with western diet intake and physical inactivity. These life styles are also risk factors for dyslipidemia and metabolic syndrome. The aim of this study was to evaluate the association between dyslipidemia and the prevalence of colon polyps including colon adenoma as a precancerous lesion of colonic neoplasms. Methods We selected subjects undergoing a colonoscopy for health screening at the Health Promotion Center of Eulji General Hospital from January 2006 to June 2010. Subjects with histories of cancers, dyslipidemia treatment, and other intestinal diseases like Crohn's disease and ulcerative colitis were excluded. The total numbers of subjects included in the study was 605. Chi-square test and t-test and were used for the analysis. Additionally we used multivariate logistic regression to adjust for sex, age, smoking, drinking, and other risk factors. Results The prevalence of colon polyps was 48.70% and 28.05% in males and females, respectively. When adjusting for variables that included age, body mass index, hypertension, diabetes mellitus, smoking, drinking, and exercise, dyslipidemia was not significantly associated with the prevalence of colon polyps. However upon analyzing adenomatous colon polyps in men, dyslipidemias due to triglycerides and high density lipoproteins were significant factors (odds ratio [OR], 2.13; confidence interval [CI], 1.14 to 3.98; OR, 2.24; CI, 1.15 to 4.34, respectively). Conclusion Dyslipidemia was not a significant factor in the prevalence of colon polyps. However it had a significant association with the prevalence of adenomatous colon polyps in men.

Colonoscopic and histopathological assessment of colorectal polyps among north Indian population

Article

Full-text available

Feb 2023

Background: Colonic polyps are the abnormal growths from the colonic mucosa, usually benign but there is a definite though a small risk for cancerous transformation. Scarce data about this condition is available from Northern India. In this study we aimed to determine the prevalence of colonic polyps in patients undergoing colonoscopy for various health indications. In addition, we studied the various characteristics of these polyps including the histological classification Methods: In this observational cross-sectional study we included adult patients (≥18 years) who underwent colonoscopy from July 2016 to June 2018 at a tertiary care hospital setting in New Delhi, India. The socio-demographic variables were ascertained for all patients. Data about indication of colonoscopy, the findings on colonoscopy, finding regarding the colonic polyps (type, number, size, location and histological type) was collected. Results: We found a total of 246 patients to have colonic polyps and total number of polyps found was 369.The median age of the patients was 56 years (IQR 44-68). Majority of the patients with polyps (74.8%) were males. Polyps were most commonly seen in left colon (35.36%). Histologically, most common type was adenomatous polyps 58.9% (Tubular adenoma in 44% and tubule-villous adenoma in 8%). Hyperplastic polyps were noted in 22% followed by inflammatory polyps in 14% polyps. Adenocarcinoma was reported in 2 polyps (0.8%). Conclusions: Prevalence of colorectal polyps in our study is lower compared to most of the western countries. On histology majority of polyps were adenomatous.

Automatic Colorectal Cancer Screening Using Deep Learning in Spatial Light Interference Microscopy Data

Article

Full-text available

Feb 2022

The surgical pathology workflow currently adopted by clinics uses staining to reveal tissue architecture within thin sections. A trained pathologist then conducts a visual examination of these slices and, since the investigation is based on an empirical assessment, a certain amount of subjectivity is unavoidable. Furthermore, the reliance on external contrast agents such as hematoxylin and eosin (H&E), albeit being well-established methods, makes it difficult to standardize color balance, staining strength, and imaging conditions, hindering automated computational analysis. In response to these challenges, we applied spatial light interference microscopy (SLIM), a label-free method that generates contrast based on intrinsic tissue refractive index signatures. Thus, we reduce human bias and make imaging data comparable across instruments and clinics. We applied a mask R-CNN deep learning algorithm to the SLIM data to achieve an automated colorectal cancer screening procedure, i.e., classifying normal vs. cancerous specimens. Our results, obtained on a tissue microarray consisting of specimens from 132 patients, resulted in 91% accuracy for gland detection, 99.71% accuracy in gland-level classification, and 97% accuracy in core-level classification. A SLIM tissue scanner accompanied by an application-specific deep learning algorithm may become a valuable clinical tool, enabling faster and more accurate assessments by pathologists.

Automatic colorectal cancer screening using deep-learning on spatial light interference microscopy data

Preprint

Full-text available

Jan 2022

The surgical pathology workflow currently adopted in the clinic uses staining to reveal tissue architecture within thin sections. A trained pathologist then conducts a visual examination of these slices and, as the investigation is based on an empirical assessment, a certain amount of subjectivity is unavoidable. Furthermore, the reliance on such external contrast agents like hematoxylin and eosin (H&E), albeit a well-established method, makes it difficult to standardize color balance, staining strength, and imaging conditions, hindering automated computational analysis. In response to these challenges, we applied spatial light interference microscopy (SLIM), a label-free method that generates contrast based on the intrinsic tissue refractive index signatures. Thus, we reduce human bias and make the image data comparable across instruments and clinics. We applied a Mask R-CNN deep learning algorithm to the SLIM data to achieve an automated colorectal cancer screening procedure, i.e., classifying normal vs. cancer specimens. Our results obtained on a tissue microarray consisting of specimens from 132 patients, resulted in 91% accuracy for gland detection, 99.71% accuracy in gland-level classification, and 97% accuracy in core-level classification. A SLIM tissue scanner accompanied by an application-specific deep learning algorithm may become a valuable clinical tool, enabling faster and more accurate assessment by the pathologist.

How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer? An observational study

Article

Full-text available

Mar 2022
INT J COLORECTAL DIS

PurposeRectal bleeding is a common symptom of colorectal cancer. In this paper, we describe and evaluate the operation of a central access and triage system for patients with rectal bleeding, which uses a “high-risk”/ “low-risk” designation based on the referring doctor’s subjective designation and a 10-item symptom checklist.MethodsA total of 1846 patients, referred between February 1, 2016, and December 31, 2018, were included. Exclusion criteria were the following: incorrect patient identification number, duplicate records, and pre-diagnosed gastrointestinal cancer. Data was obtained by chart review. Sensitivity, specificity, and positive and negative predictive values were calculated for each item on the symptom checklist.ResultsEight hundred seventy-nine (48%) patients received endoscopy, and 37 (2%) were found to have cancer. Five hundred eighty-two (32%) patients were deemed high-risk. Twenty-nine (78%) of the patients with cancer were in the high-risk group. Patients in the high-risk group had a higher incidence of cancer (5.0% vs 0.6%, p < 0.001) and shorter waits to endoscopy (201 vs 292 days). Patients designated as high-risk by the referring physician had a relative risk of 22.3 compared to those designated as low-risk. Patients deemed high-risk by the symptom checklist had a relative risk of 3.5 compared to low-risk patients.Conclusion Our system stratified 29/37 (78%) of the patients found to have cancer as high-risk. A total of 8/37 (22%) patients with cancer were deemed low-risk. Our research has identified two variables (weight loss and anemia) which have been added to our referral symptom checklist. This study helped us identify areas for refinement of our triage system. These findings are of interest to physicians who treat colorectal cancer.

Genome-wide association study of colorectal polyps identified highly overlapping polygenic architecture with colorectal cancer

Article

Oct 2021

No genome-wide association studies (GWAS) were reported for colorectal polyps and the overlap in polygenic backgrounds conferring risk of colorectal cancer and polyps remains unclear. We performed GWAS on subjects with colorectal polyps using the BioBank Japan data with 4447 cases and 157,226 controls. We evaluated genetic correlations between colorectal polyps and cancer, and effects on colorectal polyps of single nucleotide polymorphisms (SNPs) known to be associated with colorectal cancer. We identified CUX2, a known genetic locus to colorectal cancer, as a susceptibility locus to colorectal polyps (p value = 1.1 × 10−15). Subsequent fine-mapping analysis indicated that rs11065828 in CUX2 is the causal variant for colorectal polyps. We found that known colorectal cancer-susceptible SNPs were also associated with colorectal polyps. The genetic correlation between colorectal cancer and polyps is very high (r = 0.98 and p value = 0.0006). We additionally identified 14 significant loci of colorectal polyps and three significant loci of colorectal cancer by applying the multi-trait analysis of GWAS of colorectal cancer and colorectal polyps. We showed very similar germline polygenic features, which gives us the additional insight into potential cancers at polygenic levels for patients with polyps who are followed up at outpatients’ clinic; thus, close observation and polypectomy is critical to prevent colorectal cancers.

Clinical and Pathological Study of the Rectal Mucosa in Cases of Bleeding Per Rectum

Article

Aug 2021

Label-free colorectal cancer screening using deep learning and spatial light interference microscopy (SLIM)

Article

Full-text available

Apr 2020

Current pathology workflow involves staining of thin tissue slices, which otherwise would be transparent, followed by manual investigation under the microscope by a trained pathologist. While the hematoxylin and eosin (H&E) stain is well-established and a cost-effective method for visualizing histology slides, its color variability across preparations and subjectivity across clinicians remain unaddressed challenges. To mitigate these challenges, recently, we have demonstrated that spatial light interference microscopy (SLIM) can provide a path to intrinsic objective markers that are independent of preparation and human bias. Additionally, the sensitivity of SLIM to collagen fibers yields information relevant to patient outcome, which is not available in H&E. Here, we show that deep learning and SLIM can form a powerful combination for screening applications: training on 1660 SLIM images of colon glands and validating on 144 glands, we obtained an accuracy of 98% (validation dataset) and 99% (test dataset), resulting in benign vs cancer classification accuracy of 97%, defined as area under the receiver operating characteristic curve. We envision that the SLIM whole slide scanner presented here paired with artificial intelligence algorithms may prove valuable as a pre-screening method, economizing the clinician’s time and effort.

Label-free colorectal cancer screening using deep learning and spatial light interference microscopy (SLIM)

Preprint

Feb 2020

Current pathology workflow involves staining of thin tissue slices, which otherwise would be transparent, followed by manual investigation under the microscope by a trained pathologist. While the hematoxylin and eosin (H&E) stain is well-established and a cost-effective method for visualizing histology slides, its color variability across preparations and subjectivity across clinicians remain unaddressed challenges. To mitigate these challenges, recently we have demonstrated that spatial light interference microscopy (SLIM) can provide a path to intrinsic, objective markers, that are independent of preparation and human bias. Additionally, the sensitivity of SLIM to collagen fibers yields information relevant to patient outcome, which is not available in H&E. Here, we show that deep learning and SLIM can form a powerful combination for screening applications: training on 1,660 SLIM images of colon glands and validating on 144 glands, we obtained a benign vs. cancer classification accuracy of 99%. We envision that the SLIM whole slide scanner presented here paired with artificial intelligence algorithms may prove valuable as a pre-screening method, economizing the clinician's time and effort.

Giant villous adenoma of rectum- what is the malignant potential and what is the optimal treatment? A case and review of literature

Article

Full-text available

Jun 2019
World J Surg Oncol

Introduction: Villous adenomas are dubiously benign lesions, which are difficult to interpret because of their malignant potential. Distal villous adenomas present with bleeding or mucus discharge. Giant adenomas are not amenable for endoscopic or transanal resection. Only few isolated cases have been reported by laparoscopic resection. We present our case of a circumferential giant villous adenoma of the rectum managed successfully by laparoscopic ultra-low anterior resection with colo-anal anastomosis with a review of literature in regard to their malignant potential. Case report: A 62-year-old lady presented with complaints of painless bleeding per rectum and a fleshy mass protruding from the anal canal which on digital rectal examination appeared a large soft velvety flat mass with mucus discharge. Colonoscopy showed circumferential irregular, friable, edematous mucosa in rectum extending for 15 cm. Computed tomography showed a large heterogeneously enhancing polypoid mass lesion in the rectal wall involving the entire rectum. The patient underwent laparoscopic low anterior resection with colo-anal anastomosis and protecting loop ileostomy. Histopathological examination of the resected specimen revealed villous adenoma of the rectum with moderate to severe dysplasia. Discussion: Villous adenomas are sessile growths lined by dysplastic glandular epithelium, whose risk of malignancy is especially high up to 50% when greater than 2 cm in size. Large size, villous content, and distal location are all associated with severe dysplasia in colorectal adenomas. Large villous rectal tumors, particularly of circumferential type pose a great challenge for endoscopic or transanal removal. Henceforth, open or laparoscopic surgery is required for these cases. Conclusion: Giant rectal villous polyps are usually unresectable by endoscopic methods or transanal endoscopic microsurgery and are associated with a high rate of unsuspected cancer which requires a formal radical oncologic resection. As per current data, the combined risk of dysplasia/malignancy is about 83% with 50% risk of dysplasia and frank malignancy in 33% of cases of giant rectal villous adenomas of more than 8 cm in size. Laparoscopic colorectal resection is safe and effective.

Surgical Approach of Degenerated Giant Rectal Villous Adenoma in Elderly Patient

Article

Full-text available

Jan 2018

Villous tumors of gastrointestinal area are infrequent and villous adenoma is a type of polyp that grows in the colon and other spaces in the gastrointestinal tract and sometimes in other parts of the body. These adenomas may turn into malignant. Their detection is, typically, fortuitous during an endoscopic investigation. For their degenerative potential and recurrence the complete excision of villous tumors is highly recommended. Voluminous villous tumors are the main cause of limitation for endoscopic resection and require a surgical management. Great morbi-mortality rate and functional conditions of surgery have directed to a growing attention in many further procedures which can expose to recurrence risk particularly in the rectum. We present our experience in dealing a case of huge villous tumors of the rectum in elderly patient. Surgical Approach of Degenerated Giant Rectal Villous Adenoma in Elderly Patient

Risk factors for delayed hemorrhage after colonoscopic postpolypectomy: Polyp size and operative modality: Risk factors for delayed hemorrhage after colonoscopic postpolypectomy

Article

Full-text available

Nov 2018

Background and Aim Delayed postpolypectomy hemorrhage is relatively common, with occasional extensive blood loss, endangering life. This study aimed to determine the factors associated with postoperative hemorrhage. Methods The study was a retrospective cohort study of patients hospitalized for colonoscopic polypectomy at the Department of Gastroenterology and Hepatology, Tenth People's Hospital of Tongji University, China, between January and December 2015. Data on gender, age, bowel preparation, location, size, number of polyps, operative modality, pathology, and operation practitioner were collected. Patients were divided into two groups based on the presence or absence of postoperative hemorrhage. Results A total of 1962 polyps were detected in patients and they underwent polypectomy; hemorrhage occurred in 41 cases. A correlation was demonstrated between postpolypectomy hemorrhage and each of the following factors: polyp size and operative modality. The odds ratio (OR) was 4.535 (95% confidence interval [CI], 2.331–8.823) for 1–2‐cm polyps, 4.008 (95% CI, 0.904–17.776) for 2–3‐cm polyps, and 22.407 (95% CI, 5.783–86.812) for ≥3‐cm polyps. Compared with argon plasma coagulation, OR was 9.128 (95% CI, 3.548–23.486) for endoscopic mucosal resection and 31.257 (95% CI, 7.009–139.395) for endoscopic submucosal dissection. Conclusions The independent risk factors for delayed postpolypectomy hemorrhage include polyp size and operative modality.

Morphologic spectrum of gastrointestinal polyps and polypoid lesions-A five year study

Article

Full-text available

Oct 2018

Introduction: Polyps begin as small elevations of the mucosa and polyps are most common in the colorectal region. The neoplastic polyps are important because they have a risk of transformation into malignancy. The role of the Pathologist is to identify any dysplastic changes and inform the clinician regarding the risk of development of carcinoma. Materials and Methods: This is a retrospective analysis of polyps and polypoid lesions of 5 year duration from January 2013 to December 2017. The biopsies were stained with Haematoxylin & Eosin and studied under light microscope. Results: 107 cases of gastrointestinal polyps and polypoid lesions were included in our study. Hyperplastic polyps were the most common polyps found in our study. The most common site was rectum and stomach. Variety of lesions included in our study are multiple Peutz Jeghers (PJ) polyps, adenocarcinoma arising in PJ polyp, neuroendocrine tumours, and an angiomatous polyp. Conclusion: Gastrointestinal polyps are divergent lesions. Differentiation of neoplastic polyps from non-neoplastic polyps is important in view of adenoma-carcinoma sequence developing in neoplastic polyps. Identification of hamartomatous polyps is also crucial since they are associated with syndromes and may unusually transform in to cancers. Pathologists play a key role in diagnosis of neoplastic polyps and polyps associated with syndromes. In our study hyperplastic polyps were most common with a variety of other lesions.

Colorectal Adenoma Detection Rate in Northeast Texas-Outcome from Community Service Project Using the Fecal Immunochemical Test and Colonoscopy

Article

Full-text available

Jul 2018

Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in the United States. CRC incidence rates in Northeast Texas, a primarily rural region of the state, far exceed state and national averages. The current study sought to determine the proportion of polyps found in a sample of 5,391 individuals living in Northeast Texas using either colonoscopy or fecal immunochemical testing. In addition, the role of insurance to CRC screening was also investigated. An adenomatous polyp was detected in 44.7% participants in the colonoscopy group and in 2.6% of participants undergoing FIT testing. Additionally, participants in the colonoscopy group who were un-or under-insured were 30% more likely to have an adenomatous polyp detected. While a larger proportion of participants had an adenomatous polyp detected in the colonoscopy group, many including the un-or under-insured are not able to afford, at which point FIT testing may be a better option.

Use of diagnostic modalities in the treatment of perianal fistula: A retrospective cohort study of 307 patients

Article

Full-text available

Jul 2018

Amaç: Anal fistül hastalığında fistül tipine karar vermek ve en uygun ameliyat tipine karar vermek ileri tetkiklerin kullanılmasına karşın halen içerisinde zorluklar barındırmaktadır. Bu çalışmada, anal fistül hastalarının ameliyat öncesi hazırlıklarında manyetik rezonans görüntüleme (MRG), endoskopik inceleme ve her ikisinin birlikte uygulanmasının bu konuda yararlı olup olmadığını değerlendirmeyi amaçladık. Yöntemler: Çalışma 2008-2017 yılları arasında perianal fistül nedeniyle cerrahi tedavi uygulanan hastalarda retrospektif olarak yapıldı. Anal fistül nedeniyle ameliyat edilen 307 hastanın verileri hastane kayıtları ile gözden geçirildi. Hastalar ameliyat öncesi MRG yapılan ve yapılmayanlar, endoskopik inceleme yapılan ve yapılmayanlar ve her ikisi yapılan ve yapılmayanlar başlıkları altında gruplandırıldı. Hastaların demografik verileri (yaş, cinsiyet), fistül tipi (basit veya komplike), seton yerleşiminin olup olmadığı ve uygulanan cerrahi tipi kaydedildi. Bu parametreler gruplarla karşılaştırıldı. Bulgular: Ameliyat öncesi değerlendirmede 162 (% 53) hastaya MRG, 83 (% 27) hastaya endoskopik inceleme ve 60 (% 20) hastaya da her ikisinin birden yapıldığı saptandı. Ameliyat öncesi MRG varlığı ile seton yerleştirilme gereksinimi arasında istatistiksel olarak anlamlı korelasyon saptandı (p<0,05). Ameliyat öncesi MRG, ameliyat öncesi endoskopi ve ameliyat öncesi her iki uygulamanın varlığı ile hastaların demografik özellikleri, fistül tipi ve uygulanan cerrahi tipi arasında istatistiksel olarak anlamlı ilişki saptanmadı (p>0,05). Sonuç: Anal fistül hastalığında fistül tipini saptamada ve uygulanacak cerrahi şekline karar vermede MRG, endoskopi gibi preoperatif modaliteler yeterli olamamaktadır, bu incelemelerin peroperatif muayene ile birleştirilerek değerlendirilmesinin daha etkili sonuç elde etmede faydalı olacağı kanaatindeyiz. Ayrıca preoperatif MRG uygulamasının seton gereksinimi konusunda cerrahlara yardımcı olabileceğini düşünmekteyiz.

Colorectal Cancer and Alcohol Consumption—Populations to Molecules

Article

Full-text available

Jan 2018

Colorectal cancer (CRC) is a major cause of morbidity and mortality, being the third most common cancer diagnosed in both men and women in the world. Several environmental and habitual factors have been associated with the CRC risk. Alcohol intake, a common and rising habit of modern society, is one of the major risk factors for development of CRC. Here, we will summarize the evidence linking alcohol with colon carcinogenesis and possible underlying mechanisms. Some epidemiologic studies suggest that even moderate drinking increases the CRC risk. Metabolism of alcohol involves ethanol conversion to its metabolites that could exert carcinogenic effects in the colon. Production of ethanol metabolites can be affected by the colon microbiota, another recently recognized mediating factor to colon carcinogenesis. The generation of acetaldehyde and alcohol’s other metabolites leads to activation of cancer promoting cascades, such as DNA-adduct formation, oxidative stress and lipid peroxidation, epigenetic alterations, epithelial barrier dysfunction, and immune modulatory effects. Not only does alcohol induce its toxic effect through carcinogenic metabolites, but alcoholics themselves are predisposed to a poor diet, low in folate and fiber, and circadian disruption, which could further augment alcohol-induced colon carcinogenesis.

Label-free tissue scanner for colorectal cancer screening

Article

Full-text available

Jun 2017

The current practice of surgical pathology relies on external contrast agents to reveal tissue architecture, which is then qualitatively examined by a trained pathologist. The diagnosis is based on the comparison with standardized empirical, qualitative assessments of limited objectivity. We propose an approach to pathology based on interferometric imaging of "unstained" biopsies, which provides unique capabilities for quantitative diagnosis and automation. We developed a label-free tissue scanner based on "quantitative phase imaging," which maps out optical path length at each point in the field of view and, thus, yields images that are sensitive to the "nanoscale" tissue architecture. Unlike analysis of stained tissue, which is qualitative in nature and affected by color balance, staining strength and imaging conditions, optical path length measurements are intrinsically quantitative, i.e., images can be compared across different instruments and clinical sites. These critical features allow us to automate the diagnosis process. We paired our interferometric optical system with highly parallelized, dedicated software algorithms for data acquisition, allowing us to image at a throughput comparable to that of commercial tissue scanners while maintaining the nanoscale sensitivity to morphology. Based on the measured phase information, we implemented software tools for autofocusing during imaging, as well as image archiving and data access. To illustrate the potential of our technology for large volume pathology screening, we established an "intrinsic marker" for colorectal disease that detects tissue with dysplasia or colorectal cancer and flags specific areas for further examination, potentially improving the efficiency of existing pathology workflows. © 2017 Society of Photo-Optical Instrumentation Engineers (SPIE).

Polyp Genetics

Article

Dec 2016

The genetic events involved in the transformation of normal colonic epithelium to neoplastic polyps to invasive carcinoma, as initially proposed by Fearon and Vogelstein, form the foundation of our understanding of colorectal cancer. The identification of the polyp as the precursor lesion to colorectal cancer is the basis of many of our current practices for screening, surveillance, and prevention. The last three decades have seen a veritable explosion in our understanding of the molecular events involved in the pathogenesis of colorectal cancer. It is now clear that there are multiple genetic pathways in the polyp to carcinoma sequence. Some polyps previously thought to be nonneoplastic have now been shown to have malignant potential. Finally, increased understanding of the sequence of genetic events has led to the development of targeted therapeutics. The clinical translation of these scientific advances has made a significant impact on the management of patients with colorectal cancer. Accordingly, it is imperative that all clinicians caring for these patients have an understanding of the genetics of colorectal polyps and cancer. In this article, we review the etiology and genetic pathways to carcinoma associated with a range of polyps of the colon and rectum.

Association between the location of colon polyps at baseline and surveillance colonoscopy - A retrospective study

Article

Full-text available

Sep 2016
REV ESP ENFERM DIG

Introduction: Several factors are used to stratify the probability of polyp recurrence. However, there are no studies correlating the location of the initial polyps and the recurrent ones. The aim of this study was to verify whether the polyp location at the surveillance colonoscopy was correlated with the location of the previously excised polyps at the baseline colonoscopy. Methods: A retrospective study of patients submitted to colonoscopy with presence and excision of all polyps, followed by a surveillance colonoscopy. Polyp location was divided into proximal/distal to splenic flexure and rectum. Characteristics and recurrent rates at the same colon location were also evaluated. Results: Out of the 346 patients who underwent repeated colonoscopy, 268 (77.4%) had at least 1 polyp detected. For all the segments there was an increased risk of recurrent polyps in the same location and it was about four times higher in proximal (OR 3.5; CI 2.1-6.0) and distal colon segments (OR 3.8; CI 2.1-6.8), followed by three times higher in the rectum (OR 2.6; CI 1.5-4.6). No difference was found between the rates of recurrence at the same segment, taking into consideration the polyp morphology, size, polypectomy technique employed and histological classification. Conclusion: There seems to be a significant association between polyp location at baseline and surveillance colonoscopy.

Demographic And Histopathological Characteristics Of Colorectal Polyps: A Descriptive Study Based On Samples Obtained From Symptomatic Patients

Article

Full-text available

Feb 2016

Background: Colorectal polyps (CP) are common among individuals older than 50 years. Some polyp types can precede colorectal cancer (CRC). This study aimed at describing histopathological characteristics of colorectal polyps in relation to age and gender among symptomatic patients referred for a colonoscopy examination during 2011-2014 in Tirana, Albania. Methods: Study population included 267 individuals aged ≥ 20 years and diagnosed with ≥ 1 polyp during a colonoscopy examination. A total of 346 polyps were identified, excised and measured, and underwent histopathological examination. Results: Adenomas accounted for 79.8% of all polyps and tubular type was the most frequent one (74.4%). The majority of polyps (42.5%) were small (<1 cm), 38.7% of a medium size (1-2 cm) and 18.8% large (>2 cm). Adenomas were larger than non-adenomatous polyps (p<0.01) There was no gender difference with regard to patient age (p=0.22) or polyp size (p=0.84) Adenomas were more frequent among men compared to women (p=0.02). Age was strongly related to polyp characteristics. The proportion of adenomas increased significantly with age (p<0.01). Within adenomas, the proportion of villous types - a precursor of colorectal cancer - increased remarkably with age (p=0.01). Older age was positively associated with potentially malignant adenomas (defined as adenomas > 1 cm and showing high-grade dysplasia) (p<0.01). Conclusion: Adenomas accounted for the majority of polyps. Their morphology, size and malignant potential were related to patient age.

Clinical and endoscopic-pathological characteristics of colorectal polyps: An analysis of 1,234 cases

Article

Oct 2015
Int J Clin Exp Med

Purpose: To analyze the correlation of clinical symptom and endoscopic-pathological characteristics of colorectal polyps. Methods: A retrospective study was performed on 1,234 continuous colorectal polyp patients. Their clinical, colonoscopic and pathological data were collected and analyzed. Results: In 1,234 patients, 46.0% cases were asymptomatic, and 54.0% cases were symptomatic, and the female to male ratio was 2.23:1 and 1.74:1, respectively (P = 0.048). The mean polyp size in symptomatic group was significantly larger than asymptomatic group [7.6±5.1 mm (95% CI: 7.2, 8.0) vs. 6.3±3.7 mm (95% CI: 6.0, 6.6), P < 0.001]. Tubu-villous polyp and villous polyp occurred more frequently in symptomatic group, compared with asymptomatic group (P = 0.002). In symptomatic group, 37.4% cases complained of abdominal pain and 62.6% cases complained of bowel habit alteration. The polyp number in abdominal pain group was larger than bowel habit alteration group (P = 0.036). Three major symptoms of bowel habit alteration were diarrhea, constipation and hematochezia, with proportion of 54.2% (278/513), 27.7% (142/513) and 18.1% (93/513), respectively. The hematochezia group had larger polyp size than diarrhea group (P = 0.001) and consisted of more villous component than the constipation patients (P = 0.005). Conclusion: Almost half of colorectal polyp patients do not complain of bowel symptoms, especially the male. Colorectal polyp patients have bowel habit alteration more commonly than abdominal pain. Half of patients with bowel habit alteration demonstrate diarrhea. The hematochezia patients are more susceptible to advanced adenomas than the diarrhea and constipation ones.

Increased risk of colorectal polyps in patients with non-alcoholic fatty liver disease undergoing liver transplant evaluation

Article

Oct 2015

Background: Screening colonoscopy is a standard part of the liver transplant (LT) evaluation process. We aimed to evaluate the yield of screening colonoscopy and determine whether non-alcoholic fatty liver disease (NAFLD) was associated with an increased risk of colorectal neoplasia. Methods: We retrospectively assessed all patients who completed LT evaluation at our center between 1/2008-12/2012. Patients <50 years old and those without records of screening colonoscopy, or with greater than average colon cancer risk were excluded. Results: A total of 1,102 patients were evaluated, 591 met inclusion criteria and were analyzed. The mean age was 60 years, 67% were male, 12% had NAFLD and 88% had other forms of chronic liver disease. Overall, 42% of patients had a polyp found on colonoscopy: 23% with adenomas, 14% with hyperplastic polyps and with 1% inflammatory polyps. In the final multivariable model controlling for age, NAFLD [odds ratio (OR) 2.41, P=0.001] and a history of significant alcohol use (OR 1.69, P=0.004) were predictive of finding a polyp on colonoscopy. In addition, NAFLD (OR 1.95, P=0.02), significant alcohol use (OR 1.70, P=0.01) and CTP class C (OR 0.57, P=0.02) were associated with adenoma, controlling for age. Conclusions: Screening colonoscopy in patients awaiting LT yields a high rate of polyp (43%) and adenoma (22%) detection, perhaps preventing the accelerated progression to carcinoma that can occur in immunosuppressed post-LT patients. Patients with NAFLD may be at a ~2 fold higher risk of adenomas and should be carefully evaluated prior to LT.

Association between Diverticular Disease an Pre-Neoplastic Colorectal Lesions in an Urban African-American Population

Article

Full-text available

Jul 2015
DIGESTION

It is unclear whether there is a shared pathway in the development of diverticular disease (DD) and potentially neoplastic colorectal lesions since both diseases are found in similar age groups and populations. To determine the association between DD and colorectal pre-neoplastic lesions in an African-American urban population. Data from 1986 patients who underwent colonoscopy at the Howard University Hospital from January 2012 through December 2012 were analyzed for this study. The presence of diverticula and polyps was recorded using colonoscopy reports. Polyps were further classified into adenoma or hyperplastic polyp based on histopathology reports. Multiple logistic regression was done to analyze the association between DD and colonic lesions. Of the 1986 study subjects, 1,119 (56%) were females, 35% had DD and 56% had at least one polyp. There was a higher prevalence of polyps (70 vs. 49%; OR = 2.3; 95% CI: 1.9-2.8) and adenoma (43 vs. 25%; OR = 2.0; 95% CI: 1.7-2.5) in the diverticular vs. non-diverticula patients. Among patients who underwent screening colonoscopy, the presence of diverticulosis was associated with increased odds of associated polyps (OR = 9.9; 95% CI: 5.4-16.8) and adenoma (OR = 5.1; 95% CI: 3.4-7.8). Patients with DD are more likely to harbor colorectal lesions. These findings call for more vigilance on the part of endoscopists during colonoscopy in patients known to harbor colonic diverticula. © 2015 S. Karger AG, Basel.

Endoscopic management of iatrogenic perforations during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal polyps: A case series

Article

Full-text available

Jul 2015

Iatrogenic perforation during therapeutic colonoscopy, reported in up to 1% of endoscopic mucosal resections (EMRs) and up to 14% of endoscopic submucosal dissections (ESDs), has conventionally been an indication for surgery. We present a case series of successful endoscopic management of iatrogenic colorectal perforation during EMR and ESD, demonstrating the feasibility and safety of the method. Retrospective analysis of a database of patients undergoing EMR and ESD for colorectal polyps in a tertiary referral centre in the United Kingdom. Four cases of perforation were identified (two EMRs and two ESDs) in a series of 218 procedures (1.8%), all detected at the time of endoscopy and managed with endoscopic clips. Patients were observed in hospital and treated with antibiotics. Their median length of stay was 3 days (range 2-6 days), with no mortality or need for surgery. Surgery is no longer the first choice in the management of iatrogenic perforations during EMR and ESD for colorectal polyps; in selected patients with small perforations and minimal extraluminal contamination, conservative management with application of endoscopic clips, antibiotics and close patient monitoring constitute a safe and effective treatment option, avoiding the morbidity of major surgery.

Histopathological Characteristics of Colon Polyps Â– A Population-based Study in Tirana, Albania

Article

Jan 2015

Cekodhima Gentiana

USING GENETIC EPIDEMIOLOGIC METHODS TO EXPLORE THE INFLUENCE OF GENE-ENVIRONMENT INTERACTIONS ON COLORECTAL ADENOMA RECURRENCE

Article

Kimberly Anne Lowe

A cross-sectional study of global DNA methylation and risk of colorectal adenoma

Article

Full-text available

Jul 2014
BMC CANCER

Background The methylation of DNA is recognized as a key epigenetic mechanism and evidence for its role in the development of several malignancies is accumulating. We evaluated the relationship between global methylation in DNA derived from normal appearing colon mucosal tissue and blood leukocytes, and colorectal adenoma risk. Methods Patients, aged 40 to 65, scheduled for a screening colonoscopy were recruited. During the colonoscopy, two pinch biopsies of healthy, normal appearing mucosa were obtained from the descending colon. A fasting blood sample was also collected. The methylation status of LINE-1 (long interspersed nuclear element-1) repetitive sequences, as a surrogate measure of global methylation, was quantified in DNA extracted from normal colon mucosa and blood leukocytes. Statistical analysis of the relationship between global DNA methylation and adenoma risk was conducted on 317 participants, 108 subjects with at least one pathologically confirmed adenoma and 209 subjects with a normal colonoscopy. Results A statistically significant inverse relationship was observed between LINE-1 methylation in colon tissue DNA and adenoma risk for males and for both sexes combined for the lowest methylation quartile compared to the highest (adjusted ORs = 2.94 and 2.26 respectively). For blood, although the overall pattern of odds ratio estimates was towards an increase in risk for lower methylation quartiles compared to the highest methylation quartile, there were no statistically significant relationships observed. A moderate correlation was found between LINE-1 methylation levels measured in tissue and blood (Pearson correlation 0.36). Conclusions We observed that lower levels of LINE-1 DNA methylation in normal appearing background colon mucosa were associated with increased adenoma risk for males, and for both sexes combined. Though these findings provide some support for a relationship between LINE-1 DNA methylation in colon mucosal tissue and adenoma risk, large prospective cohort studies are needed to confirm results. Until such investigations are done, the clinical usefulness of LINE-1 methylation as a biomarker of increased adenoma risk is uncertain. Regardless, this study contributes to a better understanding of the role of global DNA methylation as an early event in CR carcinogenesis with implications for future etiologic research.

Retrospective Analysis of 504 Colonoscopies

Article

Full-text available

Jun 2010

The authors retrospectively analyzed 504 outpatient undergoing colonoscopy, performed from June 2008 to May 2009, in the "Center for Medical Specialties" of Santa Casa de Belo Horizonte, by the Group of Coloproctology of Santa Casa de Belo Horizonte and School of Medical Sciences of Minas Gerais (CPG). The study deserve special highlights the analysis of gender, age, specialty of referring physicians, indications of colonoscopy, bowel preparation used, height achieved by colonoscopy and colonoscopic findings. Regarding gender, 67% (337) were women and 33% (167) men, and as to age, stood sixth (130 patients, 26%) and seventh (113 patients, 22%). The examination was self-generated by the GCP in 79.56% (401 colonoscopies) and the most common indications were low bleeding (76 cases, 13.0%) and control patients undergoing surgical approach to colorectal cancer (70 cases; 12.0%). Bowel preparation was done with mannitol, lactulose and sodium picosulphate, according to the clinical status, allowing for 71% (359 cases) of excellent results. Colonoscopy reached the cecum in 445 patients (88.0%), having reached the terminal ileum in 293 cases (58.0%). The main findings were polyps (163 cases, 28.0%), followed by normal findings (149 cases, 26.0%) and diverticular disease of the colon (141 cases, 24.0%). Of the 151 polyps that had marked its size, 130 polyps were the largest diameter less than 10 mm (86.0%). Of 207 histopathological examinations performed, either in biopsies or in polyp resection, the polyp was the most common finding (163 cases, 78.8%), and among the 163 polyps resected the most common finding was the adenoma with low grade dysplasia (116 cases ; 71.2%). There were no complications. The data were compared with some published reports, all within the usual standards.

16. Vitamin D, calcium, bone mineral density, osteoporosis and the risk of colorectal adenomas and colorectal cancer

Chapter

Mar 2016

Nora L Nock

Comparison of Cold Snare and Hot Snare Polypectomy for the Resection of Sporadic Non-Ampullary Duodenal Adenomas

Article

May 2022
GASTROINTEST ENDOSC

Background and Aims Non-ampullary duodenal adenomas can undergo malignant transformation, making endoscopic resection, often by hot snare (HSP) or cold snare polypectomy (CSP), necessary. While CSP has been shown to be safer for removal of colon polyps, there is limited data comparing these techniques for the resection of duodenal adenomas. Our aim was to compare the safety and efficacy of CSP and HSP for the removal of non-ampullary duodenal adenomas. Methods We performed a retrospective cohort study of patients referred to two academic medical centers with a histologically confirmed sporadic, non-ampullary duodenal adenoma who underwent endoscopic snare polypectomy between 1/1/2007 and 3/1/2021. Patients with underlying polyposis syndromes were excluded. Outcomes included post procedural complications and polyp recurrence. Results Out of 110 total patients, 69 underwent HSP and 41 underwent CSP. Intraprocedural bleeding was similar between both groups but 7 patients in the HSP group experienced delayed complications versus zero in the CSP group (p = 0.04). 54 patients had complete polyp resection and subsequent surveillance endoscopies. Multivariate analysis showed polyp size to be associated with recurrence (per mm; OR 1.11 95% CI (1.04 - 1.20), p < 0.01). Endoscopic resection technique (HSP vs. CSP) was not a predictor of recurrence (p = 0.18). Conclusion HSP led to more delayed complications compared to CSP while no significant differences on outcomes were noted, suggesting that CSP is equally effective and potentially safer for the removal of duodenal adenomas.

When is transanal endoscopic surgery appropriate?

Article

Apr 2022
SURG ONCOL

Rectal cancer is a complex medical diagnosis which requires critical decision making on the part of physician and patient. Organ preservation with local excision for early stage rectal cancer, if done under the correct circumstances, allows for oncologically sound surgery with good patient outcomes. However, locally advanced disease as well as tumor location and size can change potential long-term outcomes. This chapter will investigate the technical and clinical aspects of transanal surgery and the decision-making algorithms for clinicians and patients.

The value of hydrogen and methane breath test in predicting colorectal polyps

Preprint

Full-text available

Jun 2020

Background To investigate the value of hydrogen and methane breath test in predicting colorectal polyps. Methods 382 patients were enrolled in this study. They were divided into colorectal polyps group and Non polyps group as control. Hydrogen and methane breath test was used in both groups for small intestinal bacteria overgrowth (SIBO) diagnosis. All patients were examined by colonoscopy to investigate colorectal polyps. Diamine oxidase, D-lactate and Lipopolysaccharides (LPS) were measured in all patients to evaluate the intestinal barrier function. Results 1) The age of colorectal polys group is significantly higher than control group (P=0.000); the prevalence of colorectal polyps increases with age. 2) The prevalence of colorectal polys in male is significantly higher than female (P=0.004); 3) Lactuloses breath test (LBT) was used for small intestinal bacteria overgrowth (SIBO) diagnoses. Prevalence of hydrogen dominate SIBO and methane dominate SIBO in colorectal polys group were significantly higher than control group (P = 0.000, 0.013); 4) The prevalence of constipation was higher in colorectal polys group than control group (P=0.023); 5) The peoples who had high hydrogen production peoples showed less intestinal barrier function damage and lower LPS level than peoples who had low hydrogen production (P=0.029, 0.049); 6) The sensitivity and specificity of SIBO is 75.5% and 51.0% respectively in SIBO diagnosis. Conclusion The occurrence of colorectal polyp increase with age, the year 46 is a cut off age for peoples need colonoscopy examination. Male has a higher prevalence than female. Intestinal hydrogen may play a role in prevent intestinal mucosa damage via its antioxidant function. SIBO shows a positive relationship with colorectal polyp. Hydrogen and methane breath test is a useful mass prescreening method for colorectal polyp risk.

Identifying potential DNA methylation markers in early-stage colorectal Cancer

Article

Jun 2020

Colorectal cancer (CRC) is the second leading malignancy worldwide. Accurate screening is pivotal to early CRC detection, yet current screening modality involves invasive colonoscopy while non-invasive FIT tests have limited sensitivity. We applied a DNA methylation assay to identify biomarkers for early-stage CRC detection, risk stratification and precancerous lesion screening at tissue level. A model of biomarkers SFMBT2, ITGA4, THBD and ZNF304 showed 96.1% sensitivity and 87% specificity in CRC detection, with 100% sensitivity for advanced precancerous lesion and stage I CRC. Performances were further validated with TCGA data set, which showed a consistent AUC of 0.99 and exhibited specificity against other cancer types. KCNJ12, VAV3-AS1 and EVC were further identified for stage stratification (stage 0-I versus stage II-IV), with AUC of 0.87, 83.0% sensitivity and 71.2% specificity. Additionally, dual markers of NEUROD1 and FAM72C showed 83.2% sensitivity and 77.4% specificity in differing non-advanced precancerous lesions from inflammatory bowel diseases.

Association Between Colonic Diverticulosis and Colorectal Polyps, Advanced Neoplastic Lesions, and Colorectal Carcinomas: A Cross-Sectional, Retrospective Study

Article

Sep 2019
SURG LAPARO ENDO PER

Kamer Tomaoğlu

Purpose: The aim of the present study was to evaluate the association of diverticulosis with colorectal polyps, advanced neoplastic lesions (ANLs), and colorectal cancers (CRCs). Methods: The first-time colonoscopy records of 3496 patients were evaluated in this retrospective, cross-sectional cohort study. Data on clinical indications, presence of diverticulosis and diverticulitis, location of diverticula and polps, the size and number of polyps, and results of histopathologic examinations of polypectomies were noted. Categorical data were analyzed with χ test or the Fisher exact probability. P-values <0.05 (2 sided) were considered statistically significant. Statistical analyses were conducted with SPSS, version 18. Results: Of the 3496 patients, 1691 were male individuals (48.4%) and 1805 (51.6%) were female individuals. Diverticulosis was present in 12.6% of patients. A total of 870 polyps were detected in 716 patients. A total of 170 polyps (19.5%) were classified as ANLs. CRC was diagnosed in 112 (3.2%) patients. A significant relationship between diverticulosis and colorectal polyps (odds ratio: 1.99; 95% confidence interval: 1.59-0.2.48, P<0.001) was found. Similarly, adenomas and ANLs were more frequent in diverticulosis (P<0.05). There was no significant relationship between diverticulosis and CRCs (P=0.243). Conclusions: Adenomatous polyps and ANLs were more frequently observed in patients with diverticulosis, but no significant relationship was found between CRC and diverticulosis. The results of this retrospective cross-sectional study need to be confirmed by longitudinal prospective cohort studies.

Intake consumption of ginsenoside Rg3, profiling of selected cytokines, and development of rectal polyps

Article

Full-text available

May 2019

Background: Rectal polyps is a major risk factor for rectal cancer. There is a need to explore a panel of preventive measures, as well as reliable biomarkers for screening of rectal polyps. Patients and methods: We conducted a case control study which aimed to explore the effects of regular consumption of ginsenoside Rg3, profiling of selected cytokines, and development of rectal polyps in a Chinese population. Results: Significantly higher levels of IL-4, MIP-1β, FasL, TGF-β1, and RANTES were detected in rectal polyp cases. Further, we found significant dose-response relationships between quartile-categorized levels of IL-4, MIP-1β, FasL, and TGF-β1, and risk of rectal polyps. The strongest associations for IL-4, MIP-1β, FasL, and TGF-β1 were observed for the highest quartile vs the lowest quartile with an OR of 1.78, 2.70, 1.49, and 2.36, respectively. Compared with non-Rg3 consumers, regular Rg3 consumers had a significantly lower risk of rectal polyps (OR =0.71; 95% CI: 0.55–0.92; P=0.009). We also found that Rg3 consumers had significantly lower levels of IL-4, MIP-1β, FasL, and TGF-β1 than non-Rg3 consumers, in both rectal polyp cases and healthy controls. Conclusion: These results indicate that regular consumption of Rg3 might prevent the occurrence of rectal polyps through decreasing the serum level of selected cytokines, including IL-4, MIP-1β, FasL, and TGF-β1. Further clinical trials and prospective cohort studies with larger sample sizes are warranted to validate the anti-inflammatory activity and the anti-tumorigenic role of Rg3.

Understanding human DNA variants affecting pre-mRNA splicing in the NGS era

Chapter

Jan 2019
Adv Genet

Pre-mRNA splicing, an essential step in eukaryotic gene expression, relies on recognition of short sequences on the primary transcript intron ends and takes place along transcription by RNA polymerase II. Exonic and intronic auxiliary elements may modify the strength of exon definition and intron recognition. Splicing DNA variants (SV) have been associated with human genetic diseases at canonical intron sites, as well as exonic substitutions putatively classified as nonsense, missense or synonymous variants. Their effects on mRNA may be modulated by cryptic splice sites associated to the SV allele, comprehending exon skipping or shortening, and partial or complete intron retention. As splicing mRNA outputs result from combinatorial effects of both intrinsic and extrinsic factors, in vitro functional assays supported by computational analyses are recommended to assist SV pathogenicity assessment for human Mendelian inheritance diseases. The increasing use of next-generating sequencing (NGS) targeting full genomic gene sequence has raised awareness of the relevance of deep intronic SV in genetic diseases and inclusion of pseudo-exons into mRNA. Finally, we take advantage of recent advances in sequencing and computational technologies to analyze alternative splicing in cancer. We explore the Catalog of Somatic Mutations in Cancer (COSMIC) to describe the proportion of splice-site mutations in cis and trans regulatory elements. Genomic data from large cohorts of different cancer types are increasingly available, in addition to repositories of normal and somatic genetic variations. These are likely to bring new insights to understanding the genetic control of alternative splicing by mapping splicing quantitative trait loci in tumors.

Are Upfront Levels for Colon “Polyps” Necessary? A Pragmatic Review

Article

Jun 2018
INT J SURG PATHOL

Introduction: Colon biopsies are among the most frequently examined specimens by pathologists. Many pathology practices, ours included, review upfront levels on all gastrointestinal biopsies. In our experience, when a lesion is present on specimens labeled "colon polyp," it is readily identified on the first level. To test our hypothesis, we re-reviewed 500 cases in which a lesion was identified histologically and determined if the diagnosis could be made on the first level. Furthermore, we examined 50 additional cases of high-grade dysplasia/carcinoma to determine if the higher-grade component was also present on the first level. Materials and methods: Cases were retrieved for lesions that could account for a colon polyp clinically, and the first level was examined to determine if lesional tissue was present on the first level. Fifty additional cases of higher-grade lesions were included to ensure higher-grade lesions were present on the first level. Results: Overall, 497/500 (99.4%) of the non-high-grade lesions were present on the first level, whereas 3/500 (0.6%) required the additional level for diagnosis. All 50 high-grade lesions were present on the first level examined. Discussion: Many pathology practices routinely order upfront levels on all gastrointestinal biopsies, often generating 2 or 3 slides. Additional slides increase costs, increase the likelihood of laboratory-generated errors, and can waste limited tissue on small biopsies for which ancillary studies may be necessary. Our study showed that a single level is sufficient in the overwhelming majority of cases in which a lesion is identified histologically.

Principal Curvature Based Polyp Detection in Wireless Capsule Endoscopy Images

Conference Paper

Mar 2017

Adenoma, Colorectal

Chapter

Jan 2017

Sibel Erdamar

Association between the location of colon polyps at baseline and surveillance colonoscopy - A retrospective study

Article

Sep 2016
REV ESP ENFERM DIG

Polyps

Chapter

Apr 2011

Paul E Wise

Polyps are defined as pathologic epithelial elevations of the aerodigestive and genitourinary tracts. This term serves to describe any of the types of abnormal growths identified on or involving the colonic mucosa that protrude into the bowel lumen. Polyps are of concern to clinicians due to their malignant potential depending on the histologic type of the polyp identified. The primary histologic colonic polyp types include the following: adenomas, serrated polyps (including hyperplastic polyps and sessile serrated adenomas (SSAs)), hamartomas, and inflammatory polyps. Because some of these polyps are neoplastic, they are the target of screening modalities (including colonoscopy, computed tomography (CT) colonography, etc.) to remove them prior to their malignant degeneration. Other polyp-like lesions, usually submucosal rather than mucosal in nature, such as carcinoids, leiomyomas, and lipomas will be described and discussed in Chap. 49.

Clinical, endoscopical and morphological study of colorectal polyps

Article

Jan 2009

Colonic polyps are slow-growing overgrowths of the colonic mucosa that carry a small risk (<1%) of becoming malignant. The aim of our study was to assess the profile of colonic polyps in the colon cancer patients hospitalized during a one year period in Clinical County Hospital of Timisoara. Data from 795 colonoscopies done in our department during the period January 1, 2008 to December 31, 2008 were scrutinized and 183 cases with polyps were selected for this study. For each patient, age, sex, anatomic location of polyps at the level of the colon and morphological details of the polyps were recorded. The sex repartition of the patients was 43.4% men and 56.6% women. A progressive, linear increase of the percentage of the adenomatous polyps was noticed depending on the age of the patients. The most frequently affected, 33.96%, was the age group between 50-59 years. We followed the anatomic distribution of these polyps at the level of the colon: cecum 6.16%, ascending colon 9.06%, hepatic flexure 2.17%, transverse colon 15.22%, splenic flexure 2.54%, descending colon 5.79%, sigmoid 39.85 %, rectosigmoidian junction 2.54%, rectum 16.67%. Dimensions of the polyps were: 33.96% < 5 mm, 38.21% were between 5-10 mm, 17.93% were between 11-20 mm and 9.9% of them were > 20 mm. Complications of colonic polyps include bleeding, obstruction, diarrhea, and development of cancer. Colonoscopy is a valuable method of diagnosing colonic polyps. Screening programs are essentially for early cancer diagnosis and for a proper treatment, especially in patients with risk of developing colon cancer.

Creating safer pain relievers using proton pump inhibitor drug delivery mechanisms

Article

Jul 2010

J. Fort

In the US, more than 5 billion units of aspirin in all of its forms are sold each year, with approved indications ranging from the treatment of rheumatic diseases to the secondary prevention of cardiovascular and cerebrovascular events. Approximately 50 million adult Americans regularly use low-dose aspirin (75 to 325 mg daily) for cardiovascular disease (CVD) prevention. 1 A daily aspirin regimen is also recommended to help prevent a second or recurrent stroke or transient ischemic attack (TIA, or mini stroke). 2 Worldwide, aspirin is the most widely used drug to prevent heart attack and stroke. Unfortunately, aspirin therapy is also associated with the development of clinically important upper gastrointestinal (GI) side effects that do not appear to be significantly reduced with dose reduction or the use of modified-release (enteric-coated/EC) or buffered aspirin. 3-6Even in doses as low as 75 mg daily, aspirin therapy is associated with a significant risk of developing serious GI complications, such as gastric ulcer bleeding. 7 In patients taking daily aspirin for cardiovascular prophylaxis, serious ulcer complications are reported to be approximately two- to four-fold higher compared to controls. 8 The potential for upper GI complications is even greater in individuals who are taking low-dose aspirin for cardio protection who also require other non-steroidal anti-inflammatory drugs (NSAIDs) for treatment of rheumatic diseases, such as osteoarthritis or rheumatoid arthritis. 9 Approximately 70% of Americans over the age of 65 use NSAIDs at least once weekly, and an estimated 34% of Americans in this age group take NSAIDs on a daily basis. 10 The complications of concurrent aspirin/NSAID administration include a substantially increased risk of upper GI hemorrhage compared with administration of each drug alone.

Pathological Features of Sporadic Colonic Adenoma

Chapter

Jan 2009

Colorectal cancer is one of the most common neoplasms of industrialized nations. Most colorectal cancer develops from adenomas. There are four categories of adenoma: tubular, villous, tubulo-villous, and flat-depressed, and the histological features of adenomas may be defined as low- or high-grade dysplasia. Morphological features that determine the malignant potential of an adenoma are size, growth pattern, and grade of dysplasia. Colorectal adenoma containing invasive carcinoma corresponds to a carcinoma invading the submucosa, and represents the earliest form of clinically relevant colon cancer. Improved prognostic power may derive from advancements in histopathological evaluation. The pathological features that are crucial for evaluating risk of adverse outcome include histological grade, completeness of resection margin, vasoinvasiveness, tumor budding, and level of invasion of the submucosa. These pathological parameters define two groups of early colorectal cancer with different risk of nodal and/or local recurrence: low- and highrisk early colorectal cancer. Phenotypic characteristics seen on histopathological examination are essential to planning patient management and should continue to be the major focus of pathologists’ efforts.

Association between colonic polyps and diverticular disease

Article

Apr 2008
WORLD J GASTROENTERO

Tetsuo Hirata

AIM: To evaluate the association between colonic polyps and diverticular disease in Japan. METHODS: We retrospectively reviewed the medical records of 672 consecutive patients who underwent total colonoscopy between August 2006 and April 2007 at Nishinjo Hospital, Okinawa, Japan. Patients with a history of any of the following were excluded from the study: previous polypectomy, colonic resection, and inflammatory bowel diseases. The association between colonic polyps and diverticular disease was analyzed by logistic regression analysis, adjusted for age and sex. RESULTS: Prevalence of colonic polyps in all patients with diverticular disease was significantly higher than that in those without diverticular disease (adjusted odds ratio 1.7). CONCLUSION: Our data showed that patients with diverticular disease have a higher risk of colonic polyps compared to those without.

Effektivität und Effizienz der CT- Koloskopie im Vergleich zur kon- ventionellen Koloskopie in der Dickdarmkrebsdiagnose und -früherkennung

Article

Full-text available

Jan 2009

Gesundheitspolitischer Hintergrund Darmkrebserkrankungen/kolorektale Karzinome (KRK) stellen in Deutschland für beide Geschlechter die zweithäufigste Krebserkrankung und Krebstodesursache dar. Verschiedene Verfahren zur Früherkennung von KRK stehen zur Verfügung, darunter die konventionelle Koloskopie, die im Rahmen der Krebsfrüherkennung erstattet wird, sowie die Computertomografie-Koloskopie (CTC), die derzeit nicht erstattet wird. Wissenschaftlicher Hintergrund Die CTC ist ein rein diagnostisches Verfahren, das ein geringeres Komplikationsrisiko durch Perforation aufweist als die konventionelle Koloskopie, jedoch als Röntgenverfahren mit einer Strahlenbelastung behaftet ist. Die konventionelle Koloskopie gilt aufgrund ihrer hohen Sensitivität und Spezifität für das Auffinden von Adenomen und KRK als Goldstandard und bietet den Vorteil, neben erweiterten diagnostischen auch therapeutische Maßnahmen zu ermöglichen. Fragestellung In diesem HTA-Bericht soll geklärt werden, welche Effektivität und Effizienz die CTC im Vergleich zur konventionellen Koloskopie in der Früherkennung und Diagnose von Dickdarmkrebs und/oder Vorstufen desselben hat und welche ethischen und juristischen Aspekte zu beachten sind. Methodik Die systematische Literatursuche (27 internationale Literaturdatenbanken) ergab 1.713 Zusammenfassungen. Nach einem zweiteiligen Selektionsprozess verbleiben 36 bewertete Publikationen. Ergebnisse Die Ergebnisse zur Effektivität der CTC in Diagnostik und Screening von Dickdarmkrebs und/oder Vorstufen sind teilweise vielversprechend, aber sehr heterogen. Sowohl in der Diagnostik als auch zum Screening kann die CTC deshalb hinsichtlich ihrer Erkennungsgüte derzeit nicht als gleichwertige Alternative zur konventionellen Koloskopie gesehen werden. Für die Heterogenität der Ergebnisse sind technische (Gerätetyp, Einstellungen), patienten- (Vorbereitung) und befunderbezogene (Ausbildung) Faktoren verantwortlich. Einzelne Indikationen zur Diagnostik des KRK mittels CTC liegen vor. Ökonomische Ergebnisse zum Verfahrensvergleich in der Diagnostik liegen nicht vor. Zur Kosteneffektivität eines CTC-Screenings finden sich ausländische Modellrechnungen, aufgrund derer das CTC-Screening zwar als kosteneffektiv zur Option „kein Screening“ bezeichnet werden kann, das Screening mit konventioneller Koloskopie jedoch generell kosteneffektiver ist. Diskussion Bei Verwendung moderner CTC-Geräte mit entsprechender technischer Einstellung, Software, adäquater Patientenvorbereitung und Ausbildung der Befunder sind bessere Ergebnisse hinsichtlich der Sensitivität zu erwarten. Prinzipiell ist bei der CTC die im Vergleich zur Koloskopie fehlende Therapiemöglichkeit (Polypektomie) zu berücksichtigen. Offene medizinische Fragen betreffen das Untersuchungsintervall bei Screeninguntersuchungen (unter Berücksichtigung der Strahlenbelastung), die Vorgangsweise bei kleinen Polypen und die Bedeutung von flachen bzw. eingesunkenen Läsionen. Hinsichtlich der Kosteneffektivität führt das Koloskopiescreening in den meisten modellierten Szenarien zu größeren Gesundheitseffekten bei gleichzeitig geringeren Kosten als das CTC-Screening. Diese Ergebnisse können nicht direkt auf Deutschland übertragen werden. Ein wichtiger (auch ethischer) Aspekt ist die Berücksichtigung der Patientenpräferenzen hinsichtlich der Untersuchungen. Juristische Aspekte betreffen insbesondere auch die Vorschreibung und Einhaltung von Qualitätsstandards. Schlussfolgerung Eine klare Empfehlung für die CTC als alternatives Verfahren zum bisherigen Goldstandard konventionelle Koloskopie kann derzeit weder für die Diagnose- noch für die Screeningsituation gegeben werden. Dies gilt aufgrund der vorliegenden Literatur sowohl für die medizinische als auch für die ökonomische Bewertung, ist jedoch trotz der zahlreichen Studien und Analysen zu diesem Thema mit Unsicherheiten behaftet. Wegen der schnellen Weiterentwicklung der CTC sind zu dieser Fragestellung kurzfristige Updates erforderlich.

Association between colonic diverticulosis and prevalence of colorectal polyps

Article

May 2014

Introduction Diverticulosis and colorectal polyps increase in frequency as the population ages. Proposed common mechanisms for both include lack of dietary fiber, increased saturated fats, and slow colonic transit time. The association of diverticulosis and colorectal polyps has been previously reported with conflicting results. Despite sharing common epidemiologic predisposing factors, the association between diverticulosis and colon polyps remains unclear and needs better clarification. Aim The primary aim of our study is to evaluate if there is any association between diverticular disease and colorectal polyps. Materials and methods This is a retrospective cohort study. All consecutive patients who underwent colonoscopy between January 2009 and December 2011 were included, except those with history of inflammatory bowel disease, polyposis syndrome, and poor bowel preparation. Univariate and multivariate logistic regression analysis was conducted to analyze the association between colon polyps and diverticulosis. Hyperplastic polyps were excluded from the statistical analysis, and only pre-cancerous adenomas were included. Results A total of 2,223 patients met the inclusion criteria. The prevalence of colorectal polyps in patients with diverticulosis was significantly higher than those without diverticulosis (odds ratio (OR) 1.54; 95 % confidence interval (CI) 1.27–1.80, p = 0.001). This association was found significant for all locations of polyps and all histological subtypes. There was also a statistically significant association between age, presence of diverticulosis, and colorectal polyps (OR 1.03; 95 % CI 1.02–1.04). The incidence of colorectal polyps increases as age advances in patients with diverticulosis, with the highest association in patients >70 years of age (OR 3.55; 95 % CI 2.50–5.04). There was no significant association between indication for colonoscopy and presence of colorectal polyps in patients with diverticulosis (OR 0.98; 95 % CI 0.95–1.01). The incidence of diverticulitis was low (<1 %), and there was no association between diverticulitis and colon polyps. Conclusion There is a significant association between diverticulosis and synchronous pre-cancerous colorectal polyps (adenomas). Patients with diverticulosis have a higher risk of colorectal polyps as compared to those without. This observation needs further validation by a large prospective cohort study.

Article

Full-text available

Apr 2002
EUR J CANCER PREV

Lifestyle-related variables are suggested to play a major role in the development of colorectal cancer (CRC). Within a 3-year follow-up and intervention study with calcium and antioxidants against growth and recurrence of colorectal polyps, supplementary studies were performed in which different aspects of lifestyle were examined. Instead of polypectomy at diagnosis, polyps <9 mm were left in situ in 116 polyp patients (50-76 years, 50% men). After 3 years, all polyps were removed and subjected to histology. Two different sets of control groups were included (all controls were age- and sex-matched and proven to be free of polyps). We applied two different methods in order to assess most exposure variables. Generally, in case-control studies, the validity of the study outcomes is high if they are similar regardless of choice of controls and methods, since bias due to these choices may affect the risk estimates. In contrast, the validity of the study outcomes is low if dependent upon these choices. Our preliminary data support the theory that different factors may be of importance in different stages of the neoplastive formation, and that lifestyle-related factors are likely to play a major role in CRC development.

Colorectal Cancer Prevention and Early Detection

Article

Bernard Levin

We can estimate how many of the 56,300 people who die annually of colorectal cancer whose sur-vival could have been lengthened if their disease had been prevented or detected early: more than 50 per-cent. Risk of colorectal cancer may be reduced by regular physical activity and appropriate diet, and it can be effectively treated when it is detected early. 1 Only lung cancer, which is expected to take the lives of 156,900 American men and women in 2000, out-paces colorectal cancer in the potential impact pre-vention strategies could have. 2 Increased screening and adenoma removal, which prevents progression to invasive cancer, have been credited with the 2.1 percent annual decline in incidence between 1992 and 1996. 2 Early detection translates into a 91.4 percent 5-year relative survival rate for about 37 percent of all cases diagnosed. 1 Another 37 percent are diagnosed when disease is regional, and the survival rate for these cases falls to 66.1 percent. For those remaining cases diagnosed when cancer has metastasized to a distant site, the survival rate is only 8.5 percent. In the United States, men have higher rates of colorectal cancer incidence and mortality than do women, 3 but mortality rate graph lines tended to intertwine from 1930 to about 1960, when the mor-tality rate began to decline steadily and in women fell distinctly lower than in men. 1 Cumulative life-time risk for colorectal cancer is 6 percent. 4 In the United States, a gap exists between overall survival rates by race: the rate for whites (63 percent) sur- passes that of African Americans (52.5 percent), and researchers blame more than half of the difference on African Americans' more advanced stage of dis-ease at diagnosis. 5 Globally, incidence of cancer of the colon and rectum is highest in Australia/New Zealand, North America, Western Europe, Northern Europe, and Japan and lowest in Northern, Western, and Middle Africa along with South Central Asia. 3 Worldwide it occurs slightly more frequently in men than in women.

Should we change our dietary advice on cancer prevention? Eur J Cancer Prev

Article

Mar 2001
EUR J CANCER PREV

Chromoendoscopy with Indigocarmine Improves the Detection of Adenomatous and Nonadenomatous Lesions in the Colon

Article

Jan 2002

Depressed early cancers and flat adenomas have a high potential for malignancy with possible infiltrating growth, despite the small size of the lesion. Japanese investigators have shown that early diagnosis and classification of these lesions is possible with the help of chromoendoscopy. The aim of this study, therefore, was to evaluate the usefulness of chromoendoscopy during routine colonoscopy. During routine colonoscopy, vital staining with indigocarmine solution (0.4 %, 1 - 10 ml) was performed on all visible lesions in 100 consecutive patients without visible inflammatory changes. If findings on macroscopic examination were unremarkable, the sigmoid colon and rectum were stained with indigocarmine over a defined segment (0 - 30 cm ab ano) and inspected for lesions visible only after staining. Each lesion was classified with regard to type (polypoid, flat, or depressed), position and size. The staining pattern was classified according to the pit pattern classification. A total of 52 patients had 105 visible lesions (89 polypoid, 14 flat and two depressed). The mean size of the lesions was 1.4 cm. Among the 48 patients with mucosa of normal appearance, 27 showed 178 lesions after staining (176 flat, two depressed) with a mean size of 3 mm. On histological investigation, 210 lesions showed hyperplastic or inflammatory changes, 67 were adenomas and six were cancers. Use of the pit pattern system to classify lesions (adenomatous, pit patterns III-V; nonadenomatous, pit patterns I-II) was possible, with a sensitivity of 92 % and a specificity of 93 %. Lesions with pit patterns III - V showed higher rates of dysplasia. Chromoendoscopy allows easy detection of mucosal lesions in the colon and facilitates visualization of the margins of flat lesions. This technique unmasks multiple mucosal lesions which are not identified by routine video colonoscopy. The pit pattern seen after staining allows differentiation between hyperplastic and adenomatous lesions which may have consequences with regard to the endoscopic interventions needed.

Results of Screening Colonoscopy among Persons 40 to 49 Years of Age

Article

Jul 2002
NEW ENGL J MED

The prevalence of colorectal lesions in persons 40 to 49 years of age, as identified on colonoscopy, has not been determined. We reviewed the procedure and pathology reports for 906 consecutive persons 40 to 49 years of age who voluntarily participated in an employer-based screening-colonoscopy program. The histologic features of lesions that were identified and removed on endoscopy were categorized according to those of the most advanced lesion removed proximally (up to the junction of the splenic flexure and the descending colon) and the most advanced lesion removed distally. An advanced lesion was defined as an adenoma at least 1 cm in diameter, a polyp with villous histologic features or severe dysplasia, or a cancer. Among those who underwent colonoscopic screening, 78.9 percent had no detected lesions, 10.0 percent had hyperplastic polyps, 8.7 percent had tubular adenomas, and 3.5 percent had advanced neoplasms, none of which were cancerous (95 percent confidence interval for cancer, 0 to 0.4 percent). Eighteen of 33 advanced neoplasms (55 percent) were located distally and were potentially within reach of a sigmoidoscope. If these results are applicable to the general population, at least 250 persons, and perhaps 1000 or more, would need to be screened to detect one cancer in this age group. Colonoscopic detection of colorectal cancer is uncommon in asymptomatic persons 40 to 49 years of age. The noncancerous lesions are equally distributed proximally and distally. The low yield of screening colonoscopy in this age group is consistent with current recommendations about the age at which to begin screening in persons at average risk.

Is the distal hyperplastic polyp A marker for proximal neoplasia ? A systematic review.

Article

Feb 2003

The current literature is unclear about the association between distal hyperplastic polyps and synchronous neoplasia (adenomatous polyps and cancer) in the proximal colon. To estimate the prevalence of proximal neoplasia associated with distal hyperplastic polyps. Database searches (medline and embase from 1966 to 2001) and manual search of the bibliographies of included and excluded studies, case reports, editorials, review articles, and textbooks of Gastroenterology. Studies describing the prevalence of proximal neoplasia in persons with distal hyperplastic polyps. Demographics, clinical variables, study design, and prevalence of proximal neoplasia associated with various distal colorectal findings. Of 18 included studies, 12 involved asymptomatic individuals in which the pooled absolute risk of any proximal neoplasia associated with distal hyperplastic polyps was 25% (95% confidence interval [95% CI], 21% to 29%). In 4 studies where colonoscopy was performed irrespective of distal findings, the absolute risk was 21% (95% CI, 14% to 28%). The relative risk of finding any proximal neoplasia in persons with distal hyperplastic polyps was 1.3 (95% CI, 0.9 to 1.8) compared to those with no distal polyps. Among 6 studies of patients with symptoms or risk factors for neoplasia, the absolute risk of proximal neoplasia was 35% (95% CI, 32% to 39%) in persons with distal hyperplastic polyps. In 2 studies of screening colonoscopy, advanced proximal neoplasia (cancer, or a polyp with villous histology or severe dysplasia, or a tubular adenoma >/=1 cm) was present in 4% to 5% of persons with distal hyperplastic polyps, which was 1.5 to 2.6 times greater than in those with no distal polyps. In asymptomatic persons, a distal hyperplastic polyp is associated with a 21% to 25% risk for any proximal neoplasia and a 4% to 5% risk of advanced proximal neoplasia, and may justify examination of the proximal colon. Further study is needed to determine the risk of advanced proximal neoplasia associated with size and number of distal hyperplastic polyps.

Alcohol consumption, alcohol dehydrogenase 3 polymorphism, and colorectal adenomas

Article

Jun 2003

Alcohol is a probable risk factor with regard to colorectal neoplasm and is metabolized to the carcinogen acetaldehyde by the genetically polymorphic alcohol dehydrogenase 3 (ADH3) enzyme. We evaluated whether the association between alcohol and colorectal adenomas is modified by ADH3 polymorphism. We recruited 433 cases with adenomatous polyps and 436 polyp-free controls among Caucasians undergoing endoscopy between 1995 and 2000. Frequency and amount of habitual alcohol consumption were assessed by beverage type, using a validated self-administered food frequency questionnaire. All participants provided blood for genotyping of ADH3. Multivariate analyses adjusting for gender, age, and indication for endoscopy showed that alcohol increased the risk of colorectal adenomas among women [odds ratio (OR), 1.8; 95% confidence interval (CI), 1.0-3.2, >/=10 versus <1 drink/week]. Among men, the risk of adenomas was increased only for those consuming > 21 drinks/week (OR, 1.8; 95% CI, 0.9-3.8, compared with men drinking < 1 drink/week). Among subjects in the highest tertile of alcohol consumption, those with the ADH3*1/*1 genotype were at higher risk (OR, 1.8; 95% CI, 1.0-3.1) than those with other ADH3 genotypes (OR, 1.2; 95% CI, 0.7-1.9) when compared with those in the lowest tertile with ADH3*1/*2 or ADH3*2/*2 genotypes. In conclusion, our findings are consistent with results of other studies, suggesting that alcohol consumption elevates the risk of adenomatous colorectal polyps. ADH3 polymorphism may modify the association between alcohol consumption and colorectal adenomas.

Lieberman DA, Prindiville S, Weiss DG, Willett WRisk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 290: 2959-2967

Article

Jan 2004
J Am Med Assoc

Knowledge of risk factors for colorectal neoplasia could inform risk reduction strategies for asymptomatic individuals. Few studies have evaluated risk factors for advanced colorectal neoplasia in asymptomatic individuals, compared risk factors between persons with and without polyps, or included most purported risk factors in a multivariate analysis. To determine risk factors associated with advanced colorectal neoplasia in a cohort of asymptomatic persons with complete colonoscopy. Prospective, cross-sectional study of 3121 asymptomatic patients aged 50 to 75 years from 13 Veterans Affairs medical centers conducted between February 1994 and January 1997. All participants had complete colonoscopy to determine the prevalence of advanced neoplasia, defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. Variables examined included history of first-degree relative with colorectal cancer, prior cholecystectomy, serum cholesterol level, physical activity, smoking, alcohol use, and dietary factors. An age-adjusted analysis was performed for each variable to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associated with having advanced neoplasia compared with having no polyps. We developed a multivariate logistic regression model to identify the most informative risk factors. A secondary analysis examined risk factors for having hyperplastic polyps compared with having no polyps and compared with having advanced neoplasia. Three hundred twenty-nine participants had advanced neoplasia and 1441 had no polyps. In multivariate analyses, we found positive associations for history of a first-degree relative with colorectal cancer (OR, 1.66; 95% CI, 1.16-2.35), current smoking (OR, 1.85; 95% CI, 1.33-2.58), and current moderate to heavy alcohol use (OR, 1.02; 95% CI, 1.01-1.03). Inverse associations were found for cereal fiber intake (OR, 0.95; 95% CI, 0.91-0.99), vitamin D intake (OR, 0.94; 95% CI, 0.90-0.99), and use of nonsteroidal anti-inflammatory drugs (NSAIDs) (OR, 0.66; 95% CI, 0.48-0.91). In the univariate analysis, the inverse association was found with cereal fiber intake greater than 4.2 g/d, vitamin D intake greater than 645 IU/d, and daily use of NSAIDs. Marginal factors included physical activity, daily multivitamin use, and intake of calcium and fat derived from red meat. No association was found for body mass index, prior cholecystectomy, or serum cholesterol level. Three hundred ninety-one patients had hyperplastic polyps as the worst lesion found at colonoscopy. Risk variables were similar to those for patients with no polyps, except that past and current smoking were associated with an increased risk of hyperplastic polyps. Our data endorse several important risk factors for advanced colonic neoplasia and provide a rationale for prudent risk reduction strategies. Further study is needed to determine if lifestyle changes can moderate the risk of colorectal cancer.

Perspectives of Chromo and Magnifying Endoscopy: How, How Much, When, and Whom Should We Stain?

Article

Feb 2004

The goal of every routine endoscopy in the gut is the early diagnosis of malignant and premalignant changes of the mucosa. Chromo- and magnifying endoscopes are exciting new tools and offer detailed analysis of the colonic mucosal surface and pit pattern architecture. This review summarizes recent advances in endoscopic characterization of colorectal lesions using magnification endoscopy and chromoendoscopy. Surface analysis of the colon using chromoendoscopy allows a prediction between non-neoplastic and neoplastic lesions with high specificity. The precise delineation of the borders and a more detailed macroscopic analysis of the lesions are further advantages. In particular, flat adenomas and early depressed cancers are now more frequently recognized in western countries suggesting that significant lesions were overlooked by conventional endoscopy in the past. Furthermore, chromoendoscopy can be used in a targeted fashion to screen for sporadic adenomas. Finally, in surveillance colonoscopy, patients with long-standing ulcerative colitis have a valuable benefit if targeted biopsies are performed to detect intraepithelial neoplasias after pan-chromoendoscopy with methylene blue. Although there is a long learning curve, chromoendoscopy should thus belong to every endoscopists armamentarium. However, detailed knowledge about the technique, dyes, and specific staining patterns are mandatory before the yield of screening or surveillance colonoscopy can be increased. The new detailed images seen with magnifying chromoendoscopy are unequivocally the beginning of a new era where new optical developments will allow a unique look on cellular structures.

Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo

Article

Sep 2004
GASTROENTEROLOGY

A confocal laser endoscopy system has recently been developed that may allow subsurface imaging of living cells in colonic tissue in vivo. The aim of the present study was to assess its potential for prediction of histology during screening colonoscopy for colorectal cancer. Twenty-seven patients underwent colonoscopy with the confocal endoscope using acriflavine hydrochloride or fluorescein sodium with blue laser illumination. Furthermore, 42 patients underwent colonoscopy with this system using fluorescein sodium. Standardized locations and circumscript lesions were examined by confocal imaging before taking biopsy specimens. Confocal images were graded according to cellular and vascular changes and correlated with conventional histology in a prospective and blinded fashion. Acriflavine hydrochloride and fluorescein sodium both yielded high-quality images. Whereas acriflavine hydrochloride strongly labeled the superficial epithelial cells, fluorescein sodium offered deeper imaging into the lamina propria. Fluorescein sodium was thus used for the prospective component of the study in which 13,020 confocal images from 390 different locations were compared with histologic data from 1038 biopsy specimens. Subsurface analysis during confocal laser endoscopy allowed detailed analysis of cellular structures. The presence of neoplastic changes could be predicted with high accuracy (sensitivity, 97.4%; specificity, 99.4%; accuracy, 99.2%). Confocal laser endoscopy is a novel diagnostic tool to analyze living cells during colonoscopy, thereby enabling virtual histology of neoplastic changes with high accuracy. These newly discovered diagnostic possibilities may be of crucial importance in clinical practice and lead to an optimized rapid diagnosis of neoplastic changes during ongoing colonoscopy.

Prevalence and inci-dence of colorectal adenomas and cancer in asymptomatic persons

Jan 1997
387-399

Ai Neugut
Jacobson Js
Va

Neugut AI, Jacobson JS, Rella VA (1997) Prevalence and inci-dence of colorectal adenomas and cancer in asymptomatic persons. Gastrointest Endosc Clin N Am 7:387–399

MTHFR poly-morphism, methyl-replete diets and the risk of colorectal car-cinoma and adenoma among U.S. men and women: an exam-ple of gene–environment interactions in colorectal tumorige-nesis

Jan 1999
129560-564

Chen J Giovannucci
El
Hunter
Dj

Chen J, Giovannucci EL, Hunter DJ (1999) MTHFR poly-morphism, methyl-replete diets and the risk of colorectal car-cinoma and adenoma among U.S. men and women: an exam-ple of gene–environment interactions in colorectal tumorige-nesis. J Nutr 129[Suppl 2]:560–564

Risk fac-tors for Ki-ras protooncogene mutation in sporadic colorectal adenomas

Jan 1999
5181-5185

Martinez Me
T Maltzman
Marshall
Jr

Martinez ME, Maltzman T, Marshall JR et al (1999) Risk fac-tors for Ki-ras protooncogene mutation in sporadic colorectal adenomas. Cancer Res 59:5181–5185

Epidemiology of colorectal polyps

Abstract

No full-text available

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