The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA...The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA should be determined for a further large number of studies.EMA should be used with caution for larger lesions.展开更多
BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has ass...BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.展开更多
BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationsh...BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.展开更多
Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or inc...Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.展开更多
BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters ...BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.展开更多
There have been major developments in endoscopic imaging techniques in recent years.Endoscopes with high definition and magnification can provide high quality images that allow for the histological estimation of lesio...There have been major developments in endoscopic imaging techniques in recent years.Endoscopes with high definition and magnification can provide high quality images that allow for the histological estimation of lesions in vivo and in situ when combined with ancillary enhancement techniques such as chromoendoscopy(CE)and virtual CE(narrow band imaging fujinon intelligent chromoendoscopy,or i-Scan).Despite the enormous potential for these advanced techniques,their value and feasibility in the clinic are still doubted,particularly in cases of colonic polyps that are slated for removal,where in vivo characterization may be deemed unnecessary.However,there are several advantages offered by such advanced endoscopic imaging.CE with or without magnification demonstrates highly accurate histology and invasion depth prediction,and virtual CE is a feasible and less cumbersome alternative to CE in terms of histological estimation,though not sufficiently accurate for depth invasion prediction.Furthermore,the supplementary information provided by advanced imaging systems can assist the endoscopist in the selection of a strategic approach,such as in deciding whether a colonic lesion should be resected,left in situ,or requires more intensive surgical treatment.Lastly,advanced high-resolution imaging techniques may be more cost effective,such that histopathology of lowrisk lesions following resection can be eliminated.The results of these evaluations and comparisons with traditional CE are presented and discussed.Taken together,the benefits provided by these advanced capabilities justify their development,and advocates their use for the treatment and management of colonic polyps.展开更多
BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the ris...BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.展开更多
Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk factors.Previous studies have shown variable prevalence of colon polyps in patients with BE.Our aims were to determine the preval...Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk factors.Previous studies have shown variable prevalence of colon polyps in patients with BE.Our aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without BE.Methods:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to December 2011.The control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time period.Exclusion criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis syndromes.Patient demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy results.Results:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control group.Mean age at index colonoscopy was 618 years and 75%of patients were male.On index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the follow-up.On multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during colonoscopy.Conclusions:Patients with BE had higher prevalence and incidence of colon polyps.This has important clinical implications for screening and surveillance in BE patients.展开更多
AIM： To investigate if high-definition （HD） colonoscope with i-Scan gave a higher detection rate of mucosal le- sions vs standard white-light instruments. METHODS： Data were collected from the computer- ized datab...AIM： To investigate if high-definition （HD） colonoscope with i-Scan gave a higher detection rate of mucosal le- sions vs standard white-light instruments. METHODS： Data were collected from the computer- ized database of the endoscopy unit of our tertiary referral center. We retrospectively analyzed 1101 con- secutive colonoscopies that were performed over 1 year with standard white-light （n = 849） or HD＋ with i-Scan （n = 252） instruments by four endoscopists, in an outpatient setting. Colonoscopy records included patients＇ main details and family history for colorectal cancer, indication for colonoscopy （screening, diagnos- tic or surveillance）, type of instrument used （standard white-light or HD＋ plus i-Scan）, name of endoscopist and bowel preparation. Records for each procedure included whether the cecum was reached or not and the reason for failure, complications during or imme- diately after the procedure, and number, size, location and characteristics of the lesions. Polyps or protruding lesions were defined as sessile or pedunculated, and nonprotruding lesions were defined according to Paris classification. For each lesion, histological diagnosis was recorded. RESULTS： Eight hundred and forty-nine colonosco- pies were carried with the standard white-light video colonoscope and 252 with the HD＋ plus i-Scan video colonoscope, The four endoscopists did 264, 300, 276 and 261 procedures, respectively; 21.6%, 24.0%, 21.7% and 24.1% of them with the HD＋ plus i-Scan technique. There were no significant differences be- tween the four endoscopists in either the number of procedures done or the proportions of each imaging technique used. Both techniques detected one or more mucosal lesions in 522/1101 procedures （47.4%）. The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left. A significantly higher number of colonoscopies recognized lesions in the HD＋ plus i-Scan mode （171/252 = 67.9%） than with the standard white-light technique （408/849 = 48.1%） （P 〈 0.0001）. HD＋ with i-Scan colonoscopies identified more lesions than standard white-light imag- ing （459/252 and 807/849, P 〈 0.0001）, in the right or left colon （mean ：1： SD, 1.62±1.36 vs 1.33±0.73, P 〈 0.003 and 1.55±0.98 vs 1.17±0.93, P = 0.033）, more lesions 〈 10 mm （P 〈 0.0001） or nonprotruding （P 〈 0.022）, and flat polyps （P = 0.04）. The cumulative mean number of lesions per procedure detected by the four endoscopists was significantly higher with HD＋ with i-Scan than with standard white-light imaging （1.82 ± 2.89 vs 0.95± 1.35, P 〈 0.0001）. CONCLUSION： HD imaging with i-Scan during the withdrawal phase of colonoscopy significantly increased the detection of colonic mucosal lesions, particularly small and nonprotruding polyps.展开更多
AIM: To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without polyps in the distal colon.METHODS: Data were co...AIM: To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without polyps in the distal colon.METHODS: Data were collected prospectively during colonoscopic examinations performed in 5 973 subjects as part of health evaluation at our unit from December 1997 to December 2003. Polyps were considered advanced, if they were larger than 10 mm or were tubovillous, villous or malignant. Proximal colon was defined as the splenic flexure and more proximal portions of the colon.RESULTS: Colon polyps were detected in 971 (16.3%)subjects (613 males and 358 females) with their mean age being 56.6±10.7 years. Advanced polyps were noted in 199 (3.3%) individuals. Subjects were sub-classified according to the location of polyps into three groups: distal (569, 58.6%), proximal (284, 29.2%), and combined proximal and distal (118, 12.2%) groups. Subjects with advanced polyps in these three groups were 95 (9.8%),56 (5.8%), and 48 (4.9%) respectively. In the 48 subjects with advanced combined polyps, 13 advanced polyps were distributed at the distal colon, 17 at the proximal colon,and 18 at both. Eighteen colon cancers including 12 at sigmoid and 6 at ascending colon were confirmed by final pathology. The relative risk for advanced proximal polyp according to distal findings was 3.1 (95%CI: 1.3-7.4) for hyperplastic polyp, 2.7 (95%CI: 1.4-5.3) for tubular polyp and 13.5 (95%CI: 5.1-35.4) for advanced polyp as compared to that for no polyp. However, 56 (28.2%) of 199 subjects with advanced polyps had no index polyps at the distal colon and might go undetected under sigmoidoscopic screening.CONCLUSION: Although distal lesions can predict the risk of advanced proximal polyps, a substantial portion of Chinese with advanced proximal polyps is not associated with any distal sentinel lesions. These data have implications for screening policy of colon cancers in Taiwan Residents Chinese.展开更多
AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these gen...AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.展开更多
AIM： To evaluate accuracy of in vivo diagnosis of ad- enomatous vs non-adenomatous polyps using/-SCAN digital chromoendoscopy compared with high-definition white light. METHODS： This is a single-center comparative e...AIM： To evaluate accuracy of in vivo diagnosis of ad- enomatous vs non-adenomatous polyps using/-SCAN digital chromoendoscopy compared with high-definition white light. METHODS： This is a single-center comparative effec- tiveness pilot study. Polyps （n = 103） from 75 average- risk adult outpatients undergoing screening or surveil- lance colonoscopy between December 1, 2010 and April 1, 2011 were evaluated by two participating en- doscopists in an academic outpatient endoscopy center. Polyps were evaluated both with high-definition white light and with/-SCAN to make an/n vivo prediction of adenomatous vs non-adenomatous pathology. We de- termined diagnostic characteristics of/-SCAN and high- definition white light, including sensitivity, specificity, and accuracy, with regards to identifying adenomatous vs non-adenomatous polyps. Histopathologic diagnosis was the gold standard comparison. RESULTS： One hundred and three small polyps, de- tected from forty-three patients, were included in the analysis. The average size of the polyps evaluated in the analysis was 3.7 mm （SD 1.3 mm, range 2 mm to 8 mm）. Formal histopathology revealed that 54/103 （52.4%） were adenomas, 26/103 （25.2%） were hyper- plastic, and 23/103 （22.3%） were other diagnoses in- clude ＂lymphoid aggregates＂, ＂non-specific colitis,＂ and ＂no pathologic diagnosis.＂ Overall, the combined accu- racy of endoscopists for predicting adenomas was iden- tical between/-SCAN （71.8%, 95%CI： 62.1%-80.3%） and high-definition white light （71.8%, 95%CI： 62.1%-80.3%）. However, the accuracy of each endosco- pist differed substantially, where endoscopist A demon- strated 63.0% overall accuracy （95%CI： 50.9%-74.0%） as compared with endoscopist B demonstrating 93.3% overall accuracy （95%CI： 77.9%-99.2%）, irrespective of imaging modality. Neither endoscopist demonstrated a significant learning effect with i-SCAN during the study. Though endoscopist A increased accuracy using/-SCAN from 59% （95%CI： 42.1%-74.4%） in the first half to 67.6% （95%CI： 49.5%-82.6%） in the second half, and endoscopist B decreased accuracy usingi-SCAN from 100% （95%CI： 80.5%-100.0%） in the first half to 84.6% （95%CI： 54.6%-98.1%） in the second half, nei- ther of these differences were statistically significant. CONCLUSION：i-SCAN and high-definition white light had similar efficacy predicting polyp histology. Endosco- pist training likely plays a critical role in diagnostic test characteristics and deserves further study.展开更多
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 A...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.展开更多
BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and ar...BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and are prone to complications.Endoscopic mucosal ablation(EMA)is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions.CASE SUMMARY In this case series we report the successful treatment of three flat colonic polyps using the EMA technique.Two lesions were treatment naïve and 1 was a recurrence after an endoscopic mucosal resection.The sizes ranged from 2 to 4 cm.All three polyps were ablated successfully with no immediate or delayed complications.The recurrence rate at 1 year of follow up was 0%.CONCLUSION Based on this initial experience,we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.展开更多
Colonic polyps may arise from BRAF inhibitor treatment of melanoma, possibly due to paradoxical activation of the mitogen-activated protein (MAP)-kinase pathway. In an alternative evidence based scenario, tubular colo...Colonic polyps may arise from BRAF inhibitor treatment of melanoma, possibly due to paradoxical activation of the mitogen-activated protein (MAP)-kinase pathway. In an alternative evidence based scenario, tubular colonic adenomas with APC gene mutations have also been identified in the context of BRAF inhibitor treatment, in the absence of mutations of MAPK genes. A minority of colorectal cancers develop by an alternative “serrated polyp pathway”. This article postulates a novel hypothesis, that the established phenotypic and molecular characteristics of serrated colonic polyps/CRC offer an intriguing insight into the pathobiology of BRAF inhibitor induced colonic polyps. Serrated polyps are characterized by a CpG island methylation phenotype, MLH1 silencing and cellular senescence. They also have BRAF mutations. The contention is that BRAF inhibitor induced polyps mimic the afore-described histology and molecular features of serrated polyps with the exception that instead of the presence of BRAF mutations they induce C-RAF homodimers and B-RAF: C-RAF heterodimers.展开更多
AIM： To investigate the distribution and frequency of advanced polyps over eight years.METHODS：6424 colonoscopies were reviewea aunng the study period 1998 to 2005. The study period was subdivided into period I ： 1...AIM： To investigate the distribution and frequency of advanced polyps over eight years.METHODS：6424 colonoscopies were reviewea aunng the study period 1998 to 2005. The study period was subdivided into period I ： 1998 to 2001 and period 11： 2002-2005. RESULTS： 1856 polyps （33% advanced polyps） and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6± 13.8 years, respectively. Advanced polyps were mainly lerc sided （59.5%）. Advanced polyps were found in patients ≤60 years from 17.7% in period Ⅰto 26.3% in period Ⅱ（P 〈 0.05）, especially in male subjects ≤60 years （21.6% vs 31.6%, P 〈 0.05）. Advanced tubuloviUous polyps rose from 21.5% in period I to 29.5% in period Ⅱ （P 〈 0.05）. Whereas cancers in male patients ≤ 60 years were similar in both periods： 23.2% vs 16.5% （P 〉 0.05）.CONCLUSION： Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shiE towards a proximal location.展开更多
AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was appl...AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre-and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy. RESULTS: In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp. CONCLUSION: The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.展开更多
Objective To assess the clinical values of computed tomographic colonography （CTC） in diagnosis of colonic polyps. Methods Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic po...Objective To assess the clinical values of computed tomographic colonography （CTC） in diagnosis of colonic polyps. Methods Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic polyps screening received examinations with both CTC and conventional colonoscopy. Sixteen- or 64-slice spiral computed tomography and professional imaging processing techniques were used for evaluation. Per-polyp and per-patient results were analyzed. Those by per-polyp were subsequently divided into ≥10 mm group, 5-10 mm group, and ≤5 mm group. Sensitivity, positive predictive value （PPV）, specificity, negative predictive value （NPV）, and accuracy were calculated using statistical method for diagnostic studies, with conventional colonoscopy as a gold standard. Results Ninety and 61 polyps were found by CTC and conventional colonoscopy, respectively. The per-polyp sensitivity/PPV were 80.3%/55.6% in total, and 100%/92.9%, 93.8%/65.2%, and 68.8%/ 41.5% in the ≥10 mm group, 5-10 mm group, and ≤5 turn group, respectively. The per-patient sensitivity, PPV, specificity, NPV, and accuracy were 97.1%, 89.5%, 42.9%, 75.0%, and 88.1%, respectively. Conclusion CTC can clearly reveal the morphology of colonic polyps and be used as a routine monitoring method for the clinical diagnosis of polyps.展开更多
Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypecto...Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.展开更多
BACKGROUND Pleomorphic leiomyosarcomas make up around 8.6%of all leiomyosarcomas.They behave aggressively and often have poor prognoses.They can affect the gastrointestinal tract and retroperitoneum.To date,pleomorphi...BACKGROUND Pleomorphic leiomyosarcomas make up around 8.6%of all leiomyosarcomas.They behave aggressively and often have poor prognoses.They can affect the gastrointestinal tract and retroperitoneum.To date,pleomorphic leiomyosarcoma involving the mesocolon have been reported in nine patients.CASE SUMMARY The patient was a 44-year-old man with a history of pleomorphic leiomyosarcoma of the left maxilla with metastasis to the lung and liver.His most recent positron emission tomography-computed tomography(PET-CT)scan showed uptake in the ascending and transverse colons.A colonoscopy revealed a 5.0 cm×3.5 cm×3.0 cm pedunculated polyp in the ascending colon.The polyp was removed using hot snare polypectomy technique and retrieved with Rothnet.Histopathologic examination of the polyp showed a metastatic pleomorphic leiomyosarcoma.CONCLUSION Uptake(s)on PET-CT in a patient with pleomorphic leiomyosarcoma should raise suspicion for metastasis.展开更多
文摘The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA should be determined for a further large number of studies.EMA should be used with caution for larger lesions.
文摘BACKGROUND Thyroid nodules(TN)are increasingly diagnosed worldwide;investigating the association between TN and colon polyps could be helpful in early detection and management.To our knowledge no meta-analysis has assessed the relationship between TN and adenomatous colonic polyps.AIM To assess the association between adenomatous colonic polyps,thyroid-stimulating hormone,and TN.METHODS We searched PubMed,MEDLINE,Cochrane Library,EBSCO,and the first 100 articles in Google for articles published in English from inception until April 2025.We included prospective cohorts,retrospective studies,case-control studies,and cross-sectional studies.The keywords thyroid nodules,adenomatous colon polyps,thyroid volume,metabolic syndrome,insulin resistance,and thyroid malignancy were used.RESULTS Out of 237 articles,25 full texts were reviewed,and 5 full texts were included in the final meta-analysis.No relationship was found between TN,colonic polyps,and thyroid-stimulating hormone levels[odd ratio(OR):1.78,95%confidence interval(CI):0.55-5.74,P=0.33].Colonic polyps were more common among patients with TN when addressing heterogeneity(OR:0.42,95%CI:0.30-0.52,P<0.001 and OR:0.08,95%CI:0.70-0.86,P=0.85).CONCLUSION TN were similar among patients with and without adenomatous colonic polyps.However,TN was more common among colon polyps when addressing the heterogeneity.Thyroid-stimulating hormone was not different between those with and without TN.Age,sex,adiposity,and smoking effects might explain the higher rate observed by the included studies.Further studies controlling for the same are needed.
文摘BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.
文摘Post-colonoscopic colorectal cancer(PCCRC),also known as interval CRC,is defined as CRC diagnosed more than six months after a colonoscopy in which no cancer was detected.It typically arises from missed lesions or incomplete resections and is now recognized as one of the most reliable quality indicators for assessing colonoscopy performance.With an incidence rate of 3.6%to 9.3%,PCCRC remains a significant concern,highlighting the limitations of colonoscopy in CRC screening—not only in terms of diagnostic accuracy but also in its preventive role and effectiveness in treating lesions.A range of clinical,endoscopic,and biological factors has been associated with an increased risk of PCCRC.Identifying these factors can help stratify high-risk patients,enabling earlier detection and improving preventive strategies for interval CRC.Reducing PCCRC should be a top priority for every endoscopy unit.While technological advancements will enhance polyp detection,minimize missed lesions,prevent incomplete resections,and improve overall procedural quality,the most impactful strategy remains internal self-assessment within each unit.This review should evaluate key performance metrics,including cecal intubation rate,adenoma detection rate,withdrawal time,PCCRC incidence,and incomplete resections—both at the individual endoscopist level and across the entire unit.
文摘BACKGROUND Surveillance colonoscopies are predominantly normal,identifying patients for potential polypectomy is advantageous.AIM To assess colon capsule endoscopy(CCE)and/or faecal immunochemical test(FIT)as filters in surveillance.METHODS Patients aged≥18 due for polyp surveillance were invited for CCE and FIT.Identifying polyps or colorectal cancer resulted in a positive CCE.Significant lesions(≥3 polyps or≥6 mm polyps),incomplete studies and positive FITs(≥225 ng/mL)were referred for endoscopy.CCE and endoscopy results,FIT accuracy and patient preference were assessed.RESULTS From a total of 126 CCEs[mean age 64(31-80),67(53.2%)males),70.6%(89/126)were excreted,86.5%(109/126)had adequate image quality.CCE positivity was 70.6%(89/126),42.9%(54/126)having significant polyps with 63.5%(80/126)referred for endoscopy(19 sigmoidoscopies,61 colonoscopies).CCE reduced endoscopy need by 36.5%(46/126)and 51.6%(65/126)were spared a colonoscopy.CCE positive predictive value was 88.2%(45/51).Significant extracolonic findings were reported in 3.2%(4/126).Patients with positive CCEs were older>65[odds ratio(OR)=2.5,95%confidence interval(CI):1.1517-5.5787,P=0.0159],with personal history of polyps(OR=2.3,95%CI:0.9734-5.4066,P=0.045),with high/intermediate polyp surveillance risk(OR=5.4,95%CI:1.1979-24.3824,P=0.0156).Overall,5/114(4.4%)FITs were positive(range:0-1394 ng/mL,mean:54 ng/mL).Sensitivity(9.6%)and negative predictive values(20.3%)were inadequate.Receiver operating curve analysis gave a sensitivity and specificity of 26.9%and 91.7%,for FIT of 43 ng/mL.Patients preferred CCE 63.3%(76/120),with less impact on daily activities(21.7%vs 93.2%)and time off work(average days 0.9 vs 1.2,P=0.0201).CONCLUSION CCE appears effective in low-risk polyp surveillance.FIT does not appear to be of benefit in surveillance.
基金Supported by The CIBERehd(Centro de Investigación Biomédica en Red,enfermedades hepaticas y digestivas)to Sanabria E
文摘There have been major developments in endoscopic imaging techniques in recent years.Endoscopes with high definition and magnification can provide high quality images that allow for the histological estimation of lesions in vivo and in situ when combined with ancillary enhancement techniques such as chromoendoscopy(CE)and virtual CE(narrow band imaging fujinon intelligent chromoendoscopy,or i-Scan).Despite the enormous potential for these advanced techniques,their value and feasibility in the clinic are still doubted,particularly in cases of colonic polyps that are slated for removal,where in vivo characterization may be deemed unnecessary.However,there are several advantages offered by such advanced endoscopic imaging.CE with or without magnification demonstrates highly accurate histology and invasion depth prediction,and virtual CE is a feasible and less cumbersome alternative to CE in terms of histological estimation,though not sufficiently accurate for depth invasion prediction.Furthermore,the supplementary information provided by advanced imaging systems can assist the endoscopist in the selection of a strategic approach,such as in deciding whether a colonic lesion should be resected,left in situ,or requires more intensive surgical treatment.Lastly,advanced high-resolution imaging techniques may be more cost effective,such that histopathology of lowrisk lesions following resection can be eliminated.The results of these evaluations and comparisons with traditional CE are presented and discussed.Taken together,the benefits provided by these advanced capabilities justify their development,and advocates their use for the treatment and management of colonic polyps.
文摘BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.
文摘Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk factors.Previous studies have shown variable prevalence of colon polyps in patients with BE.Our aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without BE.Methods:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to December 2011.The control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time period.Exclusion criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis syndromes.Patient demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy results.Results:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control group.Mean age at index colonoscopy was 618 years and 75%of patients were male.On index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the follow-up.On multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during colonoscopy.Conclusions:Patients with BE had higher prevalence and incidence of colon polyps.This has important clinical implications for screening and surveillance in BE patients.
文摘AIM： To investigate if high-definition （HD） colonoscope with i-Scan gave a higher detection rate of mucosal le- sions vs standard white-light instruments. METHODS： Data were collected from the computer- ized database of the endoscopy unit of our tertiary referral center. We retrospectively analyzed 1101 con- secutive colonoscopies that were performed over 1 year with standard white-light （n = 849） or HD＋ with i-Scan （n = 252） instruments by four endoscopists, in an outpatient setting. Colonoscopy records included patients＇ main details and family history for colorectal cancer, indication for colonoscopy （screening, diagnos- tic or surveillance）, type of instrument used （standard white-light or HD＋ plus i-Scan）, name of endoscopist and bowel preparation. Records for each procedure included whether the cecum was reached or not and the reason for failure, complications during or imme- diately after the procedure, and number, size, location and characteristics of the lesions. Polyps or protruding lesions were defined as sessile or pedunculated, and nonprotruding lesions were defined according to Paris classification. For each lesion, histological diagnosis was recorded. RESULTS： Eight hundred and forty-nine colonosco- pies were carried with the standard white-light video colonoscope and 252 with the HD＋ plus i-Scan video colonoscope, The four endoscopists did 264, 300, 276 and 261 procedures, respectively; 21.6%, 24.0%, 21.7% and 24.1% of them with the HD＋ plus i-Scan technique. There were no significant differences be- tween the four endoscopists in either the number of procedures done or the proportions of each imaging technique used. Both techniques detected one or more mucosal lesions in 522/1101 procedures （47.4%）. The overall number of lesions recognized was 1266; 645 in the right colon and 621 in the left. A significantly higher number of colonoscopies recognized lesions in the HD＋ plus i-Scan mode （171/252 = 67.9%） than with the standard white-light technique （408/849 = 48.1%） （P 〈 0.0001）. HD＋ with i-Scan colonoscopies identified more lesions than standard white-light imag- ing （459/252 and 807/849, P 〈 0.0001）, in the right or left colon （mean ：1： SD, 1.62±1.36 vs 1.33±0.73, P 〈 0.003 and 1.55±0.98 vs 1.17±0.93, P = 0.033）, more lesions 〈 10 mm （P 〈 0.0001） or nonprotruding （P 〈 0.022）, and flat polyps （P = 0.04）. The cumulative mean number of lesions per procedure detected by the four endoscopists was significantly higher with HD＋ with i-Scan than with standard white-light imaging （1.82 ± 2.89 vs 0.95± 1.35, P 〈 0.0001）. CONCLUSION： HD imaging with i-Scan during the withdrawal phase of colonoscopy significantly increased the detection of colonic mucosal lesions, particularly small and nonprotruding polyps.
文摘AIM: To investigate the prevalence of advanced polyps in asymptomatic Chinese and to determine the risk of proximal advanced colonic polyps in subjects with and without polyps in the distal colon.METHODS: Data were collected prospectively during colonoscopic examinations performed in 5 973 subjects as part of health evaluation at our unit from December 1997 to December 2003. Polyps were considered advanced, if they were larger than 10 mm or were tubovillous, villous or malignant. Proximal colon was defined as the splenic flexure and more proximal portions of the colon.RESULTS: Colon polyps were detected in 971 (16.3%)subjects (613 males and 358 females) with their mean age being 56.6±10.7 years. Advanced polyps were noted in 199 (3.3%) individuals. Subjects were sub-classified according to the location of polyps into three groups: distal (569, 58.6%), proximal (284, 29.2%), and combined proximal and distal (118, 12.2%) groups. Subjects with advanced polyps in these three groups were 95 (9.8%),56 (5.8%), and 48 (4.9%) respectively. In the 48 subjects with advanced combined polyps, 13 advanced polyps were distributed at the distal colon, 17 at the proximal colon,and 18 at both. Eighteen colon cancers including 12 at sigmoid and 6 at ascending colon were confirmed by final pathology. The relative risk for advanced proximal polyp according to distal findings was 3.1 (95%CI: 1.3-7.4) for hyperplastic polyp, 2.7 (95%CI: 1.4-5.3) for tubular polyp and 13.5 (95%CI: 5.1-35.4) for advanced polyp as compared to that for no polyp. However, 56 (28.2%) of 199 subjects with advanced polyps had no index polyps at the distal colon and might go undetected under sigmoidoscopic screening.CONCLUSION: Although distal lesions can predict the risk of advanced proximal polyps, a substantial portion of Chinese with advanced proximal polyps is not associated with any distal sentinel lesions. These data have implications for screening policy of colon cancers in Taiwan Residents Chinese.
基金Supported by the Special Fund for Health Research and Development,Beijing Municipal Government,China,No.2011-4001-01
文摘AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.
基金Supported by An Unrestricted Educational Grant from PENTAX Medical CompanyA Career Development Research Awardfrom the American Society for Gastrointestinal Endoscopy,to Dr.Gellad
文摘AIM： To evaluate accuracy of in vivo diagnosis of ad- enomatous vs non-adenomatous polyps using/-SCAN digital chromoendoscopy compared with high-definition white light. METHODS： This is a single-center comparative effec- tiveness pilot study. Polyps （n = 103） from 75 average- risk adult outpatients undergoing screening or surveil- lance colonoscopy between December 1, 2010 and April 1, 2011 were evaluated by two participating en- doscopists in an academic outpatient endoscopy center. Polyps were evaluated both with high-definition white light and with/-SCAN to make an/n vivo prediction of adenomatous vs non-adenomatous pathology. We de- termined diagnostic characteristics of/-SCAN and high- definition white light, including sensitivity, specificity, and accuracy, with regards to identifying adenomatous vs non-adenomatous polyps. Histopathologic diagnosis was the gold standard comparison. RESULTS： One hundred and three small polyps, de- tected from forty-three patients, were included in the analysis. The average size of the polyps evaluated in the analysis was 3.7 mm （SD 1.3 mm, range 2 mm to 8 mm）. Formal histopathology revealed that 54/103 （52.4%） were adenomas, 26/103 （25.2%） were hyper- plastic, and 23/103 （22.3%） were other diagnoses in- clude ＂lymphoid aggregates＂, ＂non-specific colitis,＂ and ＂no pathologic diagnosis.＂ Overall, the combined accu- racy of endoscopists for predicting adenomas was iden- tical between/-SCAN （71.8%, 95%CI： 62.1%-80.3%） and high-definition white light （71.8%, 95%CI： 62.1%-80.3%）. However, the accuracy of each endosco- pist differed substantially, where endoscopist A demon- strated 63.0% overall accuracy （95%CI： 50.9%-74.0%） as compared with endoscopist B demonstrating 93.3% overall accuracy （95%CI： 77.9%-99.2%）, irrespective of imaging modality. Neither endoscopist demonstrated a significant learning effect with i-SCAN during the study. Though endoscopist A increased accuracy using/-SCAN from 59% （95%CI： 42.1%-74.4%） in the first half to 67.6% （95%CI： 49.5%-82.6%） in the second half, and endoscopist B decreased accuracy usingi-SCAN from 100% （95%CI： 80.5%-100.0%） in the first half to 84.6% （95%CI： 54.6%-98.1%） in the second half, nei- ther of these differences were statistically significant. CONCLUSION：i-SCAN and high-definition white light had similar efficacy predicting polyp histology. Endosco- pist training likely plays a critical role in diagnostic test characteristics and deserves further study.
文摘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.
文摘BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and are prone to complications.Endoscopic mucosal ablation(EMA)is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions.CASE SUMMARY In this case series we report the successful treatment of three flat colonic polyps using the EMA technique.Two lesions were treatment naïve and 1 was a recurrence after an endoscopic mucosal resection.The sizes ranged from 2 to 4 cm.All three polyps were ablated successfully with no immediate or delayed complications.The recurrence rate at 1 year of follow up was 0%.CONCLUSION Based on this initial experience,we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.
文摘Colonic polyps may arise from BRAF inhibitor treatment of melanoma, possibly due to paradoxical activation of the mitogen-activated protein (MAP)-kinase pathway. In an alternative evidence based scenario, tubular colonic adenomas with APC gene mutations have also been identified in the context of BRAF inhibitor treatment, in the absence of mutations of MAPK genes. A minority of colorectal cancers develop by an alternative “serrated polyp pathway”. This article postulates a novel hypothesis, that the established phenotypic and molecular characteristics of serrated colonic polyps/CRC offer an intriguing insight into the pathobiology of BRAF inhibitor induced colonic polyps. Serrated polyps are characterized by a CpG island methylation phenotype, MLH1 silencing and cellular senescence. They also have BRAF mutations. The contention is that BRAF inhibitor induced polyps mimic the afore-described histology and molecular features of serrated polyps with the exception that instead of the presence of BRAF mutations they induce C-RAF homodimers and B-RAF: C-RAF heterodimers.
文摘AIM： To investigate the distribution and frequency of advanced polyps over eight years.METHODS：6424 colonoscopies were reviewea aunng the study period 1998 to 2005. The study period was subdivided into period I ： 1998 to 2001 and period 11： 2002-2005. RESULTS： 1856 polyps （33% advanced polyps） and 328 CRCs were detected. The mean ages of the patients with advanced polyps and cancer were 69.2 ± 12.0 and 71.6± 13.8 years, respectively. Advanced polyps were mainly lerc sided （59.5%）. Advanced polyps were found in patients ≤60 years from 17.7% in period Ⅰto 26.3% in period Ⅱ（P 〈 0.05）, especially in male subjects ≤60 years （21.6% vs 31.6%, P 〈 0.05）. Advanced tubuloviUous polyps rose from 21.5% in period I to 29.5% in period Ⅱ （P 〈 0.05）. Whereas cancers in male patients ≤ 60 years were similar in both periods： 23.2% vs 16.5% （P 〉 0.05）.CONCLUSION： Advanced polyps increased significantly in the younger male group in the most recent period and there seems to be a shiE towards a proximal location.
文摘AIM: To examine the characteristics of colonic polyps, where it is difficult to distinguish adenomatous polyps from hyperplastic polyps, with the aid of acetic acid chromoendoscopy. METHODS: Acetic acid spray was applied to colonic polyps smaller than 10 mm before complete excision. Endoscopic images were taken before and 15-30 s after the acetic acid spray. Both pre-and post-sprayed images were shown to 16 examiners, who were asked to interpret the lesions as either hyperplastic or adenomatous polyps. Regression analysis was performed to determine which factors were most likely related to diagnostic accuracy. RESULTS: In 50 cases tested by the 16 examiners, the overall accuracy was 62.4% (499/800). Regression analysis demonstrated that surrounding colonic mucosa was the only factor that was significantly related to accuracy in discriminating adenomatous from hyperplastic polyps (P < 0.001). Accuracy was higher for polyps with linear surrounding colonic mucosa than for those with nodular surrounding colonic mucosa (P < 0.001), but was not related to the shape, location, or size of the polyp. CONCLUSION: The accuracy of predicting histology is significantly related to the pattern of colonic mucosa surrounding the polyp. Making a histological diagnosis of colon polyps merely by acetic acid spray is helpful for colon polyps with linear, regularly patterned surrounding colonic mucosa, and less so for those with nodular, irregularly patterned surrounding colonic mucosa.
文摘Objective To assess the clinical values of computed tomographic colonography （CTC） in diagnosis of colonic polyps. Methods Forty-two patients who were clinically suspicious of colonic polyps or underwent colonic polyps screening received examinations with both CTC and conventional colonoscopy. Sixteen- or 64-slice spiral computed tomography and professional imaging processing techniques were used for evaluation. Per-polyp and per-patient results were analyzed. Those by per-polyp were subsequently divided into ≥10 mm group, 5-10 mm group, and ≤5 mm group. Sensitivity, positive predictive value （PPV）, specificity, negative predictive value （NPV）, and accuracy were calculated using statistical method for diagnostic studies, with conventional colonoscopy as a gold standard. Results Ninety and 61 polyps were found by CTC and conventional colonoscopy, respectively. The per-polyp sensitivity/PPV were 80.3%/55.6% in total, and 100%/92.9%, 93.8%/65.2%, and 68.8%/ 41.5% in the ≥10 mm group, 5-10 mm group, and ≤5 turn group, respectively. The per-patient sensitivity, PPV, specificity, NPV, and accuracy were 97.1%, 89.5%, 42.9%, 75.0%, and 88.1%, respectively. Conclusion CTC can clearly reveal the morphology of colonic polyps and be used as a routine monitoring method for the clinical diagnosis of polyps.
文摘Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.
文摘BACKGROUND Pleomorphic leiomyosarcomas make up around 8.6%of all leiomyosarcomas.They behave aggressively and often have poor prognoses.They can affect the gastrointestinal tract and retroperitoneum.To date,pleomorphic leiomyosarcoma involving the mesocolon have been reported in nine patients.CASE SUMMARY The patient was a 44-year-old man with a history of pleomorphic leiomyosarcoma of the left maxilla with metastasis to the lung and liver.His most recent positron emission tomography-computed tomography(PET-CT)scan showed uptake in the ascending and transverse colons.A colonoscopy revealed a 5.0 cm×3.5 cm×3.0 cm pedunculated polyp in the ascending colon.The polyp was removed using hot snare polypectomy technique and retrieved with Rothnet.Histopathologic examination of the polyp showed a metastatic pleomorphic leiomyosarcoma.CONCLUSION Uptake(s)on PET-CT in a patient with pleomorphic leiomyosarcoma should raise suspicion for metastasis.
