This editorial,inspired by a recent study published in the World Journal of Gastrointestinal Oncology,covers the research findings on microbiota changes in various diseases.In recurrent colorectal polyps,the abundance...This editorial,inspired by a recent study published in the World Journal of Gastrointestinal Oncology,covers the research findings on microbiota changes in various diseases.In recurrent colorectal polyps,the abundances of Klebsiella,Parvimonas,and Clostridium increase,while those of Bifidobacterium and Lactoba-cillus decrease.This dysbiosis may promote the formation and recurrence of polyps.Similar microbial changes have also been observed in colorectal cancer,inflammatory bowel disease,autism spectrum disorder,and metabolic syndrome,indicating the role of increased pathogens and decreased probiotics in these conditions.Regulating the gut microbiota,particularly by increasing probiotic levels,may help prevent polyp recurrence and promote gut health.This microbial intervention strategy holds promise as an adjunctive treatment for patients with colorectal polyps.展开更多
BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk...BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.展开更多
Colorectal polyps remain a significant health concern because they can develop into cancer.Therefore,accurate assessment and diagnosis of polyps,along with appropriate treatment decisions,are crucial in preventing com...Colorectal polyps remain a significant health concern because they can develop into cancer.Therefore,accurate assessment and diagnosis of polyps,along with appropriate treatment decisions,are crucial in preventing complications or malignant transformation.Some polyps are classified as complex polyps,which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score,which considers factors like site,morphology,size,and access.Management of complex colorectal polyps involves various options,including endoscopic and surgical approaches.Endoscopic mucosal resection(EMR)may be challenging in scarred polyps,as inadequate lifting can result in incomplete resection or recurrence.As a more advanced alternative,endoscopic submucosal dissection(ESD)is suitable for larger lesions,enabling en-bloc resection even in complex cases with EMR.However,ESD requires expertise and is more time-consuming than EMR,often necessitating hospitalization due to its complexity.Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps.Endoscopic powered resection,either alone or in combination with other modalities,can also be used to achieve less extensive resection.Managing complications during the procedure or post-procedurally is equally important,as bleeding or perforations can be fatal.Careful patient selection based on individual profiles and risk factors,along with the identification of any signs of malignancy,is crucial before treatment to avoid negative post-treatment outcomes.展开更多
BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and pre...BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.展开更多
BACKGROUND The gold standard for colorectal polyp screening is currently colonoscopy,but the miss rate is still high and the adenoma detection rate and polyp detection rate are still low.The risk factors include the p...BACKGROUND The gold standard for colorectal polyp screening is currently colonoscopy,but the miss rate is still high and the adenoma detection rate and polyp detection rate are still low.The risk factors include the patient,operators,and the tools used.The use of artificial intelligence(AI)in colonoscopy has gained popularity by assisting endoscopists in the detection and characterization of polyps.AIM To evaluate the diagnostic performance of AI-assisted colonoscopy[computer assisted diagnosis(CAD)eye function]for colorectal polyp characterization.METHODS This study used a cross-sectional design conducted at the Gastrointestinal Endoscopy Center of Dr.Cipto Mangunkusumo Hospital in January-May 2024 on adult patients with suspected colorectal polyps.RESULTS A total of 60 patients with 100 polyps were involved in this study.Based on the results of the examination,it was found that the AI CAD eye function examination had a sensitivity of 79.17%,specificity of 75.00%,positive predictive value(PPV)of 89.06%,negative predictive value(NPV)of 58.33%,and accuracy of 78.00%.In polyps with diminutive size,sensitivity was 86.27%,specificity was 60.00%,PPV was 95.65%,NPV was 30.00%,and accuracy was 83.93%.Meanwhile,in polyps with non-diminutive size,sensitivity was 61.90%,specificity was 78.26%,PPV was 72.22%,NPV was 69.23%,and accuracy was 70.45%.In polyps on the left side of the colon,sensitivity was 78.85%,specificity was 81.25%,PPV was 93.18%,NPV was 54.17%,and accuracy was 79.41%.Meanwhile,in rightsided polyps the sensitivity was 80.00%,specificity was 66.67%,PPV was 80.00%,NPV was 66.67%,and accuracy was 75.00%.In sessile polyps the sensitivity was 81.54%,specificity was 50.00%,PPV was 91.38%,NPV was 29.41%,and accuracy was 77.33%.Meanwhile,in non-sessile polyps,the sensitivity was 57.14%,specificity was 88.89%,PPV was 66.67%,NPV was 84.21%,and accuracy was 80.00%.CONCLUSION AI CAD eye function examination had a high sensitivity value in diminutive,sessile polyps and right-sided polyps and a high specificity in non-diminutive,non-sessile polyps and left-sided polyps.展开更多
OBJECTIVE:To explore the relationship between colorectal polyps and pulmonary nodules from the perspective of the lung and the large intestine being internally and externally connected,aiming to provide a theoretical ...OBJECTIVE:To explore the relationship between colorectal polyps and pulmonary nodules from the perspective of the lung and the large intestine being internally and externally connected,aiming to provide a theoretical basis for clinical diagnosis and treatment.METHODS:We retrospectively analyzed the data of patients who underwent electronic colonoscopy and were found to have colorectal polyps at the Gastrointestinal Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine,from January 1,2017,to December 31,2023.We also reviewed their lung CT results and used statistical software to analyze the recurrence,location,size,and pathology of colorectal polyps in relation to the presence,number,and size of pulmonary nodules.RESULTS:Both colorectal polyps and pulmonary nodules are more common in elderly males.Patients with recurrent colorectal polyps are more likely to have pulmonary nodules,which tend to be located in the left colon and are more likely to be adenomatous in nature;those without pulmonary nodules show no clear pattern in polyp distribution,with a tendency towards inflammatory and hyperplastic pathology;the data from this study suggests that the proportion of lung nodules larger than 0.5 cm in the recurrent group is higher than in the non-recurrent group,and the proportion of colorectal polyps larger than 1 cm in the recurrent group is also higher than in the non-recurrent group.CONCLUSION:There is a certain connection between the pathogenesis and treatment of colorectal polyps and pulmonary nodules.Cold,phlegm,dampness,blood stasis,and toxic coagulation are common pathogenic factors of the two diseases.Patients with larger colorectal polyps should be advised to undergo regular colonoscopy.Patients with recurrent polyps or those with left colon necrosis or cancer indicated by colonoscopy should be advised to complete lung related examinations to rule out the possibility of pulmonary nodules.展开更多
BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses met...BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.展开更多
BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Curren...BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.展开更多
BACKGROUND The severity of nonalcoholic fatty liver disease(NAFLD)and lipid metabolism are related to the occurrence of colorectal polyps.Liver-controlled attenuation parameters(liver-CAPs)have been established to pre...BACKGROUND The severity of nonalcoholic fatty liver disease(NAFLD)and lipid metabolism are related to the occurrence of colorectal polyps.Liver-controlled attenuation parameters(liver-CAPs)have been established to predict the prognosis of hepatic steatosis patients.AIM To explore the risk factors associated with colorectal polyps in patients with NAFLD by analyzing liver-CAPs and establishing a diagnostic model.METHODS Patients who were diagnosed with colorectal polyps in the Department of Gastroenterology of our hospital between June 2021 and April 2022 composed the case group,and those with no important abnormalities composed the control group.The area under the receiver operating characteristic curve was used to predict the diagnostic efficiency.Differences were considered statistically significant when P<0.05.RESULTS The median triglyceride(TG)and liver-CAP in the case group were significantly greater than those in the control group(mmol/L,1.74 vs 1.05;dB/m,282 vs 254,P<0.05).TG and liver-CAP were found to be independent risk factors for colorectal polyps,with ORs of 2.338(95%CI:1.154–4.733)and 1.019(95%CI:1.006–1.033),respectively(P<0.05).And there was no difference in the diagnostic efficacy between liver-CAP and TG combined with liver-CAP(TG+CAP)(P>0.05).When the liver-CAP was greater than 291 dB/m,colorectal polyps were more likely to occur.CONCLUSION The levels of TG and liver-CAP in patients with colorectal polyps are significantly greater than those patients without polyps.Liver-CAP alone can be used to diagnose NAFLD with colorectal polyps.展开更多
BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after...BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020.Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were invest-igated.Event rates for categorical variables and means for continuous variables with 95%confidence intervals were calculated,and Fisher’s exact test and Mann-Whitney test were performed.Potential risk factors of adverse outcomes were RESULTS In total,135 lesions(mean size:22.1 mm;location:42%rectal)from 129 patients(mean age:67.7 years;56%male)were enrolled.The proportion of pedunculated and non-pedunculated lesions was similar,with en bloc resection in 82%and 47%of lesions,respectively.Tumor differentiation,distance from resection margins,depth of submucosal invasion,lymphovascular invasion,and budding were reported at 89.6%,45.2%,58.5%,31.9%,and 25.2%,respectively.Residual tumor was found in 10 patients,and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection.Univariate analysis identified piecemeal resection as a risk factor for residual malignancy(odds ratio:1.74;P=0.042).At least 1 year of follow-up was available for 117 lesions from 111 patients(mean follow-up period:5.59 years).Overall,54%,30%,30%,11%,and 16%of patients presented at the 1-year,3-year,5-year,7-year,and 9-10-year surveillance examinations.Adverse outcomes occurred in 9.0%(local recurrence and dissemination in 4 patients and 9 patients,respectively),with no difference between patients undergoing secondary surgery and surveillance only.CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement.Long-term adverse outcome rates might be higher than previously reported,irrespective of whether secondary surgery was performed.展开更多
BACKGROUND Colorectal polyps are frequently observed in patients with type 2 diabetes mellitus(DM),posing a significant risk for colorectal cancer.Metformin,a widely prescribed biguanidine drug for type 2 DM,has been ...BACKGROUND Colorectal polyps are frequently observed in patients with type 2 diabetes mellitus(DM),posing a significant risk for colorectal cancer.Metformin,a widely prescribed biguanidine drug for type 2 DM,has been suggested to have potential chemoprophylactic effects against various cancers.AIM To explore the correlation between colorectal polyps and metformin use in type 2 DM patients.METHODS Type 2 DM patients were categorized into polyp and non-polyp groups.Following this,all patients were categorized into the type 2 DM-metformin,type 2 DM-non-metformin,and non-type 2 DM groups.Based on the baseline colonoscopy results,we performed pairwise comparisons of the incidence of colorectal polyps among the three groups.Additionally,we analyzed the relationship between colorectal polyps and the duration of metformin use and between the size and number of polyps and metformin use.Simultaneously,we focused on the specific pathological types of polyps and analyzed their relationship with metformin use.Finally,we compared the incidence of polyps between metformin and non-metformin groups according to the interval colonoscopy results.RESULTS The rate of metformin use in patients with colorectal polyps was 0.502 times that of patients without colorectal polyps[odds ratio(OR)=0.502,95%confidence interval(CI):0.365-0.689;P<0.001].The incidence of colorectal polyps did not differ significantly between the type 2 DM-metformin and non-type 2 DM groups(P>0.05).Furthermore,the correlations between the duration of metformin use and the incidence of colorectal polyps and between the size and number of polyps and metformin use were not statistically significant(P>0.05).Metformin use did not affect the incidence of colorectal polyps during interval colonoscopy(P>0.05).CONCLUSION Metformin use and colorectal polyp incidence in type 2 DM patients showed a negative correlation,independent of the hypoglycemic effect of metformin.展开更多
BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Poly...BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.展开更多
Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and c...Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and classification.It could also help prevent endoscopists from missing polyps and make an accurate optical diagnosis.These functions provided by AI could result in a higher adenoma detection rate and decrease the cost of polypectomy for hyperplastic polyps.In addition,AI has good performance in the staging,diagnosis,and segmentation of colorectal cancer.This article provides an overview of recent research focusing on the application of AI in colorectal polyps and cancer and highlights the advances achieved.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a...BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIM To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODS Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases,including Pub Med,Embase,Cochrane Library,CNKI,and Wanfang Data,monographs,theses,and papers presented at conferences.Statistical analyses were performed using Revman 5.3 software.RESULTS Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria.In total,1382 patients(1511 polyps)were included in the study,including 722 who received UEMR and 789 who received EMR.In the UEMR and EMR groups,the en bloc resection rates were 85.87%and 73.89%,respectively,with a relative risk(RR)value of 1.14(95%confidence interval[CI]:1.01-1.30;P<0.05).In the sub-group analysis,the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter.However,a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter.The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26%and 15.17%,respectively,with an RR value of 0.27(95%CI:0.09-0.83;P<0.05).The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25%and 14.40%,respectively,with an RR value of 0.43(95%CI:0.20-0.92;P<0.05).Additionally,the incidence of adverse events was 8.17%and 6.21%,respectively,with an RR value of 1.07(95%CI:0.50-2.30;P>0.05).CONCLUSION UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR,particularly with regard to some treatment outcomes.展开更多
BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduc...BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.展开更多
BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR...BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.展开更多
Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced e...Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced endoscopy are widely available,optical diagnosis has not been incorporated into routine clinical practice,mainly due to significant inter-operator variability.In recent years,there has been a growing number of studies demonstrating the potential of convolutional neural networks(CNN)to enhance optical diagnosis of polyps.Data suggest that the use of CNNs might mitigate the inter-operator variability amongst endoscopists,potentially enabling a“resect and discard”or“leave in”strategy to be adopted in real-time.This would have significant financial benefits for healthcare systems,avoid unnecessary polypectomies of non-neoplastic polyps and improve the efficiency of colonoscopy.Here,we review advances in CNN for the optical diagnosis of colorectal polyps,current limitations and future directions.展开更多
AIM： To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS： All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendosc...AIM： To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS： All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS： A total of 240 lesions were identified, of which 158 （65.8%） were non-neoplastic and 82 （34.2%） were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% （183/240） and 95.4% （229/240）, respectively （P〈 0.001） CONCLUSION： The combination of colonoscopy and magnified chromoendoscopy is the most reliable nonbiopsy method for distinguishing the non-neoplastic from the neoplastic lesions.展开更多
AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonosc...AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonoscopy were examined. Tissues were investigated histologically and ultrastructurally. GST-pi expression was also analysed immunohistochemically, using peroxidase anti-peroxidase (PAP) method and immunogold labelling method, for light and electron microscope respectively. RESULTS: All polyp tissues examined were adenoma of low, mild and high-grade dysplasia as shown in the histopathological reports. Nevertheless, the examination of the above specimens with electron microscope revealed that 3 of 9 adenoma of mild dysplasia had ultrastuctural features similar to high-grade dysplasia adenoma. GST-pi was variably expressed in adenoma, with the lowest relative levels occurring in low-gradeadenoma and the highest levels found in high-grade adenoma. GST-pi was located mainly in undifferentiated epithelial cells. GST-pi positive particles were found in the cytoplasm and especially in the nucleus adjacent to the nuclear membrane of these cells. CONCLUSION:The overexpression of GST-pi in mildgrade adenomas with significant subcellular changes and in the majority of high-grade dysplasia adenoma suggests that this might be related to the carcinogenetic proceeding. Immunohistochemical localization of GST-pi in combination with ultrastructural changes indicate that GST-pi might be a sensitive agent for the detection of preneoplastic transformations in adenoma.展开更多
We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified ...We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.展开更多
文摘This editorial,inspired by a recent study published in the World Journal of Gastrointestinal Oncology,covers the research findings on microbiota changes in various diseases.In recurrent colorectal polyps,the abundances of Klebsiella,Parvimonas,and Clostridium increase,while those of Bifidobacterium and Lactoba-cillus decrease.This dysbiosis may promote the formation and recurrence of polyps.Similar microbial changes have also been observed in colorectal cancer,inflammatory bowel disease,autism spectrum disorder,and metabolic syndrome,indicating the role of increased pathogens and decreased probiotics in these conditions.Regulating the gut microbiota,particularly by increasing probiotic levels,may help prevent polyp recurrence and promote gut health.This microbial intervention strategy holds promise as an adjunctive treatment for patients with colorectal polyps.
文摘BACKGROUND Colorectal polyps(CPs)are important precursor lesions of colorectal cancer,and endoscopic surgery remains the primary treatment option.However,the shortterm recurrence rate post-surgery is high,and the risk factors for recurrence remain unknown.AIM To comprehensively explore risk factors for short-term recurrence of CPs after endoscopic surgery and develop a nomogram prediction model.METHODS Overall,362 patients who underwent endoscopic polypectomy between January 2022 and January 2024 at Nanjing Jiangbei Hospital were included.We screened basic demographic data,clinical and polyp characteristics,surgery-related information,and independent risk factors for CPs recurrence using univariate and multivariate logistic regression analyses.The multivariate analysis results were used to construct a nomogram prediction model,internally validated using Bootstrapping,with performance evaluated using area under the curve(AUC),calibration curve,and decision curve analysis.RESULTS CP re-occurred in 166(45.86%)of the 362 patients within 1 year post-surgery.Multivariate logistic regression analysis showed that age(OR=1.04,P=0.002),alcohol consumption(OR=2.07,P=0.012),Helicobacter pylori infection(OR=2.34,P<0.001),polyp number>2(OR=1.98,P=0.005),sessile polyps(OR=2.10,P=0.006),and adenomatous pathological type(OR=3.02,P<0.001)were independent risk factors for post-surgery recurrence.The nomogram prediction model showed good discriminatory(AUC=0.73)and calibrating power,and decision curve analysis showed that the model had good clinical benefit at risk probabilities>20%.CONCLUSION We identified multiple independent risk factors for short-term recurrence after endoscopic surgery.The nomogram prediction model showed a certain degree of differentiation,calibration,and potential clinical applicability.
文摘Colorectal polyps remain a significant health concern because they can develop into cancer.Therefore,accurate assessment and diagnosis of polyps,along with appropriate treatment decisions,are crucial in preventing complications or malignant transformation.Some polyps are classified as complex polyps,which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score,which considers factors like site,morphology,size,and access.Management of complex colorectal polyps involves various options,including endoscopic and surgical approaches.Endoscopic mucosal resection(EMR)may be challenging in scarred polyps,as inadequate lifting can result in incomplete resection or recurrence.As a more advanced alternative,endoscopic submucosal dissection(ESD)is suitable for larger lesions,enabling en-bloc resection even in complex cases with EMR.However,ESD requires expertise and is more time-consuming than EMR,often necessitating hospitalization due to its complexity.Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps.Endoscopic powered resection,either alone or in combination with other modalities,can also be used to achieve less extensive resection.Managing complications during the procedure or post-procedurally is equally important,as bleeding or perforations can be fatal.Careful patient selection based on individual profiles and risk factors,along with the identification of any signs of malignancy,is crucial before treatment to avoid negative post-treatment outcomes.
文摘BACKGROUNDColorectal cancer(CRC)typically progresses from benign colorectal polyps,whichrepresent a precursor to malignancy.Identifying the factors influencing thisprogression is crucial for early intervention and prevention.Although genetic andenvironmental factors have been widely studied,the role of lifestyle factors suchas physical activity,diet,smoking,sleep,and stress remains underexplored,especially in patients with early stage CRC or polyps.Recent evidence suggeststhat lifestyle behaviors may influence cancer progression by modulating inflammatorypathways,metabolic health,and immune function.For instance,highlevels of physical activity are linked to a reduced risk of CRC development,whereas poor dietary habits,smoking,and inadequate sleep have all beenimplicated in increased cancer risk and progression.Moreover,early-stage CRCpatients,who are often asymptomatic or have minimal symptoms,may particularlybenefit from lifestyle modifications to slow disease progression andimprove overall prognosis.The gap in understanding the specific influence ofthese lifestyle factors on colorectal polyps and early stage cancer progressionunderscores the need for comprehensive studies.By assessing several modifiablelifestyle factors and their association with disease progression,clinicians canidentify practical intervention points.These interventions could ultimately reducethe need for more aggressive treatments and improve the long-term outcomes inaffected patients.AIMTo investigate the association between lifestyle factors and disease progression inpatients with colorectal polyps and early stage cancer.METHODSIn this observational study conducted from January 2022 to December 2023,werecruited 120 patients with colorectal polyps or early stage cancer from Jiangshan People's Hospital.Lifestyle factors,including physical activity,dietary patterns,smoking status,sleep quality,andstress levels,were assessed using validated questionnaires.Disease progression was evaluated using standardizedfollow-up colonoscopies and pathological examinations.Cox proportional hazards models were used to analyzethe association between lifestyle factors and disease progression after adjusting for potential confounders.RESULTSDuring the median follow-up of 18.4 months,42(35.0%)patients experienced disease progression.High levels ofphysical activity were associated with reduced progression risk[adjusted hazard ratio(HR)0.55,95%confidenceinterval(CI):0.38-0.80,P=0.002]compared to low activity levels.High adherence to a healthy dietary patternshowed similar protective effects(adjusted HR 0.62,95%CI:0.43-0.89,P=0.009).Current smoking(adjusted HR1.92,95%CI:1.35-2.73,P<0.001)and poor sleep quality(adjusted HR 1.38,95%CI:1.05-1.82,P=0.021)wereassociated with increased progression risk.The impact of lifestyle factors was particularly pronounced in patientsyounger than 60 years and those with multiple polyps at baseline.CONCLUSIONThis study demonstrated significant associations between lifestyle factors and disease progression in colorectalpolyps and early stage cancer.Physical activity,dietary patterns,smoking status,and sleep quality have emergedas key modifiable factors influencing disease progression.These findings support the integration of lifestyleassessments and modifications in the clinical management of patients with colorectal neoplasia.
文摘BACKGROUND The gold standard for colorectal polyp screening is currently colonoscopy,but the miss rate is still high and the adenoma detection rate and polyp detection rate are still low.The risk factors include the patient,operators,and the tools used.The use of artificial intelligence(AI)in colonoscopy has gained popularity by assisting endoscopists in the detection and characterization of polyps.AIM To evaluate the diagnostic performance of AI-assisted colonoscopy[computer assisted diagnosis(CAD)eye function]for colorectal polyp characterization.METHODS This study used a cross-sectional design conducted at the Gastrointestinal Endoscopy Center of Dr.Cipto Mangunkusumo Hospital in January-May 2024 on adult patients with suspected colorectal polyps.RESULTS A total of 60 patients with 100 polyps were involved in this study.Based on the results of the examination,it was found that the AI CAD eye function examination had a sensitivity of 79.17%,specificity of 75.00%,positive predictive value(PPV)of 89.06%,negative predictive value(NPV)of 58.33%,and accuracy of 78.00%.In polyps with diminutive size,sensitivity was 86.27%,specificity was 60.00%,PPV was 95.65%,NPV was 30.00%,and accuracy was 83.93%.Meanwhile,in polyps with non-diminutive size,sensitivity was 61.90%,specificity was 78.26%,PPV was 72.22%,NPV was 69.23%,and accuracy was 70.45%.In polyps on the left side of the colon,sensitivity was 78.85%,specificity was 81.25%,PPV was 93.18%,NPV was 54.17%,and accuracy was 79.41%.Meanwhile,in rightsided polyps the sensitivity was 80.00%,specificity was 66.67%,PPV was 80.00%,NPV was 66.67%,and accuracy was 75.00%.In sessile polyps the sensitivity was 81.54%,specificity was 50.00%,PPV was 91.38%,NPV was 29.41%,and accuracy was 77.33%.Meanwhile,in non-sessile polyps,the sensitivity was 57.14%,specificity was 88.89%,PPV was 66.67%,NPV was 84.21%,and accuracy was 80.00%.CONCLUSION AI CAD eye function examination had a high sensitivity value in diminutive,sessile polyps and right-sided polyps and a high specificity in non-diminutive,non-sessile polyps and left-sided polyps.
基金Beijing Natural Science Foundation:Research on the Mechanism of Chaiqi Decoction in Improving Vascular Endothelial Injury in Metabolic Syndrome by Regulating Pyroptosis via miR-21(No.7212181)。
文摘OBJECTIVE:To explore the relationship between colorectal polyps and pulmonary nodules from the perspective of the lung and the large intestine being internally and externally connected,aiming to provide a theoretical basis for clinical diagnosis and treatment.METHODS:We retrospectively analyzed the data of patients who underwent electronic colonoscopy and were found to have colorectal polyps at the Gastrointestinal Endoscopy Center of Dongfang Hospital,Beijing University of Chinese Medicine,from January 1,2017,to December 31,2023.We also reviewed their lung CT results and used statistical software to analyze the recurrence,location,size,and pathology of colorectal polyps in relation to the presence,number,and size of pulmonary nodules.RESULTS:Both colorectal polyps and pulmonary nodules are more common in elderly males.Patients with recurrent colorectal polyps are more likely to have pulmonary nodules,which tend to be located in the left colon and are more likely to be adenomatous in nature;those without pulmonary nodules show no clear pattern in polyp distribution,with a tendency towards inflammatory and hyperplastic pathology;the data from this study suggests that the proportion of lung nodules larger than 0.5 cm in the recurrent group is higher than in the non-recurrent group,and the proportion of colorectal polyps larger than 1 cm in the recurrent group is also higher than in the non-recurrent group.CONCLUSION:There is a certain connection between the pathogenesis and treatment of colorectal polyps and pulmonary nodules.Cold,phlegm,dampness,blood stasis,and toxic coagulation are common pathogenic factors of the two diseases.Patients with larger colorectal polyps should be advised to undergo regular colonoscopy.Patients with recurrent polyps or those with left colon necrosis or cancer indicated by colonoscopy should be advised to complete lung related examinations to rule out the possibility of pulmonary nodules.
基金Supported by Suzhou Municipal Science and Technology Program of China,No.SKJY2021012.
文摘BACKGROUND Colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.
基金the Science and Research Office of Shandong First Medical University Affiliated Provincial Hospital(approved number SWYX:No.2024-294).
文摘BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.
基金Supported by the Special Research Project of the Capital’s Health Development,No.2024-3-7037and the Beijing Clinical Key Specialty Project.
文摘BACKGROUND The severity of nonalcoholic fatty liver disease(NAFLD)and lipid metabolism are related to the occurrence of colorectal polyps.Liver-controlled attenuation parameters(liver-CAPs)have been established to predict the prognosis of hepatic steatosis patients.AIM To explore the risk factors associated with colorectal polyps in patients with NAFLD by analyzing liver-CAPs and establishing a diagnostic model.METHODS Patients who were diagnosed with colorectal polyps in the Department of Gastroenterology of our hospital between June 2021 and April 2022 composed the case group,and those with no important abnormalities composed the control group.The area under the receiver operating characteristic curve was used to predict the diagnostic efficiency.Differences were considered statistically significant when P<0.05.RESULTS The median triglyceride(TG)and liver-CAP in the case group were significantly greater than those in the control group(mmol/L,1.74 vs 1.05;dB/m,282 vs 254,P<0.05).TG and liver-CAP were found to be independent risk factors for colorectal polyps,with ORs of 2.338(95%CI:1.154–4.733)and 1.019(95%CI:1.006–1.033),respectively(P<0.05).And there was no difference in the diagnostic efficacy between liver-CAP and TG combined with liver-CAP(TG+CAP)(P>0.05).When the liver-CAP was greater than 291 dB/m,colorectal polyps were more likely to occur.CONCLUSION The levels of TG and liver-CAP in patients with colorectal polyps are significantly greater than those patients without polyps.Liver-CAP alone can be used to diagnose NAFLD with colorectal polyps.
基金Supported by the New National Excellence Program of the Ministry for Innovation and Technology From the Source of the National Research,Development and Innovation Fund,No.ÚNKP-22-4-SZTE-296,No.ÚNKP-23-3-SZTE-268,and No.ÚNKP-23-5-SZTE-719the EU’s Horizon 2020 Research and Innovation Program under Grant Agreement,No.739593.
文摘BACKGROUND Choosing an optimal post-polypectomy management strategy of malignant colorectal polyps is challenging,and evidence regarding a surveillance-only strategy is limited.AIM To evaluate long-term outcomes after endoscopic removal of malignant colorectal polyps.METHODS A single-center retrospective cohort study was conducted to evaluate outcomes after endoscopic removal of malignant colorectal polyps between 2010 and 2020.Residual disease rate and nodal metastases after secondary surgery and local and distant recurrence rate for those with at least 1 year of follow-up were invest-igated.Event rates for categorical variables and means for continuous variables with 95%confidence intervals were calculated,and Fisher’s exact test and Mann-Whitney test were performed.Potential risk factors of adverse outcomes were RESULTS In total,135 lesions(mean size:22.1 mm;location:42%rectal)from 129 patients(mean age:67.7 years;56%male)were enrolled.The proportion of pedunculated and non-pedunculated lesions was similar,with en bloc resection in 82%and 47%of lesions,respectively.Tumor differentiation,distance from resection margins,depth of submucosal invasion,lymphovascular invasion,and budding were reported at 89.6%,45.2%,58.5%,31.9%,and 25.2%,respectively.Residual tumor was found in 10 patients,and nodal metastasis was found in 4 of 41 patients who underwent secondary surgical resection.Univariate analysis identified piecemeal resection as a risk factor for residual malignancy(odds ratio:1.74;P=0.042).At least 1 year of follow-up was available for 117 lesions from 111 patients(mean follow-up period:5.59 years).Overall,54%,30%,30%,11%,and 16%of patients presented at the 1-year,3-year,5-year,7-year,and 9-10-year surveillance examinations.Adverse outcomes occurred in 9.0%(local recurrence and dissemination in 4 patients and 9 patients,respectively),with no difference between patients undergoing secondary surgery and surveillance only.CONCLUSION Reporting of histological features and adherence to surveillance colonoscopy needs improvement.Long-term adverse outcome rates might be higher than previously reported,irrespective of whether secondary surgery was performed.
基金The International Institute of Population Health,Peking University Health Science Center,No.JKCJ202102The National Key Clinical Specialty Construction Projects,No.2199000764。
文摘BACKGROUND Colorectal polyps are frequently observed in patients with type 2 diabetes mellitus(DM),posing a significant risk for colorectal cancer.Metformin,a widely prescribed biguanidine drug for type 2 DM,has been suggested to have potential chemoprophylactic effects against various cancers.AIM To explore the correlation between colorectal polyps and metformin use in type 2 DM patients.METHODS Type 2 DM patients were categorized into polyp and non-polyp groups.Following this,all patients were categorized into the type 2 DM-metformin,type 2 DM-non-metformin,and non-type 2 DM groups.Based on the baseline colonoscopy results,we performed pairwise comparisons of the incidence of colorectal polyps among the three groups.Additionally,we analyzed the relationship between colorectal polyps and the duration of metformin use and between the size and number of polyps and metformin use.Simultaneously,we focused on the specific pathological types of polyps and analyzed their relationship with metformin use.Finally,we compared the incidence of polyps between metformin and non-metformin groups according to the interval colonoscopy results.RESULTS The rate of metformin use in patients with colorectal polyps was 0.502 times that of patients without colorectal polyps[odds ratio(OR)=0.502,95%confidence interval(CI):0.365-0.689;P<0.001].The incidence of colorectal polyps did not differ significantly between the type 2 DM-metformin and non-type 2 DM groups(P>0.05).Furthermore,the correlations between the duration of metformin use and the incidence of colorectal polyps and between the size and number of polyps and metformin use were not statistically significant(P>0.05).Metformin use did not affect the incidence of colorectal polyps during interval colonoscopy(P>0.05).CONCLUSION Metformin use and colorectal polyp incidence in type 2 DM patients showed a negative correlation,independent of the hypoglycemic effect of metformin.
文摘BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.
文摘Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and classification.It could also help prevent endoscopists from missing polyps and make an accurate optical diagnosis.These functions provided by AI could result in a higher adenoma detection rate and decrease the cost of polypectomy for hyperplastic polyps.In addition,AI has good performance in the staging,diagnosis,and segmentation of colorectal cancer.This article provides an overview of recent research focusing on the application of AI in colorectal polyps and cancer and highlights the advances achieved.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection(EMR);however,it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIM To evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODS Clinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases,including Pub Med,Embase,Cochrane Library,CNKI,and Wanfang Data,monographs,theses,and papers presented at conferences.Statistical analyses were performed using Revman 5.3 software.RESULTS Seven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria.In total,1382 patients(1511 polyps)were included in the study,including 722 who received UEMR and 789 who received EMR.In the UEMR and EMR groups,the en bloc resection rates were 85.87%and 73.89%,respectively,with a relative risk(RR)value of 1.14(95%confidence interval[CI]:1.01-1.30;P<0.05).In the sub-group analysis,the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter.However,a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter.The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26%and 15.17%,respectively,with an RR value of 0.27(95%CI:0.09-0.83;P<0.05).The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25%and 14.40%,respectively,with an RR value of 0.43(95%CI:0.20-0.92;P<0.05).Additionally,the incidence of adverse events was 8.17%and 6.21%,respectively,with an RR value of 1.07(95%CI:0.50-2.30;P>0.05).CONCLUSION UEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR,particularly with regard to some treatment outcomes.
文摘BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.
基金the Institutional Review Board of First Affiliated Hospital,School of Medicine,Zhejiang University(No.20191477)Ningbo First Hospital,Zhejiang(No.2020-R013)and other participating institutions.
文摘BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;P<0.001).No significant difference was found in the proportion of patients with adverse events(EMR-P:9.1%;CEMR:6.4%;P=0.449).CONCLUSION In this study,EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasing adverse events.However,EMR-P required a relatively longer procedure time than CEMR.Considering its potential benefits for en bloc and R0 resection,EMR-P may be a promising technique in colorectal polyp resection.
文摘Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced endoscopy are widely available,optical diagnosis has not been incorporated into routine clinical practice,mainly due to significant inter-operator variability.In recent years,there has been a growing number of studies demonstrating the potential of convolutional neural networks(CNN)to enhance optical diagnosis of polyps.Data suggest that the use of CNNs might mitigate the inter-operator variability amongst endoscopists,potentially enabling a“resect and discard”or“leave in”strategy to be adopted in real-time.This would have significant financial benefits for healthcare systems,avoid unnecessary polypectomies of non-neoplastic polyps and improve the efficiency of colonoscopy.Here,we review advances in CNN for the optical diagnosis of colorectal polyps,current limitations and future directions.
文摘AIM： To accurately differentiate the adenomatous from the non-adenomatous polyps by colonoscopy. METHODS： All lesions detected by colonoscopy were first diagnosed using the conventional view followed by chromoendoscopy with magnification. The diagnosis at each step was recorded consecutively. All polyps were completely removed endoscopically for histological evaluation. The accuracy rate of each type of endoscopic diagnosis was evaluated, using histological findings as gold standard. RESULTS： A total of 240 lesions were identified, of which 158 （65.8%） were non-neoplastic and 82 （34.2%） were adenomatous. The overall diagnostic accuracy of conventional view, and chromoendoscopy with magnification was 76.3% （183/240） and 95.4% （229/240）, respectively （P〈 0.001） CONCLUSION： The combination of colonoscopy and magnified chromoendoscopy is the most reliable nonbiopsy method for distinguishing the non-neoplastic from the neoplastic lesions.
文摘AIM:To investigate the distribution of the placental form of glutathione-S-transferase (GST) in colon polyps in order to evaluate the role of GST-pi in these tissues. METHODS: Sixteen polyp tissues removed at colonoscopy were examined. Tissues were investigated histologically and ultrastructurally. GST-pi expression was also analysed immunohistochemically, using peroxidase anti-peroxidase (PAP) method and immunogold labelling method, for light and electron microscope respectively. RESULTS: All polyp tissues examined were adenoma of low, mild and high-grade dysplasia as shown in the histopathological reports. Nevertheless, the examination of the above specimens with electron microscope revealed that 3 of 9 adenoma of mild dysplasia had ultrastuctural features similar to high-grade dysplasia adenoma. GST-pi was variably expressed in adenoma, with the lowest relative levels occurring in low-gradeadenoma and the highest levels found in high-grade adenoma. GST-pi was located mainly in undifferentiated epithelial cells. GST-pi positive particles were found in the cytoplasm and especially in the nucleus adjacent to the nuclear membrane of these cells. CONCLUSION:The overexpression of GST-pi in mildgrade adenomas with significant subcellular changes and in the majority of high-grade dysplasia adenoma suggests that this might be related to the carcinogenetic proceeding. Immunohistochemical localization of GST-pi in combination with ultrastructural changes indicate that GST-pi might be a sensitive agent for the detection of preneoplastic transformations in adenoma.
文摘We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.
