In recent years,the number of patientswith colon disease has increased significantly.Colon polyps are the precursor lesions of colon cancer.If not diagnosed in time,they can easily develop into colon cancer,posing a s...In recent years,the number of patientswith colon disease has increased significantly.Colon polyps are the precursor lesions of colon cancer.If not diagnosed in time,they can easily develop into colon cancer,posing a serious threat to patients’lives and health.A colonoscopy is an important means of detecting colon polyps.However,in polyp imaging,due to the large differences and diverse types of polyps in size,shape,color,etc.,traditional detection methods face the problem of high false positive rates,which creates problems for doctors during the diagnosis process.In order to improve the accuracy and efficiency of colon polyp detection,this question proposes a network model suitable for colon polyp detection(PD-YOLO).This method introduces the self-attention mechanism CBAM(Convolutional Block Attention Module)in the backbone layer based on YOLOv7,allowing themodel to adaptively focus on key information and ignore the unimportant parts.To help themodel do a better job of polyp localization and bounding box regression,add the SPD-Conv(Symmetric Positive Definite Convolution)module to the neck layer and use deconvolution instead of upsampling.Theexperimental results indicate that the PD-YOLO algorithm demonstrates strong robustness in colon polyp detection.Compared to the original YOLOv7,on the Kvasir-SEG dataset,PD-YOLO has shown an increase of 5.44 percentage points in AP@0.5,showcasing significant advantages over other mainstream methods.展开更多
Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies shoul...Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies should be the endoscopist’s readily available“weapons”to defeat the potentially malignant“enemies”.This article sheds light on the valuable effort by Costa et al to generate a new classification system of gastric polyps as“good”,“bad”,and“ugly”.This comprehensive overview provides clinicians with a simplified decision-making process.展开更多
With the widespread use of upper gastrointestinal endoscopy,more and more gastric polyps(GPs)are being detected.Traditional management strategies often rely on histopathologic examination,which can be time-consuming a...With the widespread use of upper gastrointestinal endoscopy,more and more gastric polyps(GPs)are being detected.Traditional management strategies often rely on histopathologic examination,which can be time-consuming and may not guide immediate clinical decisions.This paper aims to introduce a novel classification system for GPs based on their potential risk of malignant transformation,categorizing them as"good","bad",and"ugly".A review of the literature and clinical case analysis were conducted to explore the clinical implications,management strategies,and the system's application in endoscopic practice.Good polyps,mainly including fundic gland polyps and inflammatory fibrous polyps,have a low risk of malignancy and typically require minimal or no intervention.Bad polyps,mainly including hyperplastic polyps and adenomas,pose an intermediate risk of malignancy,necessitating closer monitoring or removal.Ugly polyps,mainly including type 3 neuroendocrine tumors and early gastric cancer,indicate a high potential for malignancy and require urgent and comprehensive treatment.The new classification system provides a simplified and practical framework for diagnosing and managing GPs,improving diagnostic accuracy,guiding individualized treatment,and promoting advancements in endoscopic techniques.Despite some challenges,such as the risk of misclassification due to similar endoscopic appearances,this system is essential for the standardized management of GPs.It also lays the foundation for future research into biomarkers and the development of personalized medicine.展开更多
BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer.Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer.Endoscopic mucosal resection(EMR...BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer.Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer.Endoscopic mucosal resection(EMR)is a common polypectomy proce-dure in clinical practice,but it has a high postoperative recurrence rate.Currently,there is no predictive model for the recurrence of colorectal polyps after EMR.AIM To construct and validate a machine learning(ML)model for predicting the risk of colorectal polyp recurrence one year after EMR.METHODS This study retrospectively collected data from 1694 patients at three medical centers in Xuzhou.Additionally,a total of 166 patients were collected to form a prospective validation set.Feature variable screening was conducted using uni-variate and multivariate logistic regression analyses,and five ML algorithms were used to construct the predictive models.The optimal models were evaluated based on different performance metrics.Decision curve analysis(DCA)and SHapley Additive exPlanation(SHAP)analysis were performed to assess clinical applicability and predictor importance.RESULTS Multivariate logistic regression analysis identified 8 independent risk factors for colorectal polyp recurrence one year after EMR(P<0.05).Among the models,eXtreme Gradient Boosting(XGBoost)demonstrated the highest area under the curve(AUC)in the training set,internal validation set,and prospective validation set,with AUCs of 0.909(95%CI:0.89-0.92),0.921(95%CI:0.90-0.94),and 0.963(95%CI:0.94-0.99),respectively.DCA indicated favorable clinical utility for the XGBoost model.SHAP analysis identified smoking history,family history,and age as the top three most important predictors in the model.CONCLUSION The XGBoost model has the best predictive performance and can assist clinicians in providing individualized colonoscopy follow-up recommendations.展开更多
BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double c...BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.展开更多
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 The incidence of gastric polyps(GPs)has ranged from 0.30%to 6.8%in various studies.Most GPs include hyperplastic polyps(HPs),fundic gland polyps(FGPs),and adenomatous polyps(APs).Although APs have a high ma...BACKGROUND The incidence of gastric polyps(GPs)has ranged from 0.30%to 6.8%in various studies.Most GPs include hyperplastic polyps(HPs),fundic gland polyps(FGPs),and adenomatous polyps(APs).Although APs have a high malignant potential,HPs have a low risk of potential harm,whereas sporadic FGPs have no malignant potential.It is not enough to determine the type and displacement of a polyp by biopsy alone;therefore,some polyps may require an extensive biopsy or complete resection.AIM To evaluate the detection rate and pathological features of polyps in patients undergoing upper gastrointestinal endoscopy.METHODS This retrospective study included patients with GPs or polyphenic lesions with polyps or malignant histology found in polyps or by gastroscopy at the Department of Gastroenterology at the Shaanxi Provincial Hospital of Traditional Chinese Medicine from 2019 to 2023.RESULTS In a series of 10000 patients who underwent upper gastrointestinal endoscopy,384(3.84%)had GPs.There were 98 males(25.5%)and 286 females(74.5%).The mean age of patients was 62.8±10.4(36-75)years.The frequencies of HPs,APs,and FGPs were 88.5%,5.2%,and 2.1%,respectively.The polyp size of 274 patients(71.3%)was≤1 cm.Polyps were found in 262 cases(68.2%).The most common sites for polyps were the lumen and body of the intestine.Endoscopic polypectomy was performed in 128 patients.Bleeding events were observed and endoscopic treatment was required after endoscopic polypectomy.CONCLUSION The incidence of GPs was low.HPs were the most common types of GPs.Of note,as GPs have the potential to develop into adenocarcinoma or precancerous lesions,we suggest that appropriate GP resection technology(e.g.,biopsy forceps or mesenchymal resection)be applied.展开更多
In pediatric patients,gallbladder polyps(GBPs)are lesions that are usually found incidentally on ultrasonography,which is the first-line modality for diagnosis.Though common in adults,GBPs are rare in children,and the...In pediatric patients,gallbladder polyps(GBPs)are lesions that are usually found incidentally on ultrasonography,which is the first-line modality for diagnosis.Though common in adults,GBPs are rare in children,and their prevalence remains unclear.Most GBPs in children are benign,and although the risk of malignancy is influenced by polyp size,growth rate,and morphology,specific criteria for the pediatric population are lacking.Management,therefore,is based on adult guidelines,with cholecystectomy being recommended only in symptomatic patients and for rapidly enlarging or 10-mm polyps and those with unfavorable morphology to avert the risk of malignant transformation,while surveillance is applied to asymptomatic patients with smaller polyps.Further research is needed to develop pediatric-specific guidelines for the management of GBPs.This review discusses the classification,diagnosis,risk factors,and management of pediatric GBPs.展开更多
The polyp dataset involves the confidentiality of medical records, so it might be difficult to obtain datasets with accurate annotations. This problem can be effectively solved by expanding the polyp data set with alg...The polyp dataset involves the confidentiality of medical records, so it might be difficult to obtain datasets with accurate annotations. This problem can be effectively solved by expanding the polyp data set with algorithms. The traditional polyp dataset expansion scheme usually requires the use of two models or traditional visual methods. These methods are both tedious and difficult to provide new polyp features for training data. Therefore, our research aims to efficiently generate high-quality polyp samples, so as to effectively expand the polyp dataset. In this study, we first added the attention mechanism to the generation model and improved the loss function to reduce the interference caused by reflection in the image generation process. Meanwhile, we used the improved generation model to remove polyps from the original image. In addition, we used masks of different shapes generated by random combinations to generate polyps with more characteristic information. The same generation model was used for the removal and generation of polyps. The generated polyp image has its own annotation, which is conducive to us directly using the expanded data set for training. Finally, we verified the effectiveness of the improved model and the dataset expansion scheme through a series of comparative experiments on the public dataset. The results showed that using the dataset we generate for training can significantly optimize the main performance indicators.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
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
Minimally invasive endoscopic resection techniques are the recommended firstline treatment strategy for the majority of large non-pedunculated colorectal polyps,with endoscopic mucosal resection(EMR)as a predominant r...Minimally invasive endoscopic resection techniques are the recommended firstline treatment strategy for the majority of large non-pedunculated colorectal polyps,with endoscopic mucosal resection(EMR)as a predominant resection modality due to its efficacy,efficiency,safety,and cost-effectiveness.A limitation of EMR is recurrence,which has historically occurred in 15%-20%of lesions.In the past 10 years,a number of effective mitigating strategies have been developed,including margin thermal ablation using snare-tip soft coagulation,argon plasma coagulation(APC),and hybrid-APC,alongside margin marking pre-resection.Moreover,techniques for effective recurrence management have also been developed.Herein,we appraise existing evidence on the frequency of recurrence,reasonings behind recurrence formation,as well as recurrence mitigating strategies and the effectiveness of recurrence management.展开更多
Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rel...Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.展开更多
Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data dat...Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.展开更多
Colorectal cancer is the most common cancer with a second mortality rate.Polyp lesion is a precursor symptom of colorectal cancer.Detection and removal of polyps can effectively reduce the mortality of patients in the...Colorectal cancer is the most common cancer with a second mortality rate.Polyp lesion is a precursor symptom of colorectal cancer.Detection and removal of polyps can effectively reduce the mortality of patients in the early period.However,mass images will be generated during an endoscopy,which will greatly increase the workload of doctors,and long-term mechanical screening of endoscopy images will also lead to a high misdiagnosis rate.Aiming at the problem that computer-aided diagnosis models deeply depend on the computational power in the polyp detection task,we propose a lightweight model,coordinate attention-YOLOv5-Lite-Prune,based on the YOLOv5 algorithm,which is different from state-of-the-art methods proposed by the existing research that applied object detection models or their variants directly to prediction task without any lightweight processing,such as faster region-based convolutional neural networks,YOLOv3,YOLOv4,and single shot multibox detector.The innovations of our model are as follows:First,the lightweight EfficientNetLite network is introduced as the new feature extraction network.Second,the depthwise separable convolution and its improved modules with different attention mechanisms are used to replace the standard convolution in the detection head structure.Then,theα-intersection over union loss function is applied to improve the precision and convergence speed of the model.Finally,the model size is compressed with a pruning algorithm.Our model effectively reduces parameter amount and computational complexity without significant accuracy loss.Therefore,the model can be successfully deployed on the embedded deep learning platform,and detect polyps with a speed above 30 frames per second,which means the model gets rid of the limitation that deep learning models must rely on high-performance servers.展开更多
Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine...Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine.Colorectal polyps are potential predictors of CRC,and therefore represent one of the leading targets for screening colonoscopy.The difficulty of analyzing the information obtained during colonoscopy,including the size,location,shape,type of polyps,the need to standardize morphological data,determines that recently a number of works have promoted the opinion on the advisability of using various artificial intelligence(AI)methods to improve the effectiveness of endoscopic screening for CRC.At the same time,they point to a number of errors and methodological problems in the use of AI systems for the diagnosis of colorectal polyps.In this regard,the interpretation of the work of Shi et al,devoted to the use of a machine learning-based predictive model for monitoring the results of colorectal polypectomy,is undoubtedly interesting.In our opinion,the prospects for using AI to assess endoscopic screening for CRC look certainly positive,but the road to its widespread use will not be easy.展开更多
OBJECTIVE:To investigate the therapeutic effects of Chinese medicine Weifuchun(WFC,胃复春)on gastric fundic gland polyps(FGPs).METHODS:FGPs organoids were constructed with patients-derived samples.The morphology and s...OBJECTIVE:To investigate the therapeutic effects of Chinese medicine Weifuchun(WFC,胃复春)on gastric fundic gland polyps(FGPs).METHODS:FGPs organoids were constructed with patients-derived samples.The morphology and size of FGPs organoids were detected using bright-field imaging.Effective components and corresponding potential targets of WFC were screened using multiple opensource databases and research on Traditional Chinese Medicine or compound formulas.Core genes were identified through protein-protein interaction networks.Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene Ontology(GO)enrichment analyses of the core genes were conducted.The interactions between main components and core targets were analyzed through the Ferr Db database.The expressions of core targets were detected by quantitative real-time polymerase chain reaction(q RT-PCR).RESULTS:After WFC treatment,the number and size of FGPs organoids were significantly reduced.Twenty nine active drug components and 162 candidate targets of WFC for treating FGPs were identified,including 37 targets related to ferroptosis.Quercetin,Glaucocalyxin B,Melissoidesin U,Melissoidesin O,Hesperetin,Glaucocalyxin A,Angustifolin,Melissoidesin M,Di-n-octyl phthalate,and beta-sitosterol were identified as the main active compounds.SRC proto-oncogene,non-receptor tyrosine kinase,signal transducer and activator of transcription 3,phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha,phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit beta,phosphoinositide-3-kinase regulatory subunit 1,and AKT serine/threonine kinase 1 were identified as the primary targets.KEGG pathways related to carcinogenesis,cell proliferation and metabolism,and oxidative stress.WFC promoted FGPs organoids'death and could be reversed by ferroptosis inhibitor of Erastin.The q RT-PCR results showed that WFC treatment could regulate the m RNA expression levels of solute carrier family 7 member 11,acyl-Co A synthetase long chain family member 4,and arachidonate 15-lipoxygenase,type B.CONCLUSION:WFC may exert its therapeutic effects by inducing ferroptosis in FGPs cells.展开更多
BACKGROUND Muco-submucosal elongated polyps(MSEPs)are rare benign gastrointestinal lesions,typically reported in the colon and seldom observed in the small intestine.These polyps are generally slow-growing and asympto...BACKGROUND Muco-submucosal elongated polyps(MSEPs)are rare benign gastrointestinal lesions,typically reported in the colon and seldom observed in the small intestine.These polyps are generally slow-growing and asymptomatic,making diagnosis and management challenging.Rapid enlargement of MSEPs in the duodenum is particularly rare and may raise suspicion for neoplastic potential.CASE SUMMARY We report the case of a 64-year-old female who presented with nausea and abdominal pain.Abdominal computed tomography revealed a soft tissue density in the descending duodenum.Upper endoscopy performed 15 months earlier had identified a 1.5-cm mucosal elevation in the second portion of the duodenum.On follow-up endoscopy,the lesion had enlarged significantly into a 10-cm elongated,pedunculated polyp.Endoscopic submucosal dissection was performed for complete en bloc resection.Histopathology confirmed the diagnosis of a MSEP,with no evidence of malignancy.Surveillance endoscopy performed one year after resection showed no recurrence.CONCLUSION Although MSEPs are typically benign,our case demonstrates that rapid growth may occur.This highlights the importance of continued endoscopic surveillance and early intervention,even in asymptomatic patients,to prevent potential complications and ensure timely diagnosis.展开更多
Objectives:Colorectal adenomatous polyps frequently recur after removal and are precursors to colorectal cancer,highlighting the need for effective preventive strategies.This study evaluated the efficacy of probiotic ...Objectives:Colorectal adenomatous polyps frequently recur after removal and are precursors to colorectal cancer,highlighting the need for effective preventive strategies.This study evaluated the efficacy of probiotic Clostridium butyricum MIYAIRI 588(CBM588)in preventing colorectal adenoma recurrence in high-risk patients.Methods:We conducted a randomized,single-blind,two-year crossover trial in patients with a history of adenomatous polyps.Participants received CBM588 in either the first or second year,with the alternate year as observation,and underwent annual surveillance colonoscopies.Outcomes(adenoma recurrence and polyp counts)were analyzed by intention-to-treat(ITT)and per-protocol(PP)approaches.Results:A total of 398 participants were enrolled.In firstyear ITT analysis,the CBM588-first group had a lower mean polyp count(0.78 vs.1.00)and lower adenoma recurrence rate(30.00%vs.35.35%)than the control-first group,though these differences were not statistically significant(p=0.10 and p=0.26,respectively).In contrast,first-year PP analysis showed significant reductions in the CBM588-first group’s mean polyp count(0.80 vs.1.25,p<0.05)and adenoma recurrence rate(29.76%vs.44.71%,p<0.05)compared to control.After crossover,the group receiving CBM588 in the second year experienced similar benefits,and by year two both groups had comparable outcomes.No carryover effect was evident.The number needed to treat to prevent one adenoma in one year was 19 in ITT and 7 in PP.CBM588 was well tolerated,with no serious adverse events.Conclusion:CBM588 demonstrated potential to reduce colorectal adenoma recurrence in high-risk patients,supporting its role as a feasible,non-invasive preventive strategy.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
基金funded by the Undergraduate Higher Education Teaching and Research Project(No.FBJY20230216)Research Projects of Putian University(No.2023043)the Education Department of the Fujian Province Project(No.JAT220300).
文摘In recent years,the number of patientswith colon disease has increased significantly.Colon polyps are the precursor lesions of colon cancer.If not diagnosed in time,they can easily develop into colon cancer,posing a serious threat to patients’lives and health.A colonoscopy is an important means of detecting colon polyps.However,in polyp imaging,due to the large differences and diverse types of polyps in size,shape,color,etc.,traditional detection methods face the problem of high false positive rates,which creates problems for doctors during the diagnosis process.In order to improve the accuracy and efficiency of colon polyp detection,this question proposes a network model suitable for colon polyp detection(PD-YOLO).This method introduces the self-attention mechanism CBAM(Convolutional Block Attention Module)in the backbone layer based on YOLOv7,allowing themodel to adaptively focus on key information and ignore the unimportant parts.To help themodel do a better job of polyp localization and bounding box regression,add the SPD-Conv(Symmetric Positive Definite Convolution)module to the neck layer and use deconvolution instead of upsampling.Theexperimental results indicate that the PD-YOLO algorithm demonstrates strong robustness in colon polyp detection.Compared to the original YOLOv7,on the Kvasir-SEG dataset,PD-YOLO has shown an increase of 5.44 percentage points in AP@0.5,showcasing significant advantages over other mainstream methods.
文摘Gastric polyps are commonly detected during upper gastrointestinal endoscopy.They are most often benign and rarely become malignant.Nevertheless,adequate knowledge,diagnostic modalities,and management strategies should be the endoscopist’s readily available“weapons”to defeat the potentially malignant“enemies”.This article sheds light on the valuable effort by Costa et al to generate a new classification system of gastric polyps as“good”,“bad”,and“ugly”.This comprehensive overview provides clinicians with a simplified decision-making process.
文摘With the widespread use of upper gastrointestinal endoscopy,more and more gastric polyps(GPs)are being detected.Traditional management strategies often rely on histopathologic examination,which can be time-consuming and may not guide immediate clinical decisions.This paper aims to introduce a novel classification system for GPs based on their potential risk of malignant transformation,categorizing them as"good","bad",and"ugly".A review of the literature and clinical case analysis were conducted to explore the clinical implications,management strategies,and the system's application in endoscopic practice.Good polyps,mainly including fundic gland polyps and inflammatory fibrous polyps,have a low risk of malignancy and typically require minimal or no intervention.Bad polyps,mainly including hyperplastic polyps and adenomas,pose an intermediate risk of malignancy,necessitating closer monitoring or removal.Ugly polyps,mainly including type 3 neuroendocrine tumors and early gastric cancer,indicate a high potential for malignancy and require urgent and comprehensive treatment.The new classification system provides a simplified and practical framework for diagnosing and managing GPs,improving diagnostic accuracy,guiding individualized treatment,and promoting advancements in endoscopic techniques.Despite some challenges,such as the risk of misclassification due to similar endoscopic appearances,this system is essential for the standardized management of GPs.It also lays the foundation for future research into biomarkers and the development of personalized medicine.
文摘BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer.Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer.Endoscopic mucosal resection(EMR)is a common polypectomy proce-dure in clinical practice,but it has a high postoperative recurrence rate.Currently,there is no predictive model for the recurrence of colorectal polyps after EMR.AIM To construct and validate a machine learning(ML)model for predicting the risk of colorectal polyp recurrence one year after EMR.METHODS This study retrospectively collected data from 1694 patients at three medical centers in Xuzhou.Additionally,a total of 166 patients were collected to form a prospective validation set.Feature variable screening was conducted using uni-variate and multivariate logistic regression analyses,and five ML algorithms were used to construct the predictive models.The optimal models were evaluated based on different performance metrics.Decision curve analysis(DCA)and SHapley Additive exPlanation(SHAP)analysis were performed to assess clinical applicability and predictor importance.RESULTS Multivariate logistic regression analysis identified 8 independent risk factors for colorectal polyp recurrence one year after EMR(P<0.05).Among the models,eXtreme Gradient Boosting(XGBoost)demonstrated the highest area under the curve(AUC)in the training set,internal validation set,and prospective validation set,with AUCs of 0.909(95%CI:0.89-0.92),0.921(95%CI:0.90-0.94),and 0.963(95%CI:0.94-0.99),respectively.DCA indicated favorable clinical utility for the XGBoost model.SHAP analysis identified smoking history,family history,and age as the top three most important predictors in the model.CONCLUSION The XGBoost model has the best predictive performance and can assist clinicians in providing individualized colonoscopy follow-up recommendations.
基金Supported by the Health Technology Project of Pudong New District Health Commission,No.PW2020D-12.
文摘BACKGROUND The relationship between autoimmune gastritis(AIG)and gastric polyps(GPs)is not well understood.AIM To explore the clinical characteristics and risk factors of AIG with GPs in patients.METHODS This double center retrospective study included 530 patients diagnosed with AIG from July 2019 to July 2023.We collected clinical,biochemical,serological,and demographic data were of each patient.Logistic regression analyses,both multivariate and univariate,were conducted to pinpoint independent risk factors for GPs in patients with AIG patients.Receiver operating characteristic curves were utilized to establish the optimal cutoff values,sensitivity,and specificity of these risk factors for predicting GPs in patients with AIG.RESULTS Patients with GPs had a higher median age than those without GPs[61(52.25-69)years vs 58(47-66)years,P=0.006].The gastrin-17 levels were significantly elevated in patients with GPs compared with those without GPs[91.9(34.2-138.9)pmol/mL vs 60.9(12.6-98.4)pmol/mL,P<0.001].Additionally,the positive rate of parietal cell antibody(PCA)antibody was higher in these patients than in those without GPs(88.6%vs 73.6%,P<0.001).Multivariate and univariate analyses revealed that PCA positivity[odds ratio(OR)=2.003,P=0.017],pepsinogen II(OR=1.053,P=0.015),and enterochromaffin like cells hyperplasia(OR=3.116,P<0.001)were significant risk factors for GPs,while pepsinogen I was identified as a protective factor.CONCLUSION PCA positivity and enterochromaffin like cells hyperplasia are significant risk factor for the development of GPs in patients with AIG.Elevated gastrin-17 levels may also play a role in this process.These findings suggest potential targets for further research and therapeutic intervention in managing GPs in patients with AIG.
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.
基金Supported by the Shaanxi Province Traditional Chinese Medicine Research and Innovation Talent Plan Project,No.TZKN-CXRC-16Project of Shaanxi Administration of Traditional Chinese Medicine,No.SZYKJCYC-2025-JC-010+2 种基金Shaanxi Province Outstanding TCM Talents Training Project Training Object in 2025Xi’an Science and Technology Plan Project,No.23YXYJ0162Shaanxi Province Key Research and Development Plan Project-Social Development Field,No.S2025-YF-YBSF-0391.
文摘BACKGROUND The incidence of gastric polyps(GPs)has ranged from 0.30%to 6.8%in various studies.Most GPs include hyperplastic polyps(HPs),fundic gland polyps(FGPs),and adenomatous polyps(APs).Although APs have a high malignant potential,HPs have a low risk of potential harm,whereas sporadic FGPs have no malignant potential.It is not enough to determine the type and displacement of a polyp by biopsy alone;therefore,some polyps may require an extensive biopsy or complete resection.AIM To evaluate the detection rate and pathological features of polyps in patients undergoing upper gastrointestinal endoscopy.METHODS This retrospective study included patients with GPs or polyphenic lesions with polyps or malignant histology found in polyps or by gastroscopy at the Department of Gastroenterology at the Shaanxi Provincial Hospital of Traditional Chinese Medicine from 2019 to 2023.RESULTS In a series of 10000 patients who underwent upper gastrointestinal endoscopy,384(3.84%)had GPs.There were 98 males(25.5%)and 286 females(74.5%).The mean age of patients was 62.8±10.4(36-75)years.The frequencies of HPs,APs,and FGPs were 88.5%,5.2%,and 2.1%,respectively.The polyp size of 274 patients(71.3%)was≤1 cm.Polyps were found in 262 cases(68.2%).The most common sites for polyps were the lumen and body of the intestine.Endoscopic polypectomy was performed in 128 patients.Bleeding events were observed and endoscopic treatment was required after endoscopic polypectomy.CONCLUSION The incidence of GPs was low.HPs were the most common types of GPs.Of note,as GPs have the potential to develop into adenocarcinoma or precancerous lesions,we suggest that appropriate GP resection technology(e.g.,biopsy forceps or mesenchymal resection)be applied.
文摘In pediatric patients,gallbladder polyps(GBPs)are lesions that are usually found incidentally on ultrasonography,which is the first-line modality for diagnosis.Though common in adults,GBPs are rare in children,and their prevalence remains unclear.Most GBPs in children are benign,and although the risk of malignancy is influenced by polyp size,growth rate,and morphology,specific criteria for the pediatric population are lacking.Management,therefore,is based on adult guidelines,with cholecystectomy being recommended only in symptomatic patients and for rapidly enlarging or 10-mm polyps and those with unfavorable morphology to avert the risk of malignant transformation,while surveillance is applied to asymptomatic patients with smaller polyps.Further research is needed to develop pediatric-specific guidelines for the management of GBPs.This review discusses the classification,diagnosis,risk factors,and management of pediatric GBPs.
基金supported by the Natural Science Foundation Project of Fujian Province,China(Grant Nos.2023J011439 and 2019J01859).
文摘The polyp dataset involves the confidentiality of medical records, so it might be difficult to obtain datasets with accurate annotations. This problem can be effectively solved by expanding the polyp data set with algorithms. The traditional polyp dataset expansion scheme usually requires the use of two models or traditional visual methods. These methods are both tedious and difficult to provide new polyp features for training data. Therefore, our research aims to efficiently generate high-quality polyp samples, so as to effectively expand the polyp dataset. In this study, we first added the attention mechanism to the generation model and improved the loss function to reduce the interference caused by reflection in the image generation process. Meanwhile, we used the improved generation model to remove polyps from the original image. In addition, we used masks of different shapes generated by random combinations to generate polyps with more characteristic information. The same generation model was used for the removal and generation of polyps. The generated polyp image has its own annotation, which is conducive to us directly using the expanded data set for training. Finally, we verified the effectiveness of the improved model and the dataset expansion scheme through a series of comparative experiments on the public dataset. The results showed that using the dataset we generate for training can significantly optimize the main performance indicators.
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.
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Minimally invasive endoscopic resection techniques are the recommended firstline treatment strategy for the majority of large non-pedunculated colorectal polyps,with endoscopic mucosal resection(EMR)as a predominant resection modality due to its efficacy,efficiency,safety,and cost-effectiveness.A limitation of EMR is recurrence,which has historically occurred in 15%-20%of lesions.In the past 10 years,a number of effective mitigating strategies have been developed,including margin thermal ablation using snare-tip soft coagulation,argon plasma coagulation(APC),and hybrid-APC,alongside margin marking pre-resection.Moreover,techniques for effective recurrence management have also been developed.Herein,we appraise existing evidence on the frequency of recurrence,reasonings behind recurrence formation,as well as recurrence mitigating strategies and the effectiveness of recurrence management.
基金Supported by Ministry of Science and Higher Education of the Russian Federation,No.FGMF-2025-0003.
文摘Colorectal cancer remains a major health concern,with colorectal polyps as key precursors.Endoscopic mucosal resection(EMR)is a common treatment,but recurrence rates remain high.Traditional surveillance strategies rely on polyp characteristics and completeness of the resection potentially missing key risk factors.Machine learning(ML)offers a transformative approach by integrating patient-specific data to refine risk stratification.Recent studies highlight ML models,such as Extreme Gradient Boosting,which outperform conventional methods in predicting polyp recurrence within one-year post-EMR.These models incorporate factors like age,smoking status,family history,and pathology,optimizing follow-up recommendations and minimizing unnecessary procedures.Artificial intelligence(AI)-driven tools and web-based calculators enhance clinical workflow by providing real-time,personalized risk assessments.However,challenges remain in external validation,model interpretability,and clinical integration.Future surveillance strategies should combine expert judgment with AI insights to optimize patient outcomes.As gastroenterology embraces AI,MLdriven surveillance represents a paradigm shift,advancing precision medicine in colorectal polyp management.This editorial explores AI’s role in transforming post-EMR follow-up,addressing benefits,limitations,and future directions.
文摘Objective To evaluate the impact of endometrial polyps(EP)on postoperative pregnancy outcomes in infertile women with endometriosis(EMs).Methods PubMed,Embase,The Cochrane Library,CNKI,VIP,SinoMed,and WanFang Data databases were searched to include clinical studies on the effect of EP on pregnancy outcomes in patients with EMs,published before August 31,2020.A meta-analysis was performed using Rev Man 5.3 software after two investigators independently screened the literature,extracted information,and evaluated the risk of bias of the included studies.Results The meta-analysis included ten studies(651 and 1,040 in the combined EP and uncomplicated EP groups,respectively).The spontaneous pregnancy rate,clinical pregnancy rate,and live birth rate were significantly lower in the group with combined EPs than in the group without combined EPs[Odd’s ratio(OR)=0.63,95%confidence interval(CI):0.50–0.80,P=0.0001;OR=0.63,95%CI:0.48–0.84,P=0.001;OR=0.63,95%CI:0.42–0.96,P=0.03],and the rate of embryonic abortion was significantly higher than that in the uncomplicated EP group[OR=3.10,95%CI:1.52–6.32,P=0.002].Conclusion EP may adversely affect pregnancy outcomes in patients with infertility and EMs.Even after surgical treatment,EP can still reduce natural pregnancy,clinical pregnancy,and live birth rates in infertile women with EMs and increase the risk of embryo arrest in these women.
基金the National Natural Science Foundation of China(Nos.81971767,62103263 and 62103267)the Shanghai Science and Technology Commission(Nos.19142203800,19441913800 and 19441910600)。
文摘Colorectal cancer is the most common cancer with a second mortality rate.Polyp lesion is a precursor symptom of colorectal cancer.Detection and removal of polyps can effectively reduce the mortality of patients in the early period.However,mass images will be generated during an endoscopy,which will greatly increase the workload of doctors,and long-term mechanical screening of endoscopy images will also lead to a high misdiagnosis rate.Aiming at the problem that computer-aided diagnosis models deeply depend on the computational power in the polyp detection task,we propose a lightweight model,coordinate attention-YOLOv5-Lite-Prune,based on the YOLOv5 algorithm,which is different from state-of-the-art methods proposed by the existing research that applied object detection models or their variants directly to prediction task without any lightweight processing,such as faster region-based convolutional neural networks,YOLOv3,YOLOv4,and single shot multibox detector.The innovations of our model are as follows:First,the lightweight EfficientNetLite network is introduced as the new feature extraction network.Second,the depthwise separable convolution and its improved modules with different attention mechanisms are used to replace the standard convolution in the detection head structure.Then,theα-intersection over union loss function is applied to improve the precision and convergence speed of the model.Finally,the model size is compressed with a pruning algorithm.Our model effectively reduces parameter amount and computational complexity without significant accuracy loss.Therefore,the model can be successfully deployed on the embedded deep learning platform,and detect polyps with a speed above 30 frames per second,which means the model gets rid of the limitation that deep learning models must rely on high-performance servers.
文摘Colorectal cancer(CRC)is the third most frequently diagnosed cancer and the second leading cause of cancer death worldwide.In this regard,CRC screening is one of the most important issues in modern preventive medicine.Colorectal polyps are potential predictors of CRC,and therefore represent one of the leading targets for screening colonoscopy.The difficulty of analyzing the information obtained during colonoscopy,including the size,location,shape,type of polyps,the need to standardize morphological data,determines that recently a number of works have promoted the opinion on the advisability of using various artificial intelligence(AI)methods to improve the effectiveness of endoscopic screening for CRC.At the same time,they point to a number of errors and methodological problems in the use of AI systems for the diagnosis of colorectal polyps.In this regard,the interpretation of the work of Shi et al,devoted to the use of a machine learning-based predictive model for monitoring the results of colorectal polypectomy,is undoubtedly interesting.In our opinion,the prospects for using AI to assess endoscopic screening for CRC look certainly positive,but the road to its widespread use will not be easy.
基金the National Administration of Traditional Chinese Medicine Letter([2022]-1)Dongzhimen Hospital Horizontal Project:Exploring the Effects of Weifuchun on Key Mechanisms of Different Types of Gastric Polyps based on Human Organoid Culture Technology(No.HX-DZM-202239)the Qihuang Talent Program for Renowned Physician Cultivation at Beijing University of Chinese Medicine(No.Y2023A06)。
文摘OBJECTIVE:To investigate the therapeutic effects of Chinese medicine Weifuchun(WFC,胃复春)on gastric fundic gland polyps(FGPs).METHODS:FGPs organoids were constructed with patients-derived samples.The morphology and size of FGPs organoids were detected using bright-field imaging.Effective components and corresponding potential targets of WFC were screened using multiple opensource databases and research on Traditional Chinese Medicine or compound formulas.Core genes were identified through protein-protein interaction networks.Kyoto Encyclopedia of Genes and Genomes(KEGG)and Gene Ontology(GO)enrichment analyses of the core genes were conducted.The interactions between main components and core targets were analyzed through the Ferr Db database.The expressions of core targets were detected by quantitative real-time polymerase chain reaction(q RT-PCR).RESULTS:After WFC treatment,the number and size of FGPs organoids were significantly reduced.Twenty nine active drug components and 162 candidate targets of WFC for treating FGPs were identified,including 37 targets related to ferroptosis.Quercetin,Glaucocalyxin B,Melissoidesin U,Melissoidesin O,Hesperetin,Glaucocalyxin A,Angustifolin,Melissoidesin M,Di-n-octyl phthalate,and beta-sitosterol were identified as the main active compounds.SRC proto-oncogene,non-receptor tyrosine kinase,signal transducer and activator of transcription 3,phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha,phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit beta,phosphoinositide-3-kinase regulatory subunit 1,and AKT serine/threonine kinase 1 were identified as the primary targets.KEGG pathways related to carcinogenesis,cell proliferation and metabolism,and oxidative stress.WFC promoted FGPs organoids'death and could be reversed by ferroptosis inhibitor of Erastin.The q RT-PCR results showed that WFC treatment could regulate the m RNA expression levels of solute carrier family 7 member 11,acyl-Co A synthetase long chain family member 4,and arachidonate 15-lipoxygenase,type B.CONCLUSION:WFC may exert its therapeutic effects by inducing ferroptosis in FGPs cells.
文摘BACKGROUND Muco-submucosal elongated polyps(MSEPs)are rare benign gastrointestinal lesions,typically reported in the colon and seldom observed in the small intestine.These polyps are generally slow-growing and asymptomatic,making diagnosis and management challenging.Rapid enlargement of MSEPs in the duodenum is particularly rare and may raise suspicion for neoplastic potential.CASE SUMMARY We report the case of a 64-year-old female who presented with nausea and abdominal pain.Abdominal computed tomography revealed a soft tissue density in the descending duodenum.Upper endoscopy performed 15 months earlier had identified a 1.5-cm mucosal elevation in the second portion of the duodenum.On follow-up endoscopy,the lesion had enlarged significantly into a 10-cm elongated,pedunculated polyp.Endoscopic submucosal dissection was performed for complete en bloc resection.Histopathology confirmed the diagnosis of a MSEP,with no evidence of malignancy.Surveillance endoscopy performed one year after resection showed no recurrence.CONCLUSION Although MSEPs are typically benign,our case demonstrates that rapid growth may occur.This highlights the importance of continued endoscopic surveillance and early intervention,even in asymptomatic patients,to prevent potential complications and ensure timely diagnosis.
基金funded by KaohsiungMedical University Hospital,grant Numbers KMUH110-0T05,KMUH-DK(C)114005.
文摘Objectives:Colorectal adenomatous polyps frequently recur after removal and are precursors to colorectal cancer,highlighting the need for effective preventive strategies.This study evaluated the efficacy of probiotic Clostridium butyricum MIYAIRI 588(CBM588)in preventing colorectal adenoma recurrence in high-risk patients.Methods:We conducted a randomized,single-blind,two-year crossover trial in patients with a history of adenomatous polyps.Participants received CBM588 in either the first or second year,with the alternate year as observation,and underwent annual surveillance colonoscopies.Outcomes(adenoma recurrence and polyp counts)were analyzed by intention-to-treat(ITT)and per-protocol(PP)approaches.Results:A total of 398 participants were enrolled.In firstyear ITT analysis,the CBM588-first group had a lower mean polyp count(0.78 vs.1.00)and lower adenoma recurrence rate(30.00%vs.35.35%)than the control-first group,though these differences were not statistically significant(p=0.10 and p=0.26,respectively).In contrast,first-year PP analysis showed significant reductions in the CBM588-first group’s mean polyp count(0.80 vs.1.25,p<0.05)and adenoma recurrence rate(29.76%vs.44.71%,p<0.05)compared to control.After crossover,the group receiving CBM588 in the second year experienced similar benefits,and by year two both groups had comparable outcomes.No carryover effect was evident.The number needed to treat to prevent one adenoma in one year was 19 in ITT and 7 in PP.CBM588 was well tolerated,with no serious adverse events.Conclusion:CBM588 demonstrated potential to reduce colorectal adenoma recurrence in high-risk patients,supporting its role as a feasible,non-invasive preventive strategy.
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.
