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
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 Cold snare polypectomy(CSP)is comparatively safe and effective for removing polyps less than 10 mm in size with lower rates of postpolypectomy syndrome and delayed postpolypectomy bleeding compared with hot...BACKGROUND Cold snare polypectomy(CSP)is comparatively safe and effective for removing polyps less than 10 mm in size with lower rates of postpolypectomy syndrome and delayed postpolypectomy bleeding compared with hot snare polypectomy(HSP).Recently,CSP is also expanded for removing polyps larger than 10 mm in size.AIM To compare the efficiency and safety of CSP and HSP in the management of 10-19 mm non-pedunculated colorectal polyps.METHODS A total of 1686 inpatients with at least one 10-19 mm non-pedunculated colorectal polyp,who underwent CSP(study group,n=843)or HSP(control group,n=843)at our Digestive Endoscopy Center between February 2020 and February 2024 were enrolled.The outcome measures including complete resection rate,intraoperative bleeding rate,and healthcare expenses such as procedure time and treatment cost were compared between the CSP vs HSP groups.RESULTS No statistically significant intergroup difference was observed in histological complete resection rates(P>0.05).Polyp resection time in the study group(76.5±23.6 seconds)was notably shorter than that in the control group(91.24±32.06 seconds;P<0.05).The immediate intraoperative bleeding rate was significantly higher in the study group than in the control group(12.7%vs 4.9%,P<0.05).No instances of delayed bleeding or perforation were documented in either group.Hospitalization duration was significantly reduced in the study group(2.42±0.61 days)compared to the control group(3.21±1.02 days;P<0.05).CONCLUSION For 10-19 mm non-pedunculated colorectal polyps,CSP demonstrates operational efficiency advantages over HSP in terms of procedure time,treatment cost,and length of hospital stay.Both techniques demonstrate robust safety profiles;however,CSP is associated with a higher intraoperative bleeding rate.Clinical decision-making should incorporate individualized assessment of these factors.展开更多
BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical...BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.AIM To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques,namely,high-frequency electroresection(HFE),cold snare polypectomy(CSP),and endoscopic mucosal resection(EMR),for the treatment of colonic polyps.METHODS This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023.Patients were grouped by technique:HFE(n=107),CSP(n=106),and EMR(n=108).Standardized preoperative,intraoperative,and postoperative protocols were applied.Outcome measures included resection status(en bloc,R0,R1,and Rx),adverse events(immediate/delayed bleeding,perforation,and post-polypectomy coagulation syndrome),postoperative pain(visual analog scale at 1,3,and 5 hours),and 12-month recurrence rate.RESULTS Baseline demographics and polyp characteristics,except for polyp diameter,were comparable among groups.CSP achieved the highest en bloc resection rate,whereas HFE had a higher R0 resection rate.Polyp diameter was largest in the EMR group.Procedure duration was shortest with HFE.Adverse reactions were more frequent with HFE,particularly post-polypectomy bleeding and delayed perforation,whereas CSP demonstrated a superior safety profile and the lowest incidence of complications.Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR.Recurrence rates were significantly higher in the EMR group vs CSP group,with HFE showing intermediate recurrence.CONCLUSION CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps,whereas HFE confers a high R0 resection rate but increased risk of adverse events.EMR remains essential for large polyps despite elevated recurrence.Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.展开更多
BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing...BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.AIM To determine the timing,feasibility,and clinical benefits of early diet resumption following colorectal polypectomy.METHODS In the Second Affiliated Hospital of Zhejiang University School of Medicine,a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group(n=751)and a control group(n=751).Following polypectomy,the experimental group consumed rice soup at 2 hours,while the control group received rice soup at 6 hours.The study focused on delayed post-polypectomy bleeding(DPPB),with secondary evaluation of postpolypectomy perforation,hypoglycemia,fever,and length of stay(LOS).RESULTS The comparison between the two groups revealed no significant differences in DPPB rates(4.7%vs 5.5%,P=0.480)and major bleeding rates(1.5%vs 2.1%,P=0.332).Both groups displayed median bleeding times of 2 days.No notable differences in perforation(0.0%vs 0.3%,P=0.479)and fever rates(2.1%vs 2.9%,P=0.324)were observed between the two groups.However,the experimental group showed significantly lower incidence of hypoglycemia(0.4%vs 1.5%,P<0.05)and shorter LOS[1(1,2)day vs 2(1,2)days,P<0.001]following polypectomy.Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients,irrespective of polyp count,size,pathology,or polypectomy modalities.CONCLUSION Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.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
Fundic gland polyps are now commonly recognized during endoscopy. These polyps are benign, often multiple and usually detected in the gastric body and fundus. In the past, these polyps were sometimes associated with f...Fundic gland polyps are now commonly recognized during endoscopy. These polyps are benign, often multiple and usually detected in the gastric body and fundus. In the past, these polyps were sometimes associated with familial adenomatous polyposis. In recent years, it has become evident that increasing numbers of these polyps are being detected during endoscopic studies, particularly in patients treated with proton pump inhibitors for prolonged periods. In some, dysplastic changes in these polyps have also been reported. Recent studies have suggested that there may be no increase in risk of colon cancer with long-term proton pump inhibitor therapy. While temporarily reassuring, ongoing vigilance, particularly in those genetically predisposed to colon cancer, is still warranted.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
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
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
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
BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences b...BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.展开更多
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
Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa...Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasiaassociated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.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
Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate stagin...Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from nonpedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.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
Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypecto...Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.展开更多
BACKGROUND 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
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 Cold snare polypectomy(CSP)is comparatively safe and effective for removing polyps less than 10 mm in size with lower rates of postpolypectomy syndrome and delayed postpolypectomy bleeding compared with hot snare polypectomy(HSP).Recently,CSP is also expanded for removing polyps larger than 10 mm in size.AIM To compare the efficiency and safety of CSP and HSP in the management of 10-19 mm non-pedunculated colorectal polyps.METHODS A total of 1686 inpatients with at least one 10-19 mm non-pedunculated colorectal polyp,who underwent CSP(study group,n=843)or HSP(control group,n=843)at our Digestive Endoscopy Center between February 2020 and February 2024 were enrolled.The outcome measures including complete resection rate,intraoperative bleeding rate,and healthcare expenses such as procedure time and treatment cost were compared between the CSP vs HSP groups.RESULTS No statistically significant intergroup difference was observed in histological complete resection rates(P>0.05).Polyp resection time in the study group(76.5±23.6 seconds)was notably shorter than that in the control group(91.24±32.06 seconds;P<0.05).The immediate intraoperative bleeding rate was significantly higher in the study group than in the control group(12.7%vs 4.9%,P<0.05).No instances of delayed bleeding or perforation were documented in either group.Hospitalization duration was significantly reduced in the study group(2.42±0.61 days)compared to the control group(3.21±1.02 days;P<0.05).CONCLUSION For 10-19 mm non-pedunculated colorectal polyps,CSP demonstrates operational efficiency advantages over HSP in terms of procedure time,treatment cost,and length of hospital stay.Both techniques demonstrate robust safety profiles;however,CSP is associated with a higher intraoperative bleeding rate.Clinical decision-making should incorporate individualized assessment of these factors.
文摘BACKGROUND Colorectal polypectomy is fundamental to the prevention of colorectal cancer,utilizing several endoscopic techniques.Robust comparative data regarding the efficacy and safety of these modalities in clinical practice are limited.AIM To evaluate and compare the efficacy and safety of three endoscopic polypectomy techniques,namely,high-frequency electroresection(HFE),cold snare polypectomy(CSP),and endoscopic mucosal resection(EMR),for the treatment of colonic polyps.METHODS This single-center retrospective cohort study included adults who underwent endoscopic resection of pathologically confirmed colorectal polyps at Central Hospital Affiliated to Shandong First Medical University between January 2015 and December 2023.Patients were grouped by technique:HFE(n=107),CSP(n=106),and EMR(n=108).Standardized preoperative,intraoperative,and postoperative protocols were applied.Outcome measures included resection status(en bloc,R0,R1,and Rx),adverse events(immediate/delayed bleeding,perforation,and post-polypectomy coagulation syndrome),postoperative pain(visual analog scale at 1,3,and 5 hours),and 12-month recurrence rate.RESULTS Baseline demographics and polyp characteristics,except for polyp diameter,were comparable among groups.CSP achieved the highest en bloc resection rate,whereas HFE had a higher R0 resection rate.Polyp diameter was largest in the EMR group.Procedure duration was shortest with HFE.Adverse reactions were more frequent with HFE,particularly post-polypectomy bleeding and delayed perforation,whereas CSP demonstrated a superior safety profile and the lowest incidence of complications.Postoperative pain diminished in all groups over time but was consistently low for CSP and EMR.Recurrence rates were significantly higher in the EMR group vs CSP group,with HFE showing intermediate recurrence.CONCLUSION CSP offers the best safety profile and lowest recurrence rate among patients undergoing endoscopic resection of colorectal polyps,whereas HFE confers a high R0 resection rate but increased risk of adverse events.EMR remains essential for large polyps despite elevated recurrence.Technique selection should be tailored according to polyp characteristics and patient risk factors to optimize outcomes.
基金Supported by National Natural Science Foundation of China,No.82073160.
文摘BACKGROUND Patients with early oral intake after intestinal surgery achieve better nutritional status and fewer postoperative complications.However,no guidelines or expert consensus have established the optimal timing for diet resumption following colorectal polypectomy.AIM To determine the timing,feasibility,and clinical benefits of early diet resumption following colorectal polypectomy.METHODS In the Second Affiliated Hospital of Zhejiang University School of Medicine,a total of 1502 patients with polyps under 3 cm were recruited and randomly assigned to an experimental group(n=751)and a control group(n=751).Following polypectomy,the experimental group consumed rice soup at 2 hours,while the control group received rice soup at 6 hours.The study focused on delayed post-polypectomy bleeding(DPPB),with secondary evaluation of postpolypectomy perforation,hypoglycemia,fever,and length of stay(LOS).RESULTS The comparison between the two groups revealed no significant differences in DPPB rates(4.7%vs 5.5%,P=0.480)and major bleeding rates(1.5%vs 2.1%,P=0.332).Both groups displayed median bleeding times of 2 days.No notable differences in perforation(0.0%vs 0.3%,P=0.479)and fever rates(2.1%vs 2.9%,P=0.324)were observed between the two groups.However,the experimental group showed significantly lower incidence of hypoglycemia(0.4%vs 1.5%,P<0.05)and shorter LOS[1(1,2)day vs 2(1,2)days,P<0.001]following polypectomy.Subgroup analyses further confirmed that early diet resumption had no adverse effects on patients,irrespective of polyp count,size,pathology,or polypectomy modalities.CONCLUSION Early diet resumption following colorectal polypectomy for polyps not exceeding 3 cm is advisable as it does not significantly increase the risk of complications.
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Fundic gland polyps are now commonly recognized during endoscopy. These polyps are benign, often multiple and usually detected in the gastric body and fundus. In the past, these polyps were sometimes associated with familial adenomatous polyposis. In recent years, it has become evident that increasing numbers of these polyps are being detected during endoscopic studies, particularly in patients treated with proton pump inhibitors for prolonged periods. In some, dysplastic changes in these polyps have also been reported. Recent studies have suggested that there may be no increase in risk of colon cancer with long-term proton pump inhibitor therapy. While temporarily reassuring, ongoing vigilance, particularly in those genetically predisposed to colon cancer, is still warranted.
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.
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.
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.
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BACKGROUND Although substantial evidence supports the advantages of cold snare polypectomy(CSP)in terms of polypectomy efficacy and reduced postoperative adverse events,few studies have examined the cost differences between CSP and traditional endoscopic mucosal resection(EMR)for the treatment of intestinal polyps.AIM To compare the efficacy-cost of EMR and CSP in the treatment of intestinal polyps.METHODS A total of 100 patients with intestinal polyps were included in the retrospective data of our hospital from April 2022 to May 2023.According to the treatment methods,they were divided into EMR(n=46)group and CSP(n=54)group.The baseline data of the two groups were balanced by 1:1 propensity score matching(PSM),and the cost-effectiveness analysis was performed on the two groups after matching.The recurrence rate of the two groups of patients was followed up for 1 year,and they were divided into recurrence group and non-recurrence group according to whether they recurred.Multivariate logistic regression analysis was used to screen out the influencing factors affecting the recurrence of intestinal polyps after endoscopic resection.RESULTS Significant disparities were observed in the number of polyps and smoking background between the two groups before PSM(P<0.05).Following PSM,the number of polyps and smoking history were well balanced between the EMR and CSP groups.The direct cost incurred by the CSP group was markedly higher than that incurred by the EMR group.Concurrently,the cost-effectiveness ratio in the CSP group was substantially reduced when juxtaposed with that in the EMR group(P<0.05).Upon completion of the 1-year follow-up,the rate of recurrence after endoscopic intestinal polypectomy was 38.00%.Multivariate methods revealed that age≥60 years,male sex,number of polyps≥3,and pathological type of adenoma were risk factors for recurrence after endoscopic intestinal polypectomy(all P<0.05).CONCLUSION CSP was more cost-effective for the treatment of intestinal polyps.An age≥60 years,male sex,having a number of polyps≥3,and pathological type of adenoma are independent influencing factors for recurrence.
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Pseudopolyps are a well described entity in the literature and even though the exact pathogenesis of their formation is not completely understood, they are considered non-neoplastic lesions originating from the mucosa after repeated periods of inflammation and ulceration associated with excessive healing processes. Their occurrence is less common in Crohn's disease than in ulcerative colitis, and their overall prevalence ranges from 4% to 74%; moreover, they are found more often in colon but have been detected in other parts of the gastrointestinal tract as well. When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps. Clinical evaluation should differentiate the pseudopolyps from other polypoid lesions, such as the dysplasiaassociated mass or lesion, but this situation represents an ongoing clinical challenge. Pseudopolyps can provoke complications such as bleeding or obstruction, and their management includes medical therapy, endoscopy and surgery; however, no consensus exists about the optimal treatment approach. Patients with pseudopolyps are considered at intermediate risk for colorectal cancer and regular endoscopic monitoring is recommended. Through a review of the literature, we provide here a proposed classification of the characteristics of pseudopolyps.
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.
文摘Despite significant advances in imaging techniques, the incidence of colorectal cancer has been increasing in recent years, with many cases still being diagnosed in advanced stages. Early detection and accurate staging remain the main factors that lead to a decrease in the cost and invasiveness of the curative techniques, significantly improving the outcome. However, the diagnosis of pedunculated early colorectal malignancy remains a current challenge. Data on the management of pedunculated cancer precursors, apart from data on nonpolypoid lesions, are still limited. An adequate technique for complete resection, which provides the best long-term outcome, is mandatory for curative intent. In this context, a discussion regarding the diagnosis of malignancy of pedunculated polyps, separate from nonpedunculated variants, is necessary. The purpose of this review is to provide a critical review of the most recent literature reporting the different features of malignant pedunculated colorectal polyps, including diagnosis and management strategies.
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.
文摘Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size.Conversely,endoscopic mucosal resection is still the preferred technique for larger polyps.Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection(resulting in piecemeal removal),and the potential for local residual polyp tissue and a high rate of recurrence.On the other hand,cold snare technique has the advantages of shortening procedure time,reducing delayed bleeding risks and lowering cost of treatment.Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm,with the goal of providing clear guidelines in the near future.The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.
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.
