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Surgical Endoscopy Jan 2017The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates. (Comparative Study)
Comparative Study
BACKGROUND
The adenoma detection rate (ADR) is a quality indicator for colonoscopy. High-definition (HD) imaging has been reported to increase polyp detection rates.
OBJECTIVE
The primary objective of this study was to compare polyp detection rate (PDR) and adenoma detection rate (ADR) before and after the implementation of HD colonoscopy.
METHODS
A retrospective chart review was performed on patients aged 48-55 years old, who underwent first-time screening colonoscopy. The first group underwent standard-definition (SD) colonoscopy in the first 6 months of 2011. The second group underwent screening with HD colonoscopy during the first 6 months of 2012. We compared age, gender, PDR, ADR, and average sizes of adenomatous polyps between gastroenterologist and colorectal surgeon and among physicians themselves. Statistical analysis was performed with Fischer's exact test and Pearson Chi-square.
RESULTS
A total of 1268 patients were involved in the study (634 in each group). PDR (35.6 vs. 48.2 %, p < 0.001) and ADR (22.2 vs. 30.4 %, p = 0.02) were higher in the HD group. The average size of an adenomatous polyp was the same in the two groups (0.58 vs. 0.57, p = 0.69). However, this difference was not seen among colorectal surgeons PDR (35.7 vs. 37 %, p = 0.789), ADR (22.9 vs. 24.5 % p = 0.513), but clearly seen among gastroenterologist, PDR (35.6 vs. 53.1 % p < 0.001) and ADR (21.9 vs. 32.9 % p < 0.001). When polyps were categorized into size groups, there was no difference in ADR between the two timeframes (<5 mm in size (41.5 vs. 35.4 %), 5-10 mm (49.3 vs. 60.1 %) and >10 mm (9.2 vs. 4.5 %), p = 0.07). Polyps were most commonly seen in the sigmoid colon (26.1 vs. 24.7 %). There was no difference in the rate of synchronous polyp detection between modalities (25.6 vs. 29 %, p = 0.51). Withdrawal time was the same in both procedure (9.2 vs. 8.5 min, p = 0.10).
CONCLUSION
Screening colonoscopy with high-definition technology significantly improved both PDR and ADR. In addition, high-definition colonoscopy may be particularly useful and advantageous among less experienced endoscopists in various community settings. However, there needs to be application to specific patient populations in future studies to assess for any statistical differences between standard- and high-definition modalities to determine clinical utility.
Topics: Adenomatous Polyps; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Quality Indicators, Health Care; Retrospective Studies
PubMed: 27287897
DOI: 10.1007/s00464-016-4986-7 -
Cancer Prevention Research... Sep 2021Familial adenomatous polyposis (FAP) is a hereditary colorectal cancer syndrome, which results in the development of hundreds of adenomatous polyps carpeting the...
Familial adenomatous polyposis (FAP) is a hereditary colorectal cancer syndrome, which results in the development of hundreds of adenomatous polyps carpeting the gastrointestinal tract. NSAIDs have reduced polyp burden in patients with FAP and synthetic rexinoids have demonstrated the ability to modulate cytokine-mediated inflammation and WNT signaling. This study examined the use of the combination of an NSAID (sulindac) and a rexinoid (bexarotene) as a durable approach for reducing FAP colonic polyposis to prevent colorectal cancer development. Whole transcriptomic analysis of colorectal polyps and matched normal mucosa in a cohort of patients with FAP to identify potential targets for prevention in FAP was performed. Drug-dose synergism of sulindac and bexarotene in cell lines and patient-derived organoids was assessed, and the drug combination was tested in two different mouse models. This work explored mRNA as a potential predictive serum biomarker for this combination in FAP. Overall, transcriptomic analysis revealed significant activation of inflammatory and cell proliferation pathways. A synergistic effect of sulindac (300 μmol/L) and bexarotene (40 μmol/L) was observed in FAP colonic organoids with primary targeting of polyp tissue compared with normal mucosa. This combination translated into a significant reduction in polyp development in and mice. Finally, the reported data suggest miRNA-21 could serve as a predictive serum biomarker for polyposis burden in patients with FAP. These findings support the clinical development of the combination of sulindac and bexarotene as a treatment modality for patients with FAP. PREVENTION RELEVANCE: This study identified a novel chemopreventive regimen combining sulindac and bexarotene to reduce polyposis in patients with FAP using tools, , and models. This investigation provides the essential groundwork for moving this drug combination forward into a clinical trial.
Topics: Adenomatous Polyposis Coli; Adenomatous Polyps; Adult; Animals; Anti-Inflammatory Agents, Non-Steroidal; Antineoplastic Combined Chemotherapy Protocols; Bexarotene; Carcinogenesis; Case-Control Studies; Cells, Cultured; Female; Gene Expression Regulation, Neoplastic; HCT116 Cells; HT29 Cells; Humans; Intestinal Neoplasms; Male; Mice; Mice, Transgenic; Sulindac
PubMed: 34266857
DOI: 10.1158/1940-6207.CAPR-20-0496 -
Digestive Endoscopy : Official Journal... Apr 2014During colonoscopy, small and diminutive colorectal polyps are commonly encountered. It is estimated that at least one adenomatous polyp is detected in almost half of... (Review)
Review
During colonoscopy, small and diminutive colorectal polyps are commonly encountered. It is estimated that at least one adenomatous polyp is detected in almost half of all patients undergoing screening colonoscopy. In contrast, the 'predict, resect, and discard' strategy for diminutive and small colorectal polyps is a current topic especially in Western countries. 'Is this an acceptable policy in Japan?' Herein, we report the results of a questionnaire survey with regard to the management of diminutive colorectal polyps, including the thoughts of Japanese endoscopists regarding the 'predict, resect, and discard' strategy. At the moment, we propose that this strategy should be used by skilled endoscopists only.
Topics: Adenomatous Polyps; Adult; Aged; Biopsy, Needle; Colectomy; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Endoscopy; Female; Forecasting; Humans; Immunohistochemistry; Japan; Male; Middle Aged; Neoplasm Staging; Prognosis; Risk Assessment; Time Factors; Treatment Outcome
PubMed: 24750158
DOI: 10.1111/den.12281 -
AJR. American Journal of Roentgenology May 2005
Topics: Adenomatous Polyps; Aged; Colonic Polyps; Colonography, Computed Tomographic; False Negative Reactions; Female; Humans
PubMed: 15855119
DOI: 10.2214/ajr.184.5.01841581 -
World Journal of Gastroenterology Feb 2016Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. The identification of colonic polyps can reduce CRC mortality through earlier diagnosis of... (Review)
Review
Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. The identification of colonic polyps can reduce CRC mortality through earlier diagnosis of cancers and the removal of polyps: the precursor lesion of CRC. Following the finding and removal of colonic polyps at an initial colonoscopy, some patients are at an increased risk of developing CRC in the future. This is the rationale for post-polypectomy surveillance colonoscopy. However, not all individuals found to have colonic adenomas have a risk of CRC higher than that of the general population. This review examines the literature on post-polypectomy surveillance including current international clinical guidelines. The potential benefits of surveillance procedures must be weighed against the burden of colonoscopy: resource use, the potential for patient discomfort, and the risk of complications. Therefore surveillance colonoscopy is best utilised in a selected group of individuals at a high risk of developing cancer. Further study is needed into the specific factors conferring higher risk as well as the efficacy of surveillance in mitigating this risk. Such evidence will better inform clinicians and patients of the relative benefits of colonoscopic surveillance for the individual. In addition, the decision to continue with surveillance must be informed by the changing profile of risks and benefits of further procedures with the patient's advancing age.
Topics: Adenomatous Polyps; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Disease Progression; Early Detection of Cancer; Humans; Predictive Value of Tests; Prognosis; Reproducibility of Results; Risk Factors
PubMed: 26877600
DOI: 10.3748/wjg.v22.i6.1925 -
Acta Radiologica (Stockholm, Sweden :... Feb 2021Dual-energy computed tomography (DE-CT) scans were acquired to identify cholesterol and adenomatous gallbladder (GB) polyps, which have not been well evaluated before... (Comparative Study)
Comparative Study
BACKGROUND
Dual-energy computed tomography (DE-CT) scans were acquired to identify cholesterol and adenomatous gallbladder (GB) polyps, which have not been well evaluated before surgery.
PURPOSE
To evaluate the DE-CT findings of GB polyps 1.0-2.0 cm in size and differentiate between cholesterol and adenomatous polyps.
MATERIAL AND METHODS
Forty-six patients with GB polyps were surgically treated from December 2017 to December 2019 and divided into two groups according to their postoperative pathologic results: a cholesterol group with 26 patients and an adenomatous group with 20 patients. All of these patients underwent DE-CT imaging with tube voltages of 80 kVp and 140 kVp within two weeks before surgery. Mean attenuation values were measured for every GB polyp at 80/140 kVp and at 40/140 keV. The mean attenuation value changes between 140 kVp and 80 kVp (MAVC) and mean attenuation value changes between 100 keV and 40 keV (MAVC) were calculated.
RESULTS
The CT image parameters of all 46 patients with GB polyps were analyzed. There were significant differences in MAVC and MAVC between cholesterol and adenomatous polyps ( <0.05); these values were positive for cholesterol polyps and negative for adenomatous polyps.
CONCLUSION
The unique energy spectrum information provided by DE-CT scans is helpful in differentiating between cholesterol and adenomatous polyps 1.0-2.0 cm in size.
Topics: Adenomatous Polyps; Adult; Aged; Cholecystectomy; Cholesterol; Diagnosis, Differential; Female; Gallbladder; Gallbladder Neoplasms; Humans; Male; Middle Aged; Polyps; Radiographic Image Interpretation, Computer-Assisted; Radiography, Dual-Energy Scanned Projection; Reproducibility of Results; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
PubMed: 32295387
DOI: 10.1177/0284185120916202 -
The American Journal of Gastroenterology Mar 2022
Topics: Adenomatous Polyps; Gastric Fundus; Gastric Mucosa; Humans; Polyps; Stomach Neoplasms
PubMed: 35029159
DOI: 10.14309/ajg.0000000000001593 -
Alimentary Pharmacology & Therapeutics Apr 2004Uncertainty exists as to whether dysplastic polyps in ulcerative colitis should always be managed as dysplasia-associated lesions/masses requiring colectomy, or whether... (Comparative Study)
Comparative Study
BACKGROUND
Uncertainty exists as to whether dysplastic polyps in ulcerative colitis should always be managed as dysplasia-associated lesions/masses requiring colectomy, or whether some can be managed by polypectomy. The prevalence of non-inflammatory polyps in ulcerative colitis is unknown.
AIM
To compare dysplastic polyp occurrence in patients with ulcerative colitis and in patients without inflammatory bowel disease.
METHODS
The clinical, endoscopic and histological records of 150 ulcerative colitis patients (median disease duration, 10 years; 57% with pancolitis) undergoing colonoscopy were scrutinized for any polyp history. Two hundred and five patients undergoing colonoscopy for altered bowel habit, but without features suggestive of polyp presence, were used as a control group. Immunohistochemical staining of flat and polypoid mucosa for p16, beta-catenin, p53 and cyclo-oxygenase-2 was compared in the two groups.
RESULTS
Only six (4%) ulcerative colitis patients had ever had dysplastic polyps. Two had single adenomatous polyps proximal to the colitis segment. Of the four patients with dysplastic polyps within colitic mucosa, two were treated endoscopically, but in two the lesions were considered to be dysplasia-associated lesions/masses and colectomy was advised. In contrast, 24 controls had at least one adenomatous polyp (chi(2) = 6.7, P < 0.01). Ten (6.7%) ulcerative colitis patients and 24 (12%) control patients had metaplastic polyps (N.S.). Immunohistochemical staining was not discriminatory.
CONCLUSION
Despite the increased cancer risk in long-standing ulcerative colitis, adenomatous polyps arise less frequently in ulcerative colitis patients than in patients without ulcerative colitis.
Topics: Adenomatous Polyposis Coli; Biopsy; Colitis, Ulcerative; Colonic Neoplasms; Female; Humans; Immunohistochemistry; Intestinal Mucosa; Male; Middle Aged
PubMed: 15080849
DOI: 10.1111/j.1365-2036.2004.01914.x -
World Journal of Gastroenterology Jan 2016Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often... (Review)
Review
Duodenal polyps or lesions are uncommonly found on upper endoscopy. Duodenal lesions can be categorized as subepithelial or mucosally-based, and the type of lesion often dictates the work-up and possible therapeutic options. Subepithelial lesions that can arise in the duodenum include lipomas, gastrointestinal stromal tumors, and carcinoids. Endoscopic ultrasonography with fine needle aspiration is useful in the characterization and diagnosis of subepithelial lesions. Duodenal gastrointestinal stromal tumors and large or multifocal carcinoids are best managed by surgical resection. Brunner's gland tumors, solitary Peutz-Jeghers polyps, and non-ampullary and ampullary adenomas are mucosally-based duodenal lesions, which can require removal and are typically amenable to endoscopic resection. Several anatomic characteristics of the duodenum make endoscopic resection of duodenal lesions challenging. However, advanced endoscopic techniques exist that enable the resection of large mucosally-based duodenal lesions. Endoscopic papillectomy is not without risk, but this procedure can effectively resect ampullary adenomas and allows patients to avoid surgery, which typically involves pancreaticoduodenectomy. Endoscopic mucosal resection and its variations (such as cap-assisted, cap-band-assisted, and underwater techniques) enable the safe and effective resection of most duodenal adenomas. Endoscopic submucosal dissection is possible but very difficult to safely perform in the duodenum.
Topics: Adenomatous Polyps; Ampulla of Vater; Biopsy; Cholangiopancreatography, Endoscopic Retrograde; Duodenal Neoplasms; Duodenoscopes; Duodenoscopy; Endosonography; Equipment Design; Female; Humans; Intestinal Mucosa; Intestinal Polyps; Male; Middle Aged; Postoperative Complications; Sphincterotomy, Endoscopic; Treatment Outcome
PubMed: 26811610
DOI: 10.3748/wjg.v22.i2.600 -
The American Journal of Clinical... Mar 2012Marine-derived n-3 (omega-3) PUFAs may reduce risk of developing colorectal cancer; however, few studies have investigated the association of n-3 PUFA intakes on...
BACKGROUND
Marine-derived n-3 (omega-3) PUFAs may reduce risk of developing colorectal cancer; however, few studies have investigated the association of n-3 PUFA intakes on colorectal polyp risk.
OBJECTIVE
The objective of this study was to examine the associations of dietary PUFA intake on risk of colorectal adenomatous and hyperplastic polyps.
DESIGN
This was a colonoscopy-based case-control study that included 3166 polyp-free control subjects, 1597 adenomatous polyp cases, and 544 hyperplastic polyp cases. Dietary PUFA intake was calculated from food-frequency questionnaires and tested for association by using unconditional logistic regression. The urinary prostaglandin E(2) metabolite, which is a biomarker of prostaglandin E(2) production, was measured in 896 participants by using liquid chromatography and tandem mass spectrometry.
RESULTS
n-6 PUFAs were not associated with adenomatous or hyperplastic polyps in either men or women. Marine-derived n-3 PUFAs were associated with reduced risk of colorectal adenomas in women only, with an adjusted OR of 0.67 (95% CI: 0.47, 0.97) for the highest quintile of intake compared with the lowest quintile of intake (P-trend = 0.01). Dietary intake of α-linolenic acid was associated with an increased risk of hyperplastic polyps in men (P-trend = 0.03), which was not seen in women. In women, but not in men, dietary intake of marine-derived n-3 PUFAs was negatively correlated with urinary prostaglandin E(2) production (r = -0.18; P = 0.002).
CONCLUSION
Higher intakes of marine-derived n-3 PUFAs are associated with lower risk of adenomatous polyps in women, and the association may be mediated in part through a reduction in the production of prostaglandin E(2). This trial was registered at clinicaltrials.gov as NCT00625066.
Topics: Adenomatous Polyps; Adult; Aged; Biomarkers; Case-Control Studies; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Dietary Supplements; Dinoprostone; Fatty Acids, Omega-3; Female; Humans; Male; Middle Aged; Risk Factors; Surveys and Questionnaires
PubMed: 22277551
DOI: 10.3945/ajcn.111.024000