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Gastrointestinal Endoscopy Jul 2019Serrated polyposis syndrome (SPS) increases colorectal cancer risk. We describe the numbers of colonoscopies and polypectomies performed to achieve and maintain low...
BACKGROUND AND AIMS
Serrated polyposis syndrome (SPS) increases colorectal cancer risk. We describe the numbers of colonoscopies and polypectomies performed to achieve and maintain low polyp burdens, and the feasibility of expanding surveillance intervals in patients who achieve endoscopic control.
METHODS
We retrospectively evaluated a prospectively collected database on 115 patients with SPS undergoing surveillance at Indiana University Hospital between June 2005 and May 2018. The endoscopist provided surveillance interval recommendations based on polyp burden. Endoscopic control was considered successful if surveillance examinations exhibited fewer polyps and if no or only an occasional polyp ≥1 cm in size was present at follow-up. Initial control was designated as the clearing phase and the maintenance phase was surveillance after control was established.
RESULTS
In total, 87 patients (75.7%) achieved endoscopic control, with some others currently in the clearing phase. Achieving control required a mean of 2.84 colonoscopies (including the baseline) over 20.4 months and a mean total of 27.9 polyp resections. After establishing control, 71 patients were recommended to receive ≥24-month follow-up. Of those, 60 patients (69.0% of patients with initial control) continued surveillance at our center. The mean interval between colonoscopies during maintenance was 19.3 months with 6.74 mean polypectomies per procedure on polyps primarily <1 cm. There were no incident cancers or colon surgeries during maintenance.
CONCLUSION
Most patients achieved control of polyp burden with 2 to 3 colonoscopies over 1 to 2 years. After reaching control, 60 patients returned at intervals up to 24 months with no incident cancers and no surgeries required. Expansion of surveillance intervals to 24 months is effective and safe for many patients with SPS who reach control of polyp burden.
Topics: Adenomatous Polyps; Aftercare; Aged; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Endoscopic Mucosal Resection; Feasibility Studies; Female; Humans; Hyperplasia; Male; Middle Aged; Retrospective Studies; Syndrome; Tumor Burden
PubMed: 30465771
DOI: 10.1016/j.gie.2018.11.016 -
BMC Gastroenterology Feb 2021Single nucleotide polymorphism (SNP)-based polygenic risk scoring is predictive of colorectal cancer (CRC) risk. However, few studies have investigated the association...
BACKGROUND
Single nucleotide polymorphism (SNP)-based polygenic risk scoring is predictive of colorectal cancer (CRC) risk. However, few studies have investigated the association of genetic risk score (GRS) with detection of adenomatous polyps at screening colonoscopy.
METHODS
We randomly selected 1769 Caucasian subjects who underwent screening colonoscopy from the Genomic Health Initiative (GHI), a biobank of NorthShore University HealthSystem. Outcomes from initial screening colonoscopy were recorded. Twenty-two CRC risk-associated SNPs were obtained from the Affymetrix™ SNP array and used to calculate an odds ratio (OR)-weighted and population-standardized GRS. Subjects with GRS of < 0.5, 0.5-1.5, and > 1.5 were categorized as low, average and elevated risk.
RESULTS
Among 1,769 subjects, 520 (29%) had 1 or more adenomatous polyps. GRS was significantly higher in subjects with adenomatous polyps than those without; mean (95% confidence interval) was 1.02 (1.00-1.05) and 0.97 (0.95-0.99), respectively, p < 0.001. The association remained significant after adjusting for age, gender, body mass index, and family history, p < 0.001. The detection rate of adenomatous polyps was 10.8%, 29.0% and 39.7% in subjects with low, average and elevated GRS, respectively, p-trend < 0.001. Higher GRS was also associated with early age diagnosis of adenomatous polyps, p < 0.001. In contrast, positive family history was not associated with risk and age of adenomatous polyps.
CONCLUSIONS
GRS was significantly associated with adenomatous polyps in subjects undergoing screening colonoscopy. This result may help in stratifying average risk patients and facilitating personalized colonoscopy screening strategies.
Topics: Adenomatous Polyps; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Humans; Mass Screening; Risk Factors
PubMed: 33579203
DOI: 10.1186/s12876-021-01645-4 -
Journal of Feline Medicine and Surgery Feb 2017Objectives The aim of the study was to report the ultrasonographic and clinicopathological findings in cats with confirmed pyloroduodenal adenomatous polyps. Methods...
Objectives The aim of the study was to report the ultrasonographic and clinicopathological findings in cats with confirmed pyloroduodenal adenomatous polyps. Methods Clinicopathological data, ultrasonographic and histopathological findings were collected retrospectively from medical records. Results Pyloroduodenal polyps appeared as small moderately echogenic and homogeneous nodules filling most of the proximal duodenal or pyloroduodenal lumen. The most common presenting signs in this study included acute vomiting and anorexia in 4/6 cats and lethargy in 3/6 cats. Two cats presented with severe anemia, suggestive of active bleeding. One cat presented with increased bilirubin without anemia, suggestive of impaired bile flow. Five cats survived surgical removal of the polyp and were free of clinical signs 817 days after the procedure. Conclusions and relevance Pyloroduodenal polyps have subtle ultrasonographic changes that can easily be mistaken for ingesta. They are characterized by a discrete small (up to 1.5 cm in diameter) homogeneous echogenic nodule filling the pyloroduodenal lumen. Pyloroduodenal polyps are benign lesions but can cause severe clinical signs including gastrointestinal bleeding or biliary obstruction. The prognosis is excellent with surgical removal.
Topics: Adenomatous Polyps; Animals; Cat Diseases; Cats; Diagnosis, Differential; Duodenal Neoplasms; Female; Male; Prognosis; Retrospective Studies; Stomach Neoplasms; Ultrasonography, Doppler; Vomiting
PubMed: 26614062
DOI: 10.1177/1098612X15619206 -
Clinical and Translational... Apr 2020The prognosis of Cronkhite-Canada syndrome (CCS) is considered poor. Despite the recent therapeutic improvements, the survival outcomes and prognostic factors have been...
INTRODUCTION
The prognosis of Cronkhite-Canada syndrome (CCS) is considered poor. Despite the recent therapeutic improvements, the survival outcomes and prognostic factors have been less studied. This study aimed to investigate the long-term clinical and endoscopic outcomes of CCS.
METHODS
Thirty-one patients diagnosed since 1999 and followed up for over 6 months were included. Data regarding survival outcomes, clinical symptoms, endoscopic findings, and treatment were collected and analyzed. R (version 3.6.1) was used to perform the survival analyses.
RESULTS
The median (interquartile range) follow-up time was 42.5 (19.5-85.8) months. The 5-year overall survival (OS) was 87.4%. The maximum gastric polyp size over 2 cm was associated with worse OS (Hazard ratio [HR]: 18, 95% confidence interval [CI]: 1.6-210, P = 0.021). The 3-year relapse-free survival (RFS) after corticosteroid treatment was 66.8%. Age older than 60 years (HR: 7.0, 95% CI: 1.5-33.0, P = 0.015) and maximum gastric polyp size over 2 cm (HR: 6.0, 95% CI: 1.6-23.0, P = 0.009) were associated with worse RFS. Twenty-three patients received follow-up endoscopic examinations, with a median (interquartile range) follow-up time of 29.0 (14.0-53.5) months. Eight (34.8%) and 12 (52.2%) patients achieved complete remission under gastroscopy and colonoscopy, respectively. Colonic lesions showed a tendency of earlier responses compared with gastric lesions (25.0 [11.3-39.8] months vs 31.0 [21.0-39.8] months).
DISCUSSION
Patients with CCS usually responded well to glucocorticoids with a fairly good 5-year survival rate. Large gastric polyp was associated with worse OS and RFS, whereas age older than 60 years was another predictor for worse RFS. Diffuse gastrointestinal lesions partly or completely resolved after treatment, and colonic lesions showed a better response than gastric lesions.
Topics: Adenomatous Polyps; Age Factors; Colon; Colonoscopy; Disease-Free Survival; Female; Follow-Up Studies; Gastric Mucosa; Gastroscopy; Glucocorticoids; Humans; Intestinal Mucosa; Intestinal Polyposis; Male; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Risk Assessment; Risk Factors; Stomach; Stomach Neoplasms; Survival Rate
PubMed: 32352683
DOI: 10.14309/ctg.0000000000000167 -
Gut and Liver Nov 2014Hyperplastic or serrated polyps were once believed to have little to no clinical significance. A subset of these polyps are now considered to be precursors to colorectal... (Review)
Review
Hyperplastic or serrated polyps were once believed to have little to no clinical significance. A subset of these polyps are now considered to be precursors to colorectal cancers (CRC) in the serrated pathway that may account for at least 15% of all tumors. The serrated pathway is distinct from the two other CRC pathways and involves an epigenetic hypermethylation mechanism of CpG islands within promoter regions of tumor suppressor genes. This process results in the formation of CpG island methylator phenotype tumors. Serrated polyps are divided into hyperplastic polyps, sessile serrated adenomas/polyps (SSA/Ps), and traditional serrated adenomas (TSAs). The SSA/P and the TSA have the potential for dysplasia and subsequent malignant transformation. The SSA/Ps are more common and are more likely to be flat than TSAs. Their flat morphology may make them difficult to detect and thus explain the variation in detection rates among endoscopists. Challenges for endoscopists also include the difficulty in pathological interpretation as well surveillance of these lesions. Furthermore, serrated polyps may be inadequately resected by endoscopists. Thus, it is not surprising that the serrated pathway has been linked with interval cancers. This review will provide the physician or clinician with the knowledge to manage patients with serrated polyps.
Topics: Adaptor Proteins, Signal Transducing; Adenomatous Polyps; Colonoscopy; Colorectal Neoplasms; DNA Methylation; Humans; Intestinal Polyposis; Intestinal Polyps; MutL Protein Homolog 1; Nuclear Proteins; Proto-Oncogene Proteins; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins p21(ras); ras Proteins
PubMed: 25368744
DOI: 10.5009/gnl14248 -
Gastrointestinal Endoscopy Oct 2019There has been a tremendous increase in research focused on quality metrics in colonoscopy since 2000. However, whether national performance in colonoscopy quality...
BACKGROUND AND AIMS
There has been a tremendous increase in research focused on quality metrics in colonoscopy since 2000. However, whether national performance in colonoscopy quality outcomes has changed significantly since then is not as well known.
METHODS
We examined colonoscopy data collected prospectively through the Clinical Outcomes Research Initiative, which included 84 GI practice sites from 2000 to 2014 for patients undergoing colonoscopy for multiple indications. Colonoscopy outcomes by indication were compared across three 5-year periods (2000-2004, 2005-2009, 2010-2014) using the following metrics: bowel preparation quality (percentage good/excellent), finding a polyp, finding 2 or more polyps, and finding a polyp >9 mm. Multivariate logistic regression was used to generate odds ratios and 95% confidence intervals for each time period while controlling for age, gender, and race/ethnicity.
RESULTS
A total of 1,541,837 adults were included in the study across all indication groups. The average-risk screening group (390,741 adults) demonstrated statistically significant improvement across all 4 quality metrics when comparing the baseline period with the final time period. Bowel preparation quality improved across all indications when comparing the baseline period with the final time period. Finding a polyp, finding 2 or more polyps, and finding a polyp >9 mm improved in the average-risk screening, surveillance, and diagnostic indication groups when comparing the baseline period with the final time period. The increased-risk screening and inflammatory bowel disease indication groups did not see improvements beyond bowel preparation quality when comparing the baseline with the final time period.
CONCLUSION
Colonoscopy outcomes as measured by bowel preparation quality, finding a polyp, finding 2 or more polyps, and finding a polyp >9 mm improved significantly over the 15-year period between 2000 and 2014, with the largest and most consistent impact in the average-risk screening indication group.
Topics: Adenoma; Adenomatous Polyps; Adult; Aged; Aged, 80 and over; Colonic Polyps; Colonoscopy; Colorectal Neoplasms; Early Detection of Cancer; Female; Humans; Male; Middle Aged; Preoperative Care; Quality Improvement; Quality Indicators, Health Care; Watchful Waiting; Young Adult
PubMed: 31207221
DOI: 10.1016/j.gie.2019.06.004 -
World Journal of Gastroenterology Feb 2015Screening for colorectal cancer (CRC) has been associated with a decreased incidence and mortality from CRC. However, patient adherence to screening is less than... (Review)
Review
Screening for colorectal cancer (CRC) has been associated with a decreased incidence and mortality from CRC. However, patient adherence to screening is less than desirable and resources are limited even in developed countries. Better identification of individuals at a higher risk could result in improved screening efforts. Over the past few years, formulas have been developed to predict the likelihood of developing advanced colonic neoplasia in susceptible individuals but have yet to be utilized in mass screening practices. These models use a number of clinical factors that have been associated with colonic neoplasia including the body mass index (BMI). Advances in our understanding of the mechanisms by which obesity contributes to colonic neoplasia as well as clinical studies on this subject have proven the association between BMI and colonic neoplasia. However, there are still controversies on this subject as some studies have arrived at different conclusions on the influence of BMI by gender. Future studies should aim at resolving these discrepancies in order to improve the efficiency of screening strategies.
Topics: Adenomatous Polyps; Body Mass Index; Colonic Polyps; Colorectal Neoplasms; Early Detection of Cancer; Forecasting; Humans; Obesity; Patient Selection; Predictive Value of Tests; Risk Assessment; Risk Factors
PubMed: 25663756
DOI: 10.3748/wjg.v21.i5.1371 -
Scientific Reports Sep 2018The characteristics of the gastric microbiota in patients with gastric polyposis (GP) remain unclear. Given this we collected gastric antrum and gastric body biopsies...
The characteristics of the gastric microbiota in patients with gastric polyposis (GP) remain unclear. Given this we collected gastric antrum and gastric body biopsies from healthy controls (HC.A and HC.B group) and gastric antrum, gastric body and polyp biopsies from patients with multiple gastric polyps (GP.A, GP.B and GP.P group) for 16S rDNA sequencing. The results showed that the diversity of the gastric flora in the GP group was significantly lower than that of the HC group. The gastric flora composition of the GP group was significantly different from the HC group. However, flora diversity and compositions in different parts of the stomach (gastric antrum, gastric body or polyp tissue) were not significantly different. H. pylori abundance could influence the composition of gastric microbiota. Meanwhile, patients with fundic gland polyps (FGPs) and those with hyperplastic polyps (HPs) had considerably similar gastric bacterial compositions. We constructed a microbial dysbiosis index (MDI) based on the gastric microbiota at the genus level as a predictive model, and it was able to distinguish between individuals in the GP and HC groups. These findings showed that intragastric flora dysbiosis may be closely related to the occurrence and development of gastric polyps.
Topics: Adenomatous Polyposis Coli; Adenomatous Polyps; Adult; Aged; Biopsy; China; Female; Gastric Fundus; Gastric Mucosa; Gastrointestinal Microbiome; Helicobacter pylori; Humans; Male; Microbiota; Middle Aged; Polyps; Pyloric Antrum; Stomach; Stomach Neoplasms
PubMed: 30217998
DOI: 10.1038/s41598-018-31738-2 -
Experimental and Clinical... Dec 2017Transplant centers often recommend, but not necessarily require, screening colonoscopies for people over 50 years of age in accordance with the US Preventative Services...
OBJECTIVES
Transplant centers often recommend, but not necessarily require, screening colonoscopies for people over 50 years of age in accordance with the US Preventative Services Task Force guidelines for the general population. We sought to identify risk factors affecting colonoscopy results in renal failure patients undergoing kidney transplant evaluation.
MATERIALS AND METHODS
We retrospectively examined patients undergoing kidney transplant evaluation from 2009 to 2012 (n = 469 patients). Comparisons were made between colonoscopy reports categorized as normal (no finding or hyperplastic polyp) or abnormal (adenomatous polyp or carcinoma).
RESULTS
Of 469 patients who met the study criteria, 303 (64.6%) had normal colonoscopies and 166 (35.4%) had abnormal colonoscopies. Logistic regression analysis showed that male sex (odds ratio = 2.09; 95% confidence interval, 1.37-3.20; P = .001) and increasing age (odds ratio = 1.04; 95% confidence interval, 1.01-1.08; P = .019) were more likely to correspond to abnormal findings. Those with dialysis vintage (length of time on dialysis) up to 3 years (odds ratio = 2.10; 95% confidence interval, 1.09-4.06; P = .027) and hypertension as the cause of renal failure (odds ratio = 1.79; 95% confidence interval, 1.05-2.87; P = .002) had more abnormal findings. No differences in length of evaluation, rate of being listed for transplant, and rate of transplant were shown.
CONCLUSIONS
The overall rate of adenomatous findings on colonoscopy was higher among patients with pretransplant end-stage renal disease than in the general population, as shown in other studies. Age, sex, dialysis vintage up to 3 years, and hypertensive renal failure were associated with adenomatous polyps of the colon in this study population. Because adenomatous polyp rates are high in patients with chronic kidney disease who are undergoing transplant evaluation and colonoscopic findings do not appear to delay transplant evaluations or listing rates, screening colonoscopies should be encouraged.
Topics: Adenomatous Polyps; Aged; Carcinoma; Chi-Square Distribution; Colonic Neoplasms; Colonic Polyps; Colonoscopy; Female; Humans; Hypertension; Kidney Failure, Chronic; Kidney Transplantation; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Renal Dialysis; Retrospective Studies; Risk Factors; Waiting Lists
PubMed: 28621634
DOI: 10.6002/ect.2016.0214 -
Journal of Medical Case Reports Apr 2023Villous adenoma is the one subtype of adenomatous polyp that is very uncommon in the stomach. Data regarding clinical characteristics, natural history, and prognosis... (Review)
Review
BACKGROUND
Villous adenoma is the one subtype of adenomatous polyp that is very uncommon in the stomach. Data regarding clinical characteristics, natural history, and prognosis were scarce.
CASE PRESENTATION
This report presented an 87-year-old Thai woman with a large gastric villous adenoma incidentally revealed in a computed tomography of chest for the evaluation of right pleural effusion. The esophagogastroduodenoscopy demonstrated a huge, glossy, proliferative polypoid mass involving gastric cardia, fundus, and a lesser curve of the upper body. The pathological report confirmed villous adenoma with low grade dysplasia. Although surgical resection was suggested, the patient denied any treatment due to advanced age and multiple comorbidities. She was generally well after 12 months of clinical and radiologic surveillance.
CONCLUSION
From literature review, only 14 cases of gastric villous adenoma were reported to date. Most of the lesions were large and symptomatic. Malignancy presented in 43% of the cases. Nevertheless, our patient remained asymptomatic without surgical removal following a 12-month period.
Topics: Female; Humans; Aged, 80 and over; Adenoma, Villous; Adenomatous Polyps; Stomach Neoplasms; Polyps
PubMed: 37098577
DOI: 10.1186/s13256-023-03893-2