Colonic Adenomatous Polyps Research Articles

Expression of leptin and p-mTOR and their clinicopathological significance in human colon carcinoma

To investigate the relationship between the expression of leptin, p-mTOR protein and the pathogenesis, development and clinicopathological features in colon carcinoma. The expression of leptin and p-mTOR protein was evaluated by immunohistochemical methods in 40 normal colon mucosas, 40 colon adenomatous polyps and 108 cases of colon carcinomas. The relationship between the staining pattern and clinicopathogical features was examined. The positive rates of detection of leptin in normal colon mucosa, adenomatous polyps and colon carcinomas were 10% (4/40), 27.5% (11/40), and 71.3% (77/108), respectively; with significant differences among the three groups (P<0.05). The positive rates of p-mTOR protein in the normal colon mucosa, the adenomatous polyps, and the colon carcinomas were 2.5% (1/40), 20% (8/40), and 61.1% (66/108), respectively; with significant differences among the three groups (P<0.05). The expression of leptin and p-mTOR proteins were related to invasive depth, TNM stages, lymph node metastasis, distant metastasis and tumor differentiation (P<0.05), but not to age, sex, or site (P>0.05). In colon carcinoma tissues, leptin expression was positively correlated with p-mTOR expression (P<0.01). Leptin and p-mTOR proteins may play important roles in the occurrence and development of colon carcinoma. The detection of leptin and p-mTOR may be helpful for evaluation of the prognosis of the patient with colon carcinoma.

Ileal Pouch Adenomas and Carcinomas After Restorative Proctocolectomy for Familial Adenomatous Polyposis

Restorative proctocolectomy and IPAA has become the treatment of choice in familial adenomatous polyposis. However, several cases of adenomas and carcinomas arising in the ileal pouch were reported. The aim of this study was to evaluate the prevalence and natural history of ileal pouch adenomas and the development of carcinomas in patients with restorative proctocolectomy for familial adenomatous polyposis. We prospectively studied patients who underwent IPAA during the past 20 years at the surgical unit of the University of Florence in Italy. We investigated the extent of the risk and the factors that are involved in the development of neoplastic changes of the pouch. Furthermore, because it is not entirely clear when and how polyps should be treated, we have revised our modality of treatment for this unusual pathology. Sixty-nine patients with familial adenomatous polyposis underwent restorative proctocolectomy. In 66 patients, handsewn ileoanal anastomosis with anal canal mucosectomy was performed. After surgery, all patients underwent endoscopic surveillance. After 10 years of follow-up, 1 ileal pouch adenoma was found in 64.9% of restorative proctocolectomy patients, and ileal pouch carcinomas occurred in 2 patients (29 and 59 years old), 3 and 11 years after restorative proctocolectomy. The number of colonic adenomatous polyps influenced the occurrence of pouch adenomas. No patients with <200 colonic adenomas experienced pouch adenomas, but 46% of patients with >1000 colonic polyps had pouch adenomas, and 25% of patients with 200 to 1000 colonic polyps had pouch adenomas at follow-up. No relationship was found between ileal pouch adenomas and pouch shape (J, S, or straight ileoanal anastomosis with multiple myotomies) or the APC mutation. Polyps larger than 5 mm were removed by endoscopy or surgery. Ileal pouch adenomas were common after restorative proctocolectomy. Patients >50 years of age and patients with >1000 colonic adenomas at the time of colectomy were more prone to ileal pouch adenomas. The development of malignancy in the terminal ileum can present a fast course and does not seem to follow the classic adenoma-carcinoma sequence.

The first mutations in the MYH gene reported in Moroccan colon cancer patients

BackgroundBiallelic germline mutations in the MYH gene cause MYH-associated polyposis (MAP) disease, an autosomal recessive form of inherited colorectal cancer. People with MAP tend to develop attenuated multiple adenomatous colon polyps during their lifetime and will have an increased risk of colorectal cancer. Contrary to familial adenomatous polyposis, the number of adenomas is often lower in MAP (from 5 to 100), and even some patients have recently been reported with no identified adenomas.There have been many investigations into MAP that have been conducted in many different countries. Currently there is limited data on MAP in Morocco, and it is reasonable to think, that the prevalence of this form of genetic predisposition is as high as other autosomal recessive genetic diseases found in countries with high rates of consanguinity.The aim of this study is to examine the frequency of MYH mutations in colorectal cancer and/or attenuated polyposis in Moroccan patients. Patients and methodsThe study population consisted of 62 patients; 52 with colorectal cancer, three of them had attenuated polyposis (2 to 99 adenomatous polyps). 10 other patients were referred to our department for polyposis without colorectal cancer.We carried out DNA analysis in 62 patients to screen for the three recurrent mutations c.494A>G (p.Tyr165Cys), c.1145G>A (p.Gly382Asp) and c.1185_1186dup, p.Glu396GlyfsX43, whereas 40 subjects were screened for germline MYH mutations in the whole coding sequence of the MYH gene by direct DNA sequencing. All these 40 patients, except two, had colorectal cancer without polyposis. ResultsThree patients with colorectal cancer and attenuated polyposis carried biallelic mutations in the MUTYH gene one with the c.494 A>G mutation, one with the c.1105delC mutation, one with the c.1145G>A mutation. One patient with 25 adenomas without colorectal cancer carried the c.1145G>A mutation at a homozygote state and one patient with 3 polyps was heterozygote for the mutation c.1145G>A. No biallelic mutations of MYH gene were detected in colorectal cancer patients and in patients with small number (<5) of polyps without colorectal cancer. ConclusionWe report the first biallelic MYH mutations in four Moroccan patients with clinical criteria of MAP; three of them had colorectal cancer with attenuated polyposis. No MYH mutations were found in colorectal patients without polyposis.Despite the relatively small sample size of the current study, our findings suggest that the MAP is not a frequent cause of colon cancer in Morocco as we had expected, and the molecular analysis of MYH gene should be restricted to patients displaying the classical phenotype of MAP.

First Case Report of Turcot Syndrome Type 1 in Colombia

Turcot syndrome is an autosomal recessive disorder clinically characterized by the occurrence of primary tumors of the central nervous system and adenomatous colonic polyps during the first or second decades of life, with a spectrum of clinical features such as “café-au-lait” spots, axillary freckling, and hyperpigmented spots. Currently its prevalence globally and in Colombia remains unknown. We present the case of a 20-year-old male with a clinical presentation of both glioblastoma multiforme and multiple adenomatous colonic polyps. The molecular genetics study revealed a mutation in KrasAsp12 gene and altered expression of HMSH2 and HMSH6 proteins encoded by the DNA mismatch repair genes in two of the colonic polyps. Even though this clinical presentation may suggest a shorter survival rate, this patient is still alive after seven months of treatment. A literature review complements this report.

Incidental colorectal polyps in positron emission tomography

Fluorodeoxy glucose positron emission tomography/computed tomography (FDG PET/CT) is increasingly being used for diagnosing various malignancies and surveillance of cancer recurrence, staging and screening in high-risk individuals. Due to its high sensitivity in picking up small dysplastic lesions, incidental lesions are detected frequently. We present two patients who underwent PET CT as part of cancer screening and were incidentally detected with adenomatous colonic polyps. Colonoscopy and biopsy confirmed the diagnosis.

Hepatocellular adenoma associated with familial adenomatous polyposis coli

Hepatocellular adenoma (HCA) is a benign liver tumor that most frequently occurs in young women using oral contraceptives. We report a rare case of HCA in a 29 years old female with familial adenomatous polyposis (FAP). The first proband was her sister, who underwent a total colectomy and was genetically diagnosed as FAP. A tumor, 3.0 cm in diameter, was detected in the right lobe of the liver during a screening study for FAP. A colonoscopy and gastroendoscopy revealed numerous adenomatous polyps without carcinoma. The patient underwent a total colectomy and ileo-anal anastomosis and hepatic posterior sectoriectomy. The pathological findings of the liver tumor were compatible with HCA. The resected specimen of the colon revealed multiple colonic adenomatous polyps. Examination of genetic alteration revealed a germ-line mutation of the adenomatous polyposis coli (APC) gene. Inactivation of the second APC allele was not found. Other genetic alterations in the hepatocyte nuclear factor 1 alpha and β-catenin gene, which are reported to be associated with HCA, were not detected. Although FAP is reported to be complicated with various neoplasias in extracolic organs, only six cases of HCA associated with FAP, including the present case, have been reported. Additional reports will establish the precise mechanisms of HCA development in FAP patients.

Oncologic surveillance for subjects with biallelic mismatch repair gene mutations: 10 year follow‐up of a kindred

Heterozygous germline mutations in DNA mismatch repair (MMR) genes cause Lynch syndrome. Biallelic MMR mutations cause a distinct syndrome characterized by brain tumors, lymphoid malignancies, and gastrointestinal cancers during childhood. These children usually succumb to multiple cancers before adulthood. We developed a surveillance protocol aiming at early detection for these individuals and report the 10-year experience with a kindred. On the basis of genetic testing and early age tumors, the kindred started a cancer surveillance protocol based on the crude estimates of cancer risks and available cancer screening: imaging, endoscopy, and hematologic tests. Over the 10-year follow-up period, the screening protocol detected 15 tumors. These included three high-grade adenomatous colonic polyps and two colon cancers. In one child, MRI revealed an asymptomatic anaplastic astrocytoma which was treated by complete resection and radiation. All three cancers identified during surveillance were small and asymptomatic at diagnosis. The two sisters are currently 16 and 18 years of age with no evidence of malignant disease. Both parents have annual colonoscopies and the father at 43 years had two colonic adenomatous polyps. We report on the long-term outcome in patients with biallelic MMR mutations who benefited from prophylactic cancer surveillance. Genetic screening and subsequent surveillance led to earlier recognition of asymptomatic tumors at stages more amenable to resection and probable cure. Multicenter collaboration and implementation of surveillance guidelines is necessary to further determine genotype-phenotype correlations.

Heterotopic Pancreatic Epithelium in the Colon

Purpose: Heterotopic pancreatic tissue is frequently found in stomach and small intestine. However, endoscopists do not expect to find pancreatic tissue in the colon. A 62-year-old man underwent colonoscopy for persistent left lower quadrant abdominal pain and hematochezia for several months. Colonoscopy revealed three small sessile adenomatous polyps in the transverse colon, hepatic flexure and sigmoid colon; all were completely resected. In addition, a fourth 1.1 cm villous, friable and pedunculated polyp was completely removed from the sigmoid colon using snare cautery polypectomy. Histopathologic evaluation of hematoxylin and eosin-stained slides revealed ectopic pancreatic columnar epithelium in this fourth polyp. Cells did not have dysplastic features such as hyperchromatic, crowded nuclei. Immunohistochemical stains confirmed the diagnosis of ectopic pancreatic epithelium with positive results for cytokeratin 7 (CK7) and cytokeratin 20 (CK20); these features distinguish ectopic pancreatic epithelial cells from colonic epithelium which would be positive for CK20 but are always negative for CK7. The prevalence of heterotropic pancreatic epithelium in the colon is not known. In a study of 212 cases with heterotropic pancreatic tissue from the Mayo Clinic, no colonic involvement was reported. In most instances, ectopic pancreatic tissue is asymptomatic clinically and manifests as an incidental submucosal nodule found during upper GI endoscopy. However, in this case, a friable polyp containing pancreatic epithelium resulted in rectal bleeding and abdominal pain which resolved with polypectomy. This is the first case of heterotopic pancreatic tissue found in the sigmoid colon.Figure: Heterotopic polypoid pancreatic epithelium in the sigmoid colon.Figure: Heterotopic pancreatic epithelium; hematoxylin and eosin stain.

30 Year Old Female with Signet Ring Adenocarcinoma of the Rectum

Purpose: The pt is a 30 year old female with no significant PMH who presented with a chief complaint of rectal pain for 8 months. The pain was pressure-like, progressively worsening and associated with thin caliber blood streaked stools. ROS remarkable for 20 lbs weight loss, poor appetite, left lower quadrant discomfort, constipation, intermittent BRBPR with tenesmus. There is no FH of CRC. On physical exam abdomen was tender and DRE revealed exquisite tenderness with a large fixed, firm mass 2 cm from the anal verge and guaiac + brown stool. Lab work was showed iron deficiency anemia. On trans-vaginal U/S there was a heterogenous lesion in the lumen of the rectum. CT A/P w/contrast illustrated circumferential thickening of the rectum laterally displacing uterus with associated lymphadenopathy. Colonoscopy revealed a 4 cm stricture with friable mucosa and irregular vascular pattern. Bx confirmed the dx of signet ring adenocarcinoma of the rectum. Complete staging was done with PET CT/MRI: Stage IIIBT3N1M0. Pt completed neoadjuvant chemo RT with 5-FU + leucovorin, followed by abdominoperineal resection w/o complications. CRC is the 3rd most commonly diagnosed cancer and the 2nd leading cause of cancer death in the U.S. Over 142,000 pts will be diagnosed this year and over 50,000 will die from CRC this year alone. Typically most pts are diagnosed after the age of 55, but 7% of pts are actually diagnosed under the age of 40. Young patients present w/ colonic obstruction and interventions are limited at that stage. It is important to risk stratify these pts early as apart their routine health care maintenance exam. Personal and family history of CRC or polyps are important to note. These pts require further evaluation beginning with a DRE to evaluate for a structural lesion. Significant FH is one that includes a first-degree relative with CRC or an adenomatous polyp at the age of 60 or older or 2 second-degree relatives affected with CRC; these pts must begin screening at the age of 40. If the pt has two or more first-degree relative with CRC of any age or a single first degree relative with colon cancer or adenomatous polyps diagnosed at an age less than 60 years then they should undergo colonoscopy every 5 years beginning at the age of 40 or 10 years younger than the earliest diagnosis in the family, whichever comes first. Pts with special considerations and who may require earlier screening are those with personal history of IBD, HNPCC, FAP and Peutz-Jegher. In summary, no matter the age of your pt, blood in the stool is not a benign complaint. It warrants a DRE and further risk stratification and history taking.

Near-infrared autofluorescence spectroscopy for in vivo identification of hyperplastic and adenomatous polyps in the colon

This study reports the implementation of an endoscope-based near-infrared (NIR) autofluorescence (AF) spectroscopy technique for in vivo differentiation of normal, hyperplastic and adenomatous colonic polyps during clinical colonoscopic examination. A total of 198 in vivo NIR AF spectra in the range of 810–1050 nm were acquired from colonic tissues (normal ( n = 116); hyperplastic ( n = 48); and adenomatous polyps ( n = 34)) of 96 patients undergoing colonoscopic screening. Significant differences ( p < 0.001, one-way analysis of variance (ANOVA)) in in vivo NIR AF intensity among normal, hyperplastic, and adenomatous polyps are observed. Multivariate statistical techniques, including principal components analysis (PCA) and linear discriminate analysis (LDA) together with the leave-one tissue site-out, cross-validation, were used to develop diagnostic algorithms for distinguishing adenomatous polyps from normal and hyperplastic colonic polyps based on NIR AF spectral features. The PCA–LDA modeling on in vivo colonic NIR AF dataset yields diagnostic sensitivities of 83.6%, 77.1%, and 88.2%; and specificities of 96.3%, 88.0%, and 92.1%, respectively, for classification of normal, hyperplastic and adenomatous colonic polyps. This work suggests that NIR AF spectroscopy associated with PCA–LDA algorithms has potential for in vivo diagnosis and detection of colonic precancer at colonoscopy.

Abstracts and Case Studies From the College of American Pathologists 2011 Annual Meeting (CAP '11)

Abstracts and Case Studies From the College of American Pathologists 2011 Annual Meeting (CAP '11)

Is Obesity a Risk Factor for Advanced Colon Polyps in Males?

Obesity is associated with an increased risk of development of colonic adenomatous polyps and colorectal cancer. However, the influence of obesity on the development of advanced colon polyps is not clear. We examined the relationship between advanced colon polyps and obesity in health check-up subjects in Korea. A total of 232 adenomatous polyp patients diagnosed with colonoscopy during cancer screening between January 2005 and June 2008 were included in this study. An advanced polyp was defined as an adenomatous polyp with one or more of the following features: (1) a diameter of 1cm or larger, (2) a villous histology, and (3) high-grade dysplasia or adenocarcinoma. Total fat area, visceral fat area, and subcutaneous fat area were measured using abdominal computed tomography to evaluate abdominal obesity. Of the 232 patients, 175 (75.43%) were male and 57 (24.57%) were female. Among the 232 patients, 77 patients (33.2%) had advanced polyps. Furthermore, males with advanced polyp had a significantly higher BMI, total abdominal fat area, and visceral fat area than females. Advanced polyps were positively associated with polyp number, BMI, total fat area, subcutaneous fat area, and visceral fat area in males with multivariate analysis. Our data suggest that abdominal obesity is associated with the presence of advanced colon polyps in male.

Association of Helicobacter pylori Infection with the Development of Colorectal Polyps and Colorectal Carcinoma

Recent studies have suggested a possible association between Helicobacter pylori (HP) infection and colon neoplasia. HP infection causes hypergastrinemia, and gastrin increases colorectal mucosal proliferation, potentially leading to colorectal cancer. We investigated whether HP infection is associated with colon neoplasia. We conducted a cross-sectional, single-center study in which patients who underwent routine outpatient colonoscopy and were tested for HP infection on esophagogastroduodenoscopy from January 1, 2008 to November 1, 2009 were identified. Patient demographic data (gender and age) and information on colon polyp characteristics (size, number of polyps, location, morphology, and histology) were abstracted from retrospective chart review. Presence of adenoma/carcinoma was compared in the HP-positive cases and HP-negative controls. A total of 192 patients were included in the study, with 96 patients each in the HP-positive and -negative groups. The two groups did not differ significantly in gender, age, polyp size, number of polyps, polyp location, morphology, and histology. Adenomatous colon polyps were noted in 31% of the HP-positive cases and in 26% of the HP-negative controls (P = 0.52). Colon carcinoma was found in 6% of HP-positive and 2% of HP-negative patients (P = 0.28). The higher prevalence of adenomatous colon polyps/carcinoma in HP-positive patients compared to HP-negative patients was not statistically significant. Larger studies are needed to examine further the potential association between HP infection and colorectal adenoma/carcinoma.

The Submucosal Cushion Does Not Improve the Histologic Evaluation of Adenomatous Colon Polyps Resected by Snare Polypectomy

Although the "submucosal cushion" technique or injection-assisted polypectomy (IAP) is often used to resect colon polyps, little is known on the influence of this technique on histologic interpretation. We aimed to evaluate whether the use of a submucosal cushion improves the histologic and margin evaluation of colon polyps. Consecutive patients undergoing polypectomy with and without IAP were included. An experienced blinded gastrointestinal pathologist evaluated the specimens using standardized criteria. One hundred eleven sessile colon adenomas were analyzed (IAP, n = 65, standard, n = 46). Two-thirds of polyps ranged in size from 10 to 20 mm; the average polyp size was 13.2 mm for IAP and 9.9 mm for standard snare polypectomy (P = .001). The cautery degree, cautery amount, and margin evaluability, did not differ substantially with regard to the resection technique. For polyps ≥10-20 mm, the overall architecture quality was better in polyps resected with standard technique as compared with IAP. The utilization of IAP did not result in a better margin evaluability of the resected polyp. Overall, IAP does not result in a better histologic polyp evaluability.

Devices to improve colon polyp detection

Colon cancer is the second leading cause of cancer death in the United States. 1 Jemal A. Siegel R. Ward E. et al. Cancer statistics, 2008. CA Cancer J Clin. 2008; 58: 71-96 Crossref PubMed Scopus (10171) Google Scholar Colonoscopy is used to screen for colon cancer and adenomatous polyps. 2 U.S. Preventive Services Task ForceScreening for colorectal cancer: recommendation and rationale. Ann Intern Med. 2002; 137: 129-131 Crossref PubMed Scopus (550) Google Scholar , 3 Levin B. Lieberman D.A. McFarland B. et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008; 58: 130-160 Crossref PubMed Scopus (1378) Google Scholar Polyp detection rates depend on the proportion of mucosal surface inspected and have been correlated with the time dedicated to inspection during colonoscope withdrawal. 4 Barclay R.L. Vicari J.J. Doughty A.S. et al. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med. 2006; 355: 2533-2541 Crossref PubMed Scopus (1074) Google Scholar A significant number of polyps are missed during colonoscopy, and in a review of studies using back-to-back colonoscopy design, the pooled miss rate for all polyps was reported to be 22% (95% CI, 19%-26%). 5 van Rijn J.C. Reitsma J.B. Stoker J. et al. Polyp miss rate determined by tandem colonoscopy: a systematic review. Am J Gastroenterol. 2006; 101: 343-350 Crossref PubMed Scopus (1022) Google Scholar The adenoma miss rate was 2% for lesions 10 mm or larger (95% CI, 0.3%-7.3%), 13% for lesions 5 to 10 mm (95% CI, 8%-18%) and 26% for lesions 1 to 5 mm (95% CI, 27%-35%).

The association of serum lipids with the histological pattern of rectosigmoid adenoma in Taiwanese adults.

BackgroundThe mortality rate of colorectal cancer ranks third behind lung and hepatic cancer in Taiwan. Colorectal cancer mostly arises from adenomatous polyps of left colon. The aim of our study was to examine the association of serum lipids with the histological pattern of rectosigmoid adenoma.MethodsThere were 2,506 eligible examinees aged 20 and above who underwent sigmoidoscopy as a screening examination in National Cheng Kung University Hospital between January 2003 and October 2006. They were classified into three groups: tubular adenoma (333 subjects), villous-rich (tubulovillous/villous) adenoma (53 subjects) and normal (2,120 subjects). We defined high total cholesterol (TC) as a level ≧200 mg/dl, low high-density lipoprotein cholesterol (HDL-C) as a level <40 mg/dL, and high triglyceride (TG) as a level ≧200 mg/dl according to the third report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Adenoma histology was classified as tubular, tubulovillous and villous according to the proportion of villous part.ResultsAmong the study population, 333 subjects (13.3%) had tubular adenomas and 53 subjects (2.1%) had villous-rich adenomas. The odds ratio (OR) for villous-rich adenoma in subjects with TG≧200 mg/dL compared to those with TG < 200 mg/dL was 3.20 (95% confidence interval [CI]:1.71-6.01), after adjusting for age, gender, general obesity, central obesity, diabetes, hypertension, smoking, and alcohol consumption. If further taking high TC and low HDL-C into consideration, the OR was 4.42 (95% CI:2.03-9.63).ConclusionsOur study showed that subjects with high serum TG tended to have a higher risk of tubulovillous/villous adenoma in rectosigmoid colon. Therefore, reducing the serum TG level might be one method to prevent the incidence of colorectal cancer.

Application of Near-Infrared Fluorescence Imaging Using a Polymeric Nanoparticle-Based Probe for the Diagnosis and Therapeutic Monitoring of Colon Cancer

Early and accurate detection of adenomatous colonic polyps is a major concern in the prevention of colon cancer. Near-infrared fluorescence (NIRF) imaging with optical probes targeting specific peptides enables the noninvasive visualization and characterization of lesions. Matrix metalloproteinases (MMPs) are known to play an important role in tumorigenesis and tumor progression. To investigate the effectiveness of NIRF imaging, with a novel MMP-activatable probe based on a polymeric nanoparticle platform, in the colon cancer models. We used an azoxymethane (AOM)-induced mouse colon cancer model resembling human sporadic colon cancer and an MMP-positive xenograft tumor model. MMP expression was evaluated by Western blotting, real-time PCR, and immunohistochemical staining. NIRF imaging was performed with a novel MMP-activatable probe, an MMP-inactivatable probe, and saline. In addition, we observed the change of NIRF signal intensity after intratumoral administration of an MMP-inhibitor. Multiple tumors with various sizes developed in AOM-treated mouse colons, progressing from adenomas to adenocarcinomas, with MMP expression progressively increasing in the normal-adenoma-adenocarcinoma sequence. In mice injected with the MMP-activatable probe, the NIRF signal also increased in this sequence and was highly correlated with MMP expression (p<0.001). Tumor-background-ratios (TBR) of adenocarcinoma to adjacent normal mucosa by a novel probe were significantly higher than that of adenoma (p<0.001). In both the AOM and xenograft models, NIRF signals of tumors decreased after treatment with an MMP-inhibitor. NIRF imaging using a polymeric nanoparticle-based probe may be useful for detecting early stage disease and for assessing treatment response.

Sa1662 Clinical Association Between Microsatellite Instability in Early Gastric Cancer and Colon Adenomatous Polyp

The association of microsatellite instability (MSI) and colorectal cancer has been studied. However, it is unknown whether early gastric cancer (EGC) patients with MSI are at higher risk for colon adenomatous polyp

Tu1455 Comparison of Physician, Endoscopic and Patient Characteristics Between High and Low Polyp Detectors

Prevention of colorectal cancer depends on the timely detection and removal of adenomatous colon polyps. While the adenoma detection rate (ADR) is a frequently used quality measure for colonoscopy, the overall polypectomy rate (PR) has recently been suggested as another quality indicator because it is easy to measure and has good correlation with the ADR. However, the PR varies widely among endoscopists, and the factors leading to this variation are not entirely known. To compare endoscopic, patient and physician characteristics between endoscopists with a high PR and a low PR. A retrospective chart review was completed for all patients who underwent colonoscopy between January and December 2009. Colonoscopy performed for anemia, bleeding and/or inflammatory bowel disease was excluded. The ADR was defined as the detection of at least one adenoma per colonoscopy, and the PR was defined as the proportion of procedures in which at least one polyp was removed. Based on recent studies, a 40% PR was determined to correspond to the benchmark ADR of 25%. ADR and PR for individual endoscopists were calculated, and endoscopists were categorized into two groups: a) Low PR ≤ 40% b) high PR ≥ 40%. Demographic, endoscopic and physician factors were compared between the two groups using chi-square, t-tests, and generalized linear models to control for clustered data. Data are presented as mean ± SD and proportions, in the format: (low PR vs high PR). Data were collected from 4574 colonoscopies performed by 19 endoscopists. Physician factors did not differ significantly between low PR and high PR groups: experience (17±10 vs 14±7 yrs, P=0.46), colonoscopy volume (211±107 vs 273±104, P=0.21) and endoscopists' gender (70% M vs 89% M, P=0.58). The patient sample did not differ in age (62 ± 12 vs 62 ± 12 yrs, P = 0.434) or BMI (29 ± 23 vs 28 ± 10, P=0.41), but included more males (48% vs 53%, P<0.001) in the high PR group. The proportion of patients with good tolerance (80% vs 83%, P<0.001) and good quality of bowel preparation (92% vs 88%, P <0.001) were significantly different between two groups, but there was no significant difference in incomplete colonoscopies (6% vs 7%, P =0.11) or the largest size of resected polyps (6±13 vs 6±7mms, P=0.53). The ADR (21% vs 30%, P<0.001) and withdrawal time (9 ± 6 vs 13 ± 8 mins, P<0.001) were significantly lower in the low PR group compared to high PR group. Data from this large patient sample showed that higher polypectomy rates among endoscopists were associated with better patient tolerance, male patient population and longer withdrawal times. Further prospective studies are needed to confirm our findings and derive the factors needed to improve adenoma and polyp detection.

Colonoscopic surveillance and follow up in patients with acromegaly

IntroductionThe prevalence of colonic polyps and cancer in patients with acromegaly group has remained controversial despite some earlier reports which regarded this group of patients as high risk for developing...