Cancer Polyps Research Articles

Incidence of Colorectal Cancer and Adenomatous Polyps After a Two-Step Screening in Isfahan Province, Iran in 2018.

The aim of this study was to estimate the incidence of colorectal cancers in Iran. The results of this study are based on a screening program that is being implemented in Isfahan province. In this study, about 137,000 people were screened for colorectal cancer and adenomatous polyps in 2 steps during the year 2018. Based on the findings of this study, the incidence of adenomatous polyps was reported to be 389 (95% CI, 365-422) per 100,000 population. The incidence of adenomatous polyps was reported to be 483 (95% CI, 446-520) and 316 (95% CI, 286-346) in men and women, respectively (p < 0.001). Also, the incidence of colorectal cancer was reported to be 33 (95% CI, 23-42) per 100,000 population. The incidence of colorectal cancer in men and women was reported to be 41 (95% CI, 30-51) and 26 (95% CI, 17-34), respectively, indicating a statistically non-significant difference (p = 0.29). Based on the result of this study, despite a low participation rate of the target population in the screening program, the incidence of adenomatous polyps and colorectal cancer is relatively high in the average-risk population.

Serum Expression of β-Catenin Is a Potential Detection Marker in Patients with Colorectal Cancer.

Object To investigate the correlation between the level of serum β-catenin and the disease progression of colorectal polyp (CRP) and colorectal cancer (CRC) and find its potential diagnostic value. Methods A total of 327 clinical serum samples and their electronic medical records were collected. Detecting by enzyme-linked immunosorbent assay (ELISA), the correlations of serum β-catenin with tumor marker carcinoembryonic antigen (CEA) and CRC clinicopathological parameters and the receiver operating characteristic (ROC) curve were analyzed. Results Serum β-catenin levels in the CRP and CRC patients were significantly higher than those in the healthy control (HC) group (P < 0.05 and P < 0.001). Compared with CRP, serum β-catenin level in CRC was also increased (P < 0.05). However, there was no significant difference in gender, age, location, tumor size, Dukes staging, or metastasis (P > 0.05) between serum β-catenin and clinical parameters of CRC. There was no correlation between serum β-catenin levels and CEA in CRC patients (P = 0.14). ROC curve analysis showed that serum β-catenin possessed the maximum diagnostic efficiency in CRP (AUC = 0.73, P < 0.05) with 86.41% sensitivity and 51.56% specificity. β-Catenin combined with CEA had the highest diagnostic efficiency (AUC = 0.88, P < 0.05) with 81.88% sensitivity and 73.44% specificity. With CRC patients from CRP patients, ROC analysis of the combining detection (AUC = 0.70, P < 0.05) had the 70% sensitivity and 84.5% specificity. Conclusion The serum β-catenin levels are gradually increased in CRP and CRC, while there is no correlation between its levels and CRC disease process. Single serum β-catenin or combined CEA would be one of the potential candidate biomarkers for colorectal disease diagnosis.

Mass spectrometry transanal minimally invasive surgery (MS-TAMIS) to promote organ preservation in rectal cancer

BackgroundTransanal minimally invasive surgery (TAMIS) is deployed for organ preservation in early rectal cancer and significant rectal polyps. Rapid evaporative ionisation mass spectrometry (REIMS) provides biochemical tissue analysis, which could be applied intraoperatively to give real-time tissue feedback to the surgeon and decrease the risk of an involved margin. However, the accuracy and feasibility of this approach have not been established.MethodsIn this prospective observational study, patients undergoing resection of rectal adenomas or carcinomas were recruited. An electrosurgical handpiece analysed tissues ex vivo using diathermy, with the aerosol aspirated into a Xevo G2-S ToF mass spectrometer. The relative abundance of lipids underwent predictive statistical modelling and leave-one-patient-out cross-validation. The outcomes of interest were the ability of REIMS to differentiate normal, adenomatous and cancerous tissue, or any disease subtype from normal. REIMS was coupled with TAMIS for in vivo sampling, assessing the accuracy of tissue recognition and distinguishing bowel wall layers.ResultsForty-seven patients were included, yielding 266 spectra (121 normal, 109 tumour and 36 adenoma). REIMS differentiates normal, adenomatous and cancerous rectal tissues with 86.8% accuracy, and normal and adenomatous tissue with 92.4% accuracy and 91.4% accuracy when differentiating disease from normal. We have performed the first five in-man mass spectrometry augmented TAMIS (MS-TAMIS). In real time, MS-TAMIS can differentiate rectal mucosa and submucosa based on their relative abundance of triglycerides and glycerophospholipids. The ex vivo accuracy distinguishing diseased and normal tissues is maintained in vivo at 90%, with negative predictive value of 95%. The system identified a deep and lateral involved tumour margin during TAMIS.ConclusionsREIMS distinguishes rectal tissue types based on underlying lipid biology, and this can be translated in vivo by coupling it to TAMIS. There is a role for this technology in improving the efficacy of resection of early rectal cancers.

Does Colon Polyp Surveillance Improve Patient Outcomes?

Colon polyp surveillance now accounts for 25% of all colonoscopies performed. The evidence that colonoscopy surveillance reduces colorectal cancer (CRC) incidence or mortality is weak. The biology of the baseline lesions and quality of the baseline exam are two primary factors contributing to post-colonoscopy CRC. Prior recommendations for surveillance were based largely on the likelihood that patients with adenomas would develop advanced adenomas, a surrogate for CRC. There is now evidence that baseline colonoscopy findings are strongly associated with the risk of incidence or death from CRC. This evidence provides a basis for updated evidence-based recommendations for surveillance. In addition, there is also growing evidence that the quality of the baseline exam is an important predictor of the likelihood of developing post-colonoscopy CRC.

263 Male Gastroenterologists Have Better High-Risk Adenoma Detection Rate (HRADR) in Male Patients

INTRODUCTION: High-risk adenomas (HRA) have been associated with a significant risk of interval colorectal cancer development. Recent literature suggests that high-risk adenoma detection rate (HRADR) can be used as a complementary screening colonoscopy quality metric. Being dependent upon the experience- and skill-level of the provider, we aimed in this study to investigate the impact of gastroenterologists' gender on HRADR among screened patients. METHODS: A retrospective review of all screening colonoscopies in patients ≥50 years of age performed at our center between 2012 and 2014 was done. Average risk patients who had a complete colonoscopy with excellent, good, and fair bowel preparation were included. Overall, gender-specific, and segment-specific adenoma detection rates (ADR), large adenoma detection rate and high-risk adenoma detection rates (HRADR) were calculated and compared using t-tests. HRADR defined as either ≥3 adenomas or at least one adenoma of ≥10 mm (big adenoma) or at least one tubule-villous adenoma, high grade dysplasia or cancerous polyp. RESULTS: A total of 2641 patients were included in the analysis. Average patient age was 58 ± 7.6 years and 53.2% were females (Table 1). Compared to female gastroenterologists, male gastroenterologists had better overall HRADR (9.8 ± 6.6 vs. 5.0 ± 4.0; P &lt; 0.012) and overall Distal HRADR (4.6 ± 5.0 vs. 1.2 ± 2.2, 0.019). In male patients, male gastroenterologists had better proximal and distal HRADR (6.4 ± 7.0 vs. 1.8 ± 2.7; P &lt; 0.021 and 6.3 ± 7.4 vs. 1.2 ± 3; P &lt; 0.016, respectively). In female patients there was a non-significant trend toward better overall and segment-specific HRADR (P-value = 0.97, 0.56 and 0.30). Also, male gastroenterologists were better at detecting large adenomas (&gt;1 cm) in male patients (7.4 ± 8.3 vs.1.7 ± 3.3; P &lt; 0.016). All endoscopists met the nationally recommended ADR thresholds (25% overall, 20% for females and 30% for males). CONCLUSION: In this study, male gastroenterologists had better overall HRADR and overall Distal HRADR among all screened patients. In male patients, male gastroenterologists had better proximal and distal HRADR and were better at detecting large adenomas. This association was consistent across patient age, race, and level of colon preparation. These findings suggest that the differences in screening colonoscopy training and/or volume between male and female gastroenterologists may have important clinical implications in the detection of colon cancer and patient outcomes.

340 High Total Cholesterol Level Increases Risk of Finding Pre-Cancerous Colonic Polyps on Initial Colonoscopies

INTRODUCTION: The association of dyslipidemia with colorectal cancer (CRC) and pre-cancerous (PC) colon polyps has been studied with mixed results. Some studies show that high total cholesterol levels reduce the risk of PC colon polyps. A recent study showed that cholesterol influences stem cell growth in the intestines, accelerating tumor formation. We examined the association of lipid levels and statin use with PC polyp detection on initial colonoscopies. METHODS: Data were collected on 3,541 patients admitted to Louisville Veterans Affairs Medical Center, and 2,629 were excluded based on specific criteria including pro-inflammatory states postulated to increase polyposis (e.g., IBD history, pre-existing malignancies) and lack of recent lipid panel data. Of 912 patients included, 313 (34%) had high total cholesterol levels (&gt;200 mg/dL) and 369 (40%) had history of statin use. Median age was 61, 89% patients were male, and 22% were African American. Data were gathered by retrospective chart review of the patient’s active medications and lipid levels (within 6 months) at the time of initial colonoscopy. Statin use was further stratified by duration and intensity. A Poisson Regression Model was used for analysis with upper and lower bounds, and rate ratios (RR) with corresponding P-values were calculated. Statistical significance was set at P &lt; 0.05. Age, sex, race, smoking history and NSAID use were controlled for. RESULTS: Our study indicates that high total cholesterol levels may be associated with increased PC polyp rates. High total cholesterol level (&gt;200 mg/dL) was associated with a 21% increase in risk of PC polyps (n = 313, RR = 1.21, P = 0.024), irrespective of statin use. Statin use in “intensity-years” (intensity multiplied by years of use) did not increase PC polyp risk, and results were statistically insignificant (n = 369, RR = 1.01, P = 0.12). Other lipid levels did not reveal statistically significant differences in PC polyp risk. CONCLUSION: Despite conflicting results of earlier studies, our study shows that high total cholesterol level may be associated with increased risk of PC polyps, irrespective of statin use. Possible mechanisms include growth of intestinal stem cells, oxidative stress, colonic inflammation, and diet associated with increased total cholesterol levels. Larger studies are needed to confirm these findings, which may have future clinical implications regarding the introduction of specific diet and lipid modification strategies to reduce CRC risk.

2894 The Gastrointestinal Phenotype of Cowden’s Syndrome and Effects of Surveillance

INTRODUCTION: Cowden’s syndrome is an autosomal dominant hamartoma syndrome characterized by germline mutations in the phosphatase and tensin (PTEN) homolog gene, the protein product of which negatively regulates the PI3K-AKT-mTOR pathway. Clinically, individuals develop multiple hamartomas in body tissues, including the stomach and colon, and have a high risk of developing cancer. To mitigate the risks, individuals undergo upper and lower endoscopic surveillance. The effectiveness of endoscopic surveillance and polypectomy remains unknown. METHODS: 17 individuals who met relaxed international Cowden consortium criteria and had undergone at least two upper or lower endoscopies were included. We describe polyp number, size, location, pathology, and interventions over the surveillance period. RESULTS: The average age was 69 (43-88). 6 were males and 11 females. Average number of upper and lower endoscopies was 2 (1-8) and 5 (2-14), respectively. The average interval between upper and lower endoscopies was noted to be 2.64 years (standard deviation = 1.53) and 3.03 years (standard deviation = 2.14). One patient developed a cancerous polyp that was identified on the second colonoscopy. The polyp was located in the transverse colon and removed via snare polypectomy. Pathology showed invasive adenocarcinoma. Patient underwent colectomy with ileocolic anastomosis without chemotherapy. 68.5% of upper and lower endoscopies had an intervention performed including polypectomy with cold biopsy forceps (n = 40), cold snare (n = 7), hot biopsy forceps (n = 16), and hot snare (n = 33). Polyp pathologies in the stomach and upper intestine included hamartomas (n = 4), hyperplastic (n = 6), adenomas (n = 2), and fundic gland polyps (n = 6). Polyp pathologies in the colon included hamartomas (n = 14), hyperplastic (n = 40), ganglioneuromas (n = 2), adenomas (n = 81), inflammatory (n = 4), and sessile serrated (n = 7). 3 patients had more than one upper endoscopy, 2 of whom had a decrease in polyp size while 1 had no change. In the colon, the sizes of the polyps decreased over time in 11 of the 17 patients, 4 did not change, and 2 had an increase in size. CONCLUSION: We show that the overall size of polyps decrease in both the stomach and colon with endoscopic surveillance. One patient had a malignant polyp treated with endoscopic polypectomy.

Referral for Colonoscopy in Patients with Streptococcus bovis Bacteremia and the Association with Colorectal Cancer and Adenomatous Polyps: A Quality Assurance Study

The association between Streptococcus bovis (S. bovis) bacteremia and colorectal cancer is well established. We aimed to review patients with S. bovis bacteremia at our local hospital system and determine the percentage of patients referred for colonoscopy. Methods: We searched the regional database to identify S. bovis-positive blood cultures from 2002 to 2016 and the clinical characteristics and outcomes of those patients. Results: A total of 86 patients with S. bovis bacteremia were identified. From the 86 patients, 14 were excluded. The mean age of the 72 remaining patients was 74.5 (SD 13), 42/72 (58%) were male, 12/72 (17%) had infective endocarditis, and 19 (26%) died during admission. Of the 53 patients who survived, 37 (70%) were referred for colonoscopy or CT colonography, of which 30 had a colonoscopy. Thus, 3/30 (10%) cases showed adenocarcinoma and 11/30 (37%) cases showed adenomatous polyps. Age, gender, or the presence of infective endocarditis were not associated with adenocarcinoma or adenomatous polyps. Discussion: In our local centers, a significant proportion of patients with S. bovis were found to have colon cancer or significant polyps, and thus the importance of referral to colonoscopy remains paramount.

Pre-therapeutic MRI Assessment of Early Stage Rectal Cancer and Significant Rectal Polyps to Avoid Major Resectional Surgery: A New Approach to the Management of Early Stage Rectal Cancer.

Pre-therapeutic MRI Assessment of Early Stage Rectal Cancer and Significant Rectal Polyps to Avoid Major Resectional Surgery: A New Approach to the Management of Early Stage Rectal Cancer.

Loss of microfibril-associated protein 5 (MFAP5) expression in colon cancer stroma.

MFAP5, a 25-kD microfibril-associated glycoprotein that is involved in elastic microfibril assembly, has been demonstrated to be significantly downregulated in tumor stroma by previous gene expression study. The aim of this study was to confirm the reduced expression of MFAP5 in colonic tumor stroma using immunohistochemistry and to explore the utility of MFAP5 as a marker to facilitate diagnosing an invasive component versus pseudoinvasion in colon polyps. In all 19 colon cancer resection cases evaluated, while there was intact MFAP5 immunoreactivity in the uninvolved normal connective tissue, there was marked reduction of MFAP5 immunoreactivity in the desmoplastic stroma surrounding the invasive component. The difference in MFAP5 expression levels was most pronounced within the tumor, while a more heterogeneous expression pattern was observed at the tumor invasive front. Reduction of MFAP5 staining was also observed in the stroma around mucin pools in 6 out of 9 sections from mucinous adenocarcinomas and in areas with high-grade dysplasia. For the polypectomy cases, intact expression of MFAP5 was seen in the stroma surrounding the displaced adenomatous glands in 9 out of 12 polyps with pseudoinvasion. Loss of expression of MFAP5 was observed in the stroma surrounding small foci of invasive adenocarcinoma in 8 of 10 malignant polyps. MFAP5 is a useful marker that may help distinguish normal connective tissue from stroma within invasive colonic adenocarcinoma. MFAP5 may facilitate the distinction between pseudoinvasion and true invasive cancer in colonic adenomatous polyps with a sensitivity of 80% (confidence interval 44-96%) and a specificity of 75% (confidence interval 43-93%) in this small cohort.

Outcomes of screening and surveillance in people with two parents affected by colorectal cancers: experiences from the Familial Bowel Cancer Service

BackgroundThe Familial Bowel Cancer Service at The Royal Melbourne Hospital was started in 1980 in order to offer bowel cancer screening services to those felt to be at a higher risk of CRC due to their family history, and upon registration in this service, patients gave consent for recording of their individual and familial medical history as pertaining to colorectal cancer in the FamBIS database. Using the FamBIS database, we sought to understand whether the subpopulation of individuals in whom both parents were diagnosed with colorectal cancer carried a higher risk of colorectal cancer or neoplastic polyps and should therefore undergo more intensive screening above that of the average-risk individual.MethodsWe conducted a single-centre retrospective cohort-study of adults (18 years of age and older) in the FamBIS database, with review of their medical histories as pertaining to CRC diagnosis, screening, and surveillance from 1980 to 2015.ResultsWe identified and reviewed the medical histories of 96 registrants from 62 unique families. Registrants began screening as early as 24 years of age, with the mean age of first screening being at 44.6 ± 10.7 years old. The mean duration of screening was 17.3 ± 10.1 years, and through their screening period, registrants underwent an average of 11.5 ± 9.1 FOBTs and 4.4 ± 3.1 colonoscopies or sigmoidoscopies.Over the course of screening, 41 (42.7%) registrants were found to have at least one neoplasm of any kind (including adenomas, advanced adenomas, and CRC) as their first positive colonoscopic finding. In total, 12 (12.5%) of the registrants were found to have an advanced neoplasm over the course of screening and surveillance, while only 2 patients were found to be diagnosed with CRC.ConclusionsThe prevalence rates for neoplasms, advanced neoplasms, and CRC in our current study were statistically significantly higher compared with those seen in average-risk populations. This supports the importance of more intensive screening for this subpopulation in preventing colorectal cancers, as well as pre-and early-cancerous neoplasms.

Challenges Facing the Detection of Colonic Polyps: What Can Deep Learning Do?

Colorectal cancer (CRC) is one of the most common causes of cancer mortality in the world. The incidence is related to increases with age and western dietary habits. Early detection through screening by colonoscopy has been proven to effectively reduce disease-related mortality. Currently, it is generally accepted that most colorectal cancers originate from adenomas. This is known as the “adenoma–carcinoma sequence”, and several studies have shown that early detection and removal of adenomas can effectively prevent the development of colorectal cancer. The other two pathways for CRC development are the Lynch syndrome pathway and the sessile serrated pathway. The adenoma detection rate is an established indicator of a colonoscopy’s quality. A 1% increase in the adenoma detection rate has been associated with a 3% decrease in interval CRC incidence. However, several factors may affect the adenoma detection rate during a colonoscopy, and techniques to address these factors have been thoroughly discussed in the literature. Interestingly, despite the use of these techniques in colonoscopy training programs and the introduction of quality measures in colonoscopy, the adenoma detection rate varies widely. Considering these limitations, initiatives that use deep learning, particularly convolutional neural networks (CNNs), to detect cancerous lesions and colonic polyps have been introduced. The CNN architecture seems to offer several advantages in this field, including polyp classification, detection, and segmentation, polyp tracking, and an increase in the rate of accurate diagnosis. Given the challenges in the detection of colon cancer affecting the ascending (proximal) colon, which is more common in women aged over 65 years old and is responsible for the higher mortality of these patients, one of the questions that remains to be answered is whether CNNs can help to maximize the CRC detection rate in proximal versus distal colon in relation to a gender distribution. This review discusses the current challenges facing CRC screening and training programs, quality measures in colonoscopy, and the role of CNNs in increasing the detection rate of colonic polyps and early cancerous lesions.

Case Histories of Significant Medical Advances: Gastrointestinal Endoscopy

We describe how endoscopy transformed the diagnosis of ulcers, cancerous polyps and other diseases of the alimentary canal and enabled “minimally invasive” surgeries to treat such diseases. Specifically, we chronicle how: 1) flexible glass fiber instruments in the 1950s and 1960s; 2) new diagnostic techniques and minimally invasive endoscopic surgeries in the 1970s and early 1980s 3) digitization and miniaturization through the end of the 20th century. A concluding section summarizes the competitive situation of the equipment producers in 2000.

Interval Colorectal Cancer in Inflammatory Bowel Disease: The Role of Guideline Adherence.

Factors associated with interval colorectal cancer (CRC) development in the inflammatory bowel disease (IBD) population remain unclear. Among a cohort of patients with interval CRC, we aimed to evaluate IBD characteristics, colonoscopy quality indicators, and surveillance guideline adherence. We performed a retrospective review of IBD- and non-IBD-associated interval CRCs diagnosed between January 2007 and December 2014 within a large US healthcare system. We evaluated risk factors for CRC among patients with IBD. We assessed adherence to surveillance guidelines according to the American Society for Gastrointestinal Endoscopy (IBD surveillance) and the US Multi-Society Task Force on Colorectal Cancer (polyp surveillance). We compared colonoscopy quality measures between patients with and without IBD. Among 5345 cases of colonic adenocarcinoma, we detected 15 IBD-associated cases of interval CRC and 230 non-IBD-associated cases of interval CRC. Compared to patients without IBD, IBD patients were younger (54.5 vs. 70.4years; p < 0.0001) and experienced a shorter interval between index colonoscopy and CRC diagnosis (20.7 vs. 35.1months; p = 0.0009). Fifty three percent (8/15) of interval CRCs in IBD patients were detected within surveillance guidelines. All IBD patients with interval CRC detected after guideline surveillance interval had high-risk features, including active inflammation, previous low-grade or indefinite dysplasia, multiple pseudopolyps on index colonoscopy, or a first-degree relative with CRC. There were no differences in colonoscopy quality measures between patients with and without IBD. This study stresses the importance of strict short-interval surveillance for IBD patients with high-risk features, including active inflammation on index colonoscopy.

The protective effect of syringic acid on dextran sulfate sodium-induced experimental colitis in BALB/c mice.

Inflammatory bowel diseases involve chronic intestinal inflammation which is mostly caused by Crohn's disease and ulcerative colitis (UC) conditions. Patients having UC are prone to colorectal cancer and dysplastic polyps, and also have sporadic adenomas. Syringic acid (SA) possesses many health benefits including antioxidant, anti-bacterial, and anti-cancer. This study was aimed to identify the effects of SA on UC, using a murine experimental model. Clinical symptoms and weight loss were significantly reduced in mice induced with dextran sulfate sodium (DSS) and treated with SA, compared to untreated mice. The effects of SA exhibited in DSS-induced mice were associated with significant decrease in the expressions levels of inflammatory mediators such as inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), pro-inflammatory cytokines (tumor necrosis factor [TNF-α], interleukin [IL-1β and IL-6]), remarkable amelioration of colonic architectural disruption, and a significant reduction in the activity of colonic myeloperoxidase. To further confirm the anti-inflammatory property of SA, RAW 264.7 cells were stimulated with lipopolysaccharides. SA dose-dependently inhibited the cytokines TNF-α, IL-1β, and IL-6. It also decreased the expressions of p65-NF-κB and IκB, thus reducing the activation and nuclear accumulation of p-STAT-3Y705 . This prohibited the degradation of inhibitory protein, IκB, as well as inhibited the nuclear translocation of p65-NF-κB in colonic tissue. It was concluded that SA has a potential to limit inflammation via inhibiting the p65-NF-κB and STAT3 signaling; hence it can be used for therapeutic purposes.

Dietary Inflammatory Index and Odds of Colorectal Cancer and Colorectal Adenomatous Polyps in A Case-Control Study from Iran.

Background: Chronic inflammation is implicated in the development of colorectal cancer (CRC) and its precursor; colorectal adenomatous polyps (CAP). Some dietary factors are important triggers for systemic inflammation. Therefore, the present study aimed to investigate the association between the dietary inflammatory index (DII®) and the risk of CRC and CAP in an Iranian case-control study. Methods: 134 newly diagnosed CRC patients, 130 newly diagnosed CAP patients, and 240 hospitalized controls were recruited using convenience sampling. Energy-adjusted DII (E-DII) scores were computed based on dietary intake assessed using a reproducible and valid 148-item food frequency questionnaire. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI) after adjusting for confounders. Results: The E-DII score ranged between −4.23 (the most anti-inflammatory score) to +3.89 (the most pro-inflammatory score). The multivariable-adjusted ORs for participants in the 3rd tertile compared to the 1st tertile was 5.08 (95%CI: 2.70–9.56; P-trend < 0.0001) for CRC and 2.33 (95% CI: 1.30–4.02; P-trend = 0.005) for CAP. Conclusions: Our findings suggest that more pro-inflammatory diets, indicated by higher E-DII scores, might increase the risk of both CRC and CAP. Future steps should include testing these associations in a prospective setting in Iran.

Bariatric surgery is independently associated with a decrease in the development of colorectal lesions

BackgroundObesity is a risk factor for colorectal cancer and possibly the formation of precancerous, colorectal polyps . Bariatric surgery is very effective for long-term weight loss; however, it is not known whether bariatric surgery decreases the risk of subsequent colonic neoplasia. We hypothesized that bariatric surgery would decrease the risk of developing colorectal lesions (new cancer and precancerous polyps). MethodsWe reviewed all patients (n = 3,676) who underwent bariatric surgery (gastric bypass, sleeve gastrectomy, or gastric banding) at the University of Virginia (Charlottesville, VA) 1985–2015. Obese, nonoperative patients (n = 46,873) from an institutional data repository were included as controls. Cases and controls were propensity score matched 1:1 by demographics, comorbidities, body mass index, and socioeconomic factors. The matched cohort was compared by univariate analysis and conditional logistic regression. ResultsA total of 4,462 patients (2,231 per group) with a median follow-up of 7.8 years were well-matched with no statistically significant baseline differences in initial body mass index (48 vs 49 kg/m2), sex, and age in addition to other comorbidities (all P > .05). The operative cohort had more weight loss (55.5% vs –1.4% decrease in excess body mass index, P < .0001). The operative cohort developed fewer colorectal lesions (2.4% vs 4.8%, P < .0001). We observed no differences in polyp characteristics or staging for patients who developed cancer (all P > .05). After risk adjustment, bariatric surgery was independently associated with a decrease in new colorectal lesions (OR 0.62, 95% CI 0.42–0.91, P = .016). ConclusionBariatric surgery was associated with lesser, risk-adjusted incidence of new colorectal lesions in this large population of propensity matched patients undergoing bariatric surgery compared with a control group not undergoing bariatric surgery. These results suggest the benefits of bariatric surgery may extend beyond weight loss and mitigation of comorbidities.

Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial

SummaryBackgroundWhole-body MRI (WB-MRI) could be an alternative to multimodality staging of colorectal cancer, but its diagnostic accuracy, effect on staging times, number of tests needed, cost, and effect on treatment decisions are unknown. We aimed to prospectively compare the diagnostic accuracy and efficiency of WB-MRI-based staging pathways with standard pathways in colorectal cancer.MethodsThe Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer. Exclusion criteria were severe systemic disease, pregnancy, contraindications to MRI, or polyp cancer. Patients underwent WB-MRI, the result of which was withheld until standard staging investigations were complete and the first treatment decision made. The multidisciplinary team recorded its treatment decision based on standard investigations, then on the WB-MRI staging pathway (WB-MRI plus additional tests generated), and finally on all tests. The primary outcome was difference in per-patient sensitivity for metastases between standard and WB-MRI staging pathways against a consensus reference standard at 12 months, in the per-protocol population. Secondary outcomes were difference in per-patient specificity for metastatic disease detection between standard and WB-MRI staging pathways, differences in treatment decisions, staging efficiency (time taken, test number, and costs), and per-organ sensitivity and specificity for metastases and per-patient agreement for local T and N stage. This trial is registered with the International Standard Randomised Controlled Trial registry, number ISRCTN43958015, and is complete.FindingsBetween March 26, 2013, and Aug 19, 2016, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial; 68 (23%) had metastasis at baseline. Pathway sensitivity was 67% (95% CI 56 to 78) for WB-MRI and 63% (51 to 74) for standard pathways, a difference in sensitivity of 4% (−5 to 13, p=0·51). No adverse events related to imaging were reported. Specificity did not differ between WB-MRI (95% [95% CI 92–97]) and standard pathways (93% [90–96], p=0·48). Agreement with the multidisciplinary team's final treatment decision was 96% for WB-MRI and 95% for the standard pathway. Time to complete staging was shorter for WB-MRI (median, 8 days [IQR 6–9]) than for the standard pathway (13 days [11–15]); a 5-day (3–7) difference. WB-MRI required fewer tests (median, one [95% CI 1 to 1]) than did standard pathways (two [2 to 2]), a difference of one (1 to 1). Mean per-patient staging costs were £216 (95% CI 211–221) for WB-MRI and £285 (260–310) for standard pathways.InterpretationWB-MRI staging pathways have similar accuracy to standard pathways and reduce the number of tests needed, staging time, and cost.FundingUK National Institute for Health Research.

Polyp cancers: size matters!

Polyp cancers: size matters!

Metabolomics Analysis in Serum from Patients with Colorectal Polyp and Colorectal Cancer by 1H-NMR Spectrometry.

Colorectal cancer (CRC) is one of the leading causes of cancer-related death worldwide. Colorectal adenomatous polyps are at high risk for the development of CRC. In this report, we described the metabolic changes in the sera from patients with colorectal polyps and CRC by using the NMR-based metabolomics. 110 serum samples were collected from patients and healthy controls, including 40 CRC patients, 32 colorectal polyp patients, and 38 healthy controls. The metabolic profiles and differential metabolites of sera were analyzed by multivariate statistical analysis (MSA), including principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA), and orthogonal partial least squares discriminant analysis (OPLS-DA) methods. A total of 23 differential metabolites were identified from MSA. According to the pathway analysis and multivariate ROC curve-based exploratory analysis by using the relative concentrations of differential metabolites, we found abnormal metabolic pathways and potential biomarkers involved with the colorectal polyp and CRC. The results showed that the pyruvate metabolism and glycerolipid metabolism were activated in colorectal polyps. And the glycolysis and glycine, serine, and threonine metabolism were activated in CRC. The changed metabolism may promote cellular proliferation. In addition, we found that the rates of acetate/glycerol and lactate/citrate could be the potential biomarkers in colorectal polyp and CRC, respectively. The application of 1H-NMR metabolomics analysis in serum has interesting potential as a new detection and diagnostic tool for early diagnosis of CRC.