Colonoscopic Diagnosis Research Articles

Synchronous Neoplasia Rates at Colonoscopic Diagnosis of Early-Onset vs Average-Onset Colorectal Cancer

The incidence of early-onset colorectal cancer (CRC) (age, <50 years) continues to increase globally within high-income countries. To examine and compare rates of synchronous neoplasia found in patients at colonoscopic diagnosis of early-onset CRC with rates found at diagnosis of average-onset CRC. In this multisite retrospective and cross-sectional study conducted at Mayo Clinic sites and in the Mayo Clinic Health System from January 1, 2012, to December 31, 2022, 150 randomly selected patients with early-onset CRC were identified from the electronic health record and matched with 150 patients with average-onset CRC based on sex and colonoscopic indication. Patients with known hereditary syndromes, past history of CRC, or inflammatory bowel disease were excluded. Colonoscopic findings (polyp size, number, site) and related histopathologic findings (adenoma, advanced adenoma, sessile serrated polyp) were analyzed in association with cancer clinicopathologic features and molecular data (mismatch repair status, KRAS, and BRAFV600E). Among 300 patients (156 men [52%]), the median age at diagnosis was 43 years (IQR, 39-47 years) for those with early-onset CRC and 67 years (IQR, 57-76) for those with average-onset CRC. Overall, 85% of patients were symptomatic at CRC diagnosis. Cancer stage, grade, molecular features, body mass index, and family history did not differ significantly between these groups. Among patients with colon cancer, the overall prevalence of synchronous neoplasia was similar, yet advanced adenomas were 3 times more frequent in those with early-onset vs average-onset cancers (31 of 75 [41%] vs 10 of 75 [13%]; P < .001). This difference was not associated with cancer stage or primary location. Among patients with rectal cancer, nonadvanced adenomas were less frequent among the early-onset group than the average-onset group (21 of 75 [28%] vs 36 of 75 [48%]), and although the prevalence of advanced adenomas was similar (11 of 75 [15%] vs 14 of 75 [19%]), they were more commonly located in the rectum (early onset, 5 of 11 [45%] vs average onset, 1 of 14 [7%]). Patients with early-onset cancer of the colon were significantly more likely than those with early-onset cancer of the rectum to have a synchronous advanced adenoma (31 of 75 [41%] vs 11 of 75 [15%]; P < .001). In this cross-sectional study, synchronous advanced adenomas were more commonly found in patients with early-onset colon cancer compared with average-onset colon cancer, and they were distributed throughout the colon. In contrast, advanced adenomas were not increased in patients with rectal cancer and, when detected, were predominantly located in the rectum.

Comparison of synchronous neoplasms at colonoscopic diagnosis of early-onset versus average-onset colorectal cancer.

3623 Background: Colorectal cancer (CRC) incidence has steadily increased in adults younger than 50 years (EO-CRC) since the 1990s, with a predominance in the left colon and rectum. Precursor lesions of CRCs are adenomas, including advanced adenomas, and sessile serrated polyps. Given that neoplastic development is age-related, we hypothesized that patients with early-onset CRC (EO-CRC) may have fewer adenomas compared to patients with average-onset CRC (AO-CRC) at diagnosis. Methods: We performed a retrospective review of electronic health records at Mayo Clinic or Mayo Health System [2012 to 2021] and randomly selected 150 patients with EO-CRC who met eligibility criteria and matched them with 150 AO-CRC patients based on gender and colonoscopy indication. Known hereditary syndromes or inflammatory bowel disease were excluded. At colonoscopy where CRC was diagnosed, we recorded findings of adenomas, advanced adenomas (&gt; 1 cm, villous histology, or high-grade dysplasia), and sessile serrated polyps (SSP). Results: Median age at diagnosis was 43 years for EO-CRC and 67 years for AO-CRC. No significant differences in BMI, family history of CRC, MMR, BRAFV 600E KRAS status or SSPs were found between groups (all p &gt; 0.05). Among patients with colon cancer, no difference was found for adenoma number yet patients with EO-colon cancer (EO-CC) had larger polyps [median of 10 mm vs 5 mm, p = 0.001] (Table) compared with AO-colon cancer (AO-CC). At least 1 adenoma was found in 56% and 47% of patients with EO-CC and AO-CC, respectively. Moreover, advanced adenomas were significantly more common in the EO-CC group compared with the AO-CC group (42% and 14%, p &lt; 0.001) [ Table]. Among patients with rectal cancer, non-advanced adenomas were less frequent and although advanced adenoma were similar in frequency, they were more commonly located in the rectum in EO-rectal compared to AO-rectal cancers (Table). Conclusions: Patients with EO-colon cancer had a significantly higher likelihood of a synchronous advanced adenoma in the colon compared to those with AO-CRC. Together, these data suggest accelerated carcinogenesis throughout the colorectum in early onset patients, with increased risk for development of synchronous and metachronous CRC. [Table: see text]

Clinicopathological features and expression of regulatory mechanism of the Wnt signaling pathway in colorectal sessile serrated adenomas/polyps with different syndrome types.

Colorectal cancer (CRC) is the third most common cancer worldwide, with the fourth highest mortality among all cancers. Reportedly, in addition to adenomas, serrated polyps, which account for 15%-30% of CRCs, can also develop into CRCs through the serrated pathway. Sessile serrated adenomas/polyps (SSAs/Ps), a type of serrated polyps, are easily misdiagnosed during endoscopy. To observe the difference in the Wnt signaling pathway expression in SSAs/Ps patients with different syndrome types. From January 2021 to December 2021, patients with SSAs/Ps were recruited from the Endoscopy Room of Shanghai Traditional Chinese Medicine-Integrated Hospital, affiliated with Shanghai University of Traditional Chinese Medicine. Thirty cases each of large intestine damp-heat (Da-Chang-Shi-Re, DCSR) syndrome and spleen-stomach weakness (Pi-Wei-Xu-Ruo) syndrome were reported. Baseline comparison of the general data, typical tongue coating, colonoscopy findings, and hematoxylin and eosin findings was performed in each group. The expression of the Wnt pathway-related proteins, namely β-catenin, adenomatous polyposis coli, and mutated in colorectal cancer, were analyzed using immunohistochemistry. Significant differences were observed with respect to the SSAs/Ps size between the two groups of patients with different syndrome types (P = 0.001). The other aspects did not differ between the two groups. The Wnt signaling pathway was activated in patients with SSAs/Ps belonging to both groups, which was manifested as β-catenin protein translocation into the nucleus. However, SSAs/Ps patients with DCSR syndrome had more nucleation, higher β-catenin expression, and negative regulatory factor (adenomatous polyposis coli and mutated in colorectal cancer) expression (P < 0.0001) than SSA/P patients with Pi-Wei-Xu-Ruo syndrome. In addition, the SSA/P size was linearly correlated with the related protein expression. Patients with DCSR syndrome had a more obvious Wnt signaling pathway activation and a higher risk of carcinogenesis. A high-quality colonoscopic diagnosis was essential. The thorough assessment of clinical diseases can be improved by combining the diseases of Western medicine with the syndromes of traditional Chinese medicine.

Comparison of precursor neoplasms at colonoscopic diagnosis of early-onset and later-onset colon cancer.

74 Background: Colorectal cancer (CRC) incidence has steadily increased in adults younger than 50 years (EO-CRC) since the 1990s, with a reported higher prevalence in the left colon and rectum. Established precursor lesions of CRCs are adenomas, including advanced adenomas, and sessile serrated polyps. We hypothesized that patients at diagnosis of early-onset colon cancer (EO-CC) would have fewer adenomas compared to patients with later-onset colon cancer (LO-CC). Methods: We performed a retrospective review of electronic health records and identified 58 patients diagnosed with EO-CC who had colonoscopy at Mayo Clinic or Mayo Health System who were then matched with 58 LO-CC patients based on gender and procedure indication (diagnostic in 76%, surveillance 16%, screening 8%)[2012 to 2021]. At colonoscopy where colon cancer was diagnosed, we recorded findings of adenomas, advanced adenomas (≥ 1 cm, villous histology, and/or high-grade dysplasia) and sessile serrated polyps. On CCs, limited molecular data were available [mismatch repair (MMR); BRAFV600E, KRAS]. Results: Among 116 patients included in the EO-CC and LO-CC study arms, the median age at cancer diagnosis were 42 and 74 years, respectively. No significant differences were found between study arms and risk factors for CRC including tobacco, alcohol, BMI, genetic syndromes, family history of CRC, and MMR, BRAFV600E or KRAS status (all p&gt; 0.05). While no difference was found for polyp number by arm, patients with EO-CC had larger polyps (median of 10 mm vs 6 mm, p=0.001) compared with LO-CC. At least 1 adenoma was found in 50% and 52% of patients with EO-CC and LO-CC, respectively. Importantly, advanced adenomas were significantly more common in the EO-CC group compared with the LO-CC group (41% and 21%, p=0.027). Sidedness of all adenomas did not differ significantly for EO-CC vs LO-CCs. Conclusions: Patients found to have a primary EO-CC had a significantly higher likelihood of a synchronous advanced adenoma in the colon compared to those with a primary LO-CRC. Together, these data suggest accelerated carcinogenesis throughout the colorectum with increased risk of synchronous and metachronous patients with EO-CC. [Table: see text]

The Association between Colorectal Cancer and Colonoscopic Conditions in Saudi Patients: A 10-Year Cross-Sectional-Retrospective Study.

In Saudi Arabia, colorectal cancer (CRC) is the most common cancer in males and the third most common cancer in females. The current gold standard for colorectal cancer diagnosis is colonoscopy. Several concerns regarding the balance of ordering colonoscopy procedures for patients presenting with signs and symptoms. There are also several concerns regarding over-ordering the procedure when unnecessary. The current study aimed to evaluate the association between colorectal cancer and colonoscopic conditions in Saudi patients. A 10-year cross-sectional study was conducted at Alnoor Specialty Hospital, Makkah, over the last ten years. Colonoscopy reports of patients were evaluated to identify the colonoscopy manifestations associated with mass, polyps, and bleeding. The current study evaluated 2158 cases admitted to the hospital for colonoscopic diagnosis. Results indicated that most of the patients were males (55.4%). Additionally, results showed a significant statistical association between tumor and bleeding, polyp, and hemorrhage. Moreover, it highlighted the association between polyps and bleeding, inflammation, and diverticulosis. CRC screening in Saudi Arabia is comprehensive; however, there are a few areas for improvement, including standardization of colorectal cancer pathology reporting to improve the health system's quality. Also, the current study identified conditions that are significantly associated with reported colon polyps and tumors, which could aid in stratifying patients selected for screening via colonoscopy.

A unique case report of three morphologically distinct malignancies in an appendix specimen

Introduction and importanceAppendiceal neoplasms have a diverse histological classification, the commonest type being neuro-endocrine neoplasm and accounting for 60% of all primary appendiceal malignancies. Others include colonic-type adenocarcinoma; mucinous neoplasm, and goblet cell carcinoma. This report describes a unique case of three different histological subtypes of appendiceal malignancy within a single specimen.Case presentationA 65-year-old female presented with symptoms concerning of GI malignancy and underwent computerised tomography pneumocolon showing an abnormally enhancing appendix concerning for an appendiceal tumour.After multidisciplinary team discussion the patient underwent an open right hemicolectomy. Post-operative histological analysis showed complete resection of three distinct tumour subgroups within the specimen: a neuroendocrine tumour; a well-differentiated adenocarcinoma, and a low-grade appendiceal mucinous neoplasm.Clinical discussionThis report describes, to our knowledge, the first documented case of three separate histological malignancies in a single appendix. Appendiceal malignancy is rare and there are less than 10 cases pertaining to the appendix in the literature: all describing dual neuroendocrine tumours and appendiceal mucinous neoplasms.The case also highlights a limitation of colonoscopy in the diagnosis of colorectal malignancy, specifically for appendiceal tumours, and caution must be taken in discharging patients after a negative colonoscopy. A multi-disciplinary approach is of utmost importance in managing these patients.ConclusionThis is a rare case of 3 morphologically different neoplasms contained within one appendix and demonstrates the importance of an MDT approach to management of such cases. It also highlights the limitation of colonoscopy in diagnosis of appendiceal malignancy.

Magnetic Targeting Systems for Endo-Bronchoscope Diagnosis and Intramedullary-Nail Surgery: A Review

Nowadays, magnetic targeting systems are developed for clinical/surgical applications, such as treatment of carotid artery aneurysm, endo-bronchoscopic diagnosis for lung-cancer tumors, colonoscopic diagnosis for colon-cancer tumors, and intramedullary interlocking-nail surgery. Based on clinical requirements, the targeting systems specific for above endo-bronchoscopic diagnosis and nail surgery are urgently needed and thus rapidly developed. Moreover, because the systems have similar magnetic configurations and use similar magnetic targeting principles, the systems can be reviewed together. Endo-bronchoscopic diagnosis is a new clinical-proved method for doctors to diagnose lung-cancer tumors/lesions. However, in the diagnosis, targeting the endo-bronchoscope to tumors/lesions must be repeated many times and thereby is inconsistent. Thus, diagnosis-yield decreases and diagnosis-duration increases. To address this issue, researchers developed novel magnetic targeting systems to more accurately and rapidly target the endo-bronchoscope, i.e., increase yield and save time. The systems are categorized to magnetic-sensors based and magnetic-materials based targeting systems. Representative systems are reviewed (design, targeting principles, test methods, results, and features are highlighted) in this paper. Intramedullary interlocking-nail surgery is a standard clinical-method for fractured-bones. In the surgery, 2D X-ray imaging system is a conventional most-used method to target distal screw-hole of the nail for fractured-bones fixing. However, patients are over-exposed under X-ray radiation. To solve this problem, researchers presented innovative magnetic targeting systems to target the screw-hole without any X-ray radiation. Same as above-section, the systems are divided to magnetic-sensors based and magnetic-materials based targeting systems. Representative systems and corresponding design, targeting principles, test methods, results, and features are reviewed in this paper.

Analysis of Colonoscopic Diagnosis in Terms of Age, Gender and Symptoms

Analysis of Colonoscopic Diagnosis in Terms of Age, Gender and Symptoms

Histomorphological spectrum of colonic biopsies: A two year study

Introduction: Colonoscopy and accompanying mucosal biopsy is the diagnostic tool of choice in the evaluation of patients with colo rectal pathologies. The objectives of this study were to study the histo morphological spectrum of colonoscopic biopsies, to find age, gender, site distribution of these lesions and to correlate them with clinical presentation and colonoscopic diagnosis. Materials and Methods: The study included all the colonoscopic biopsies received at Department of Pathology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad from January 2015 to December 2016, over a period of two years. Results: There were 198 colonoscopic biopsies during this period. Two biopsies were inadequate for opinion and were excluded from the study. All the colorectal resection specimens, anal lesion were excluded from the study. Out of total 196 biopsies, 104 were non-neoplastic lesions, 92 were neoplastic lesions. Mean age of patients was 49.7 years with a male to female ratio of 1.6:1. Most common location of the lesion was rectum. The most common presenting complaint for both non-neoplastic and neoplastic lesions was bleeding per rectum. Non-specific colitis was commonest non-neoplastic lesion followed by ulcerative colitis. In the neoplastic lesions, adenocarcinoma was the commonest subtype followed by adenomatous polyps. Conclusion: Both neoplastic and non-neoplastic lesions equally affect colon. Non-specific colitis, ulcerative colitis, Crohns disease, tuberculosis, amoebic colitis, eosinophilic enteritis, hamartomatous and hyperplastic polyps were the various non neoplastic lesions encountered in our study. Adenocarcinoma was the most common malignancy on colonic biopsies. Carcinomas occurred at a later age than adenomas. Colonscopic diagnosis correlated well with histopathology diagnosis in carcinomas. Keywords: Colonoscopy, Mucosal biopsy, Non-neoplastic lesions, Neoplastic lesions, Rectum, Non-specific colitis, Adenocarcinoma.

Colonoscopy and Microscopy: Two sides of the coin- Our experience at Tertiary Care Centre in Central India

Introduction: The colonoscopy along with mucosal biopsy interpretation forms a prime diagnostic tool in work of patients with lesional diversity of colorectal region. The study was conduted to evaluate the histomorphological spectrum of colorectal lesions on colonoscopic biopsies and correlate the microscopy (histomorphology) with colonoscopic diagnosis offered. Materials and Methods: The material consisted of 168 colonoscopic biopsies which were submitted to the Department of Pathology, Govt. Medical College & Superspeciality Hospital, Nagpur during the period of Jan 2014 –Dec 2016. The histopathological classification of these lesions was based on WHO. Statistical analysis was done by Open Epi Info software. Result: Out of 168 colonoscopicbiopsies, 116 were non-neoplastic and 52 were neoplastic. A higher frequency of colonic diseases occur in males with male: female ratio -1.4:1 and the age range was between 2yrs to 92 yrs. Among the non-neoplastic lesions, ulcerative colitis was most common diagnosis, with frequent age group involved was 41- 50 yrs. Uncommon but interesting lesions like amoebic colitis (2 cases), pseudo membranous colitis(1 case), Melanosis coli (1 case) & congestive colopathy (1 case) were also found. Hyper plastic polyp & retention polyps were most common in non-neoplastic category while villous adenoma with dysplasia’s was most common in neoplastic polyps. Among the neoplastic lesions, conventional adenocarcinoma was the commonest subtype with rectum as the most common site. Conclusion: Colonoscopy & Microscopy are the two sides of the coin which can be used effectively together not only in diagnosis &treatment of colorectal lesions but alsosurveillance of inflammatory bowel disease. As 48% of overall malignant lesions occurred in less than 50yrs of age, due importance should be given to colonoscopic screening to detect early colorectal neoplasm. Keywords: Colonoscopy, Colorectal carcinoma, Dysplasia, Microscopy (histomrphology), Ulc

An unexpected cause of lower gastrointestinal bleeding.

Although appendiceal bleeding is rare, physicians should keep this finding in mind as a possible cause of bleeding from the right colon because the colonoscopic diagnosis may be essential in determining the need for surgical intervention.

Association between lifestyle-related factors and colorectal adenoma

Objective: To explore the association between lifestyle-related factors and colorectal adenoma. Methods: Based on the Screening Project of Early Diagnosis and Treatment of Colorectal Cancer in Jiashan county Zhejiang province, from August 2012 to March 2018, information gathered through records on questionnaire and colonoscopic diagnosis were collected from participants with positive results during the primary screening stage. According to the findings of colonoscopy, 11 232 controls without any colorectal diseases and 3 895 cases with colorectal adenoma were included in the study. Multivariate logistic regression models were used to analyze the association between lifestyle-related factors and colorectal adenoma. Results: After adjusting for possible confounding factors, results from multivariate logistic regression analysis showed that smoking, alcohol drinking and obesity were positively related to the risk of colorectal adenoma, with ORs (95%CIs) as 1.38 (1.24-1.54), 1.37 (1.24-1.51) and 1.38 (1.20-1.59) respectively. However, regular aspirin intake was negatively related with the risk of colorectal adenoma (OR=0.65, 95%CI: 0.53-0.80). After stratified by sex and age, data showed that the associations between smoking, alcohol drinking and colorectal adenoma were statistically significant in males, and the association between regular aspirin intake and colorectal adenoma was also statistically significant in older participants (aged 60 years and older). Conclusion: Smoking, alcohol drinking, regular aspirin intake and obesity were associated with colorectal adenoma.

Association between obesity and risk for colorectal advanced adenoma

Objectives: To understand the association between obesity and the risk for colorectal advanced adenoma. Methods: Community residents aged 45 to 74 who had participated in the Shanghai community-based colorectal cancer (CRC) screening project in 2008 were included in our study. Anthropometries information including body weight, height and risk factors for colorectal advanced adenoma were collected. Results on colonoscopic diagnosis and personal health records were used for supplementary outcome information retrieval. Multivariate Cox proportional hazard regression models were used to evaluate the hazard ratio (HR) and 95%CI of obesity on the risk for colorectal advanced adenoma. Results: 20 811 residents were followed up for 122 739.36 person-years, with a median follow-up time of 5.87 years. A total of 657 cases of advanced adenomas were identified. After adjusting for potential confounding risk factors such as age, sex, family history of CRC, level of education, marriage, cigarette smoking, alcohol drinking, foods intake including fat, fried or pickled, vegetables and fruits etc., the HR was 1.25 (95%CI: 1.04-1.51) for obese people when compared with the normal weight persons. Further stratified analysis by age, gender and family history of CRC, results showed that obese people had a much higher risk of colorectal advanced adenoma than those with normal weight (male: HR=1.57, 95%CI: 1.20-2.04; more than 60- year-old: HR=1.63, 95%CI: 1.23-2.16). Conclusion: Data from this large scale population-based study revealed that obesity might be an independent risk factor for colorectal advanced adenoma and the risk increases along with the increase of BMI in China.

Prevalence and Distribution of Colonic Diverticular Disease from Ordu in Turkey

Objective: Diverticulosis of the colon is the most frequent anatomical alteration diagnosed at colonoscopy. Most cases of diverticulosis in Western countries involve left side of the colon, while diverticulosis is predominantly present on the right side of the colon in Asian countries. With the aim of this study is to contribute to epidemiologic studies on colonic diverticula in Turkey located in Europe and Asian continent. We analyzed the data of patients undergoing colonoscopy with regard to age, gender, anatomic localization of diverticula retrospectively in the Ordu State Hospital in the Black Sea region.Methods: We retrospectively reviewed a consecutive series of patients with regard to age, gender, location of diverticula and other colonoscopic lesions from an electronic endoscopic database who had undergone colonoscopy at the endoscopy unit of the Ordu State Hospital between 2016 and 2018. If diverticula were observed that distribution type was defined as cecum, ascending colon, transverse colon, descending colon, entire colon and sigmoid colon. In addition, we recorded that the additional diagnoses established in colonoscopic evaluations.Results: We screened 2626 female (51.1%) and 2511 male (48.9%); totally 5137 patients from an electronic endoscopic database who had undergone colonoscopy. 227 (47.4%) female, 252 (52.6%) male, a total of 479 patients who had diverticulosis were included in this study. The mean age was determined female and male 65.44±12.01 (min 31-max 91), 64.91±10.97 (min 27-max 89) respectively and no statistically significant difference between two groups (p&amp;gt;0.05). A total of 479 patients who had diverticulosis were divided into two groups: age ≤ 50 (10.4%) and 50&amp;gt; 429 (89.6%). No significant difference was found with regard to diverticulosis localization between two groups (p&amp;gt;0.05). The other colonoscopic diagnoses are as follows; hemorrhoid (40.7%), polyp (40.2%), inflammatory bowel disease (4.7%) colorectal cancer (0.9%), angiodysplasia (2.3%), ulcer (0.9%), anal fissure (1.9%), parasitosis (1.9%), terminal ileitis (0.5%), nonspecific colitis (3.7%), bowel surgery (1.9%) and submucosal lesion (0.5%). Conclusion: Diverticular disease is a worldwide condition that affect elderly people with an increasing incidence in younger patients as well as in developing countries that have started adopting Western diets. So that in the future diverticular disease will induce a significant economic burden in terms of healthcare cost in Turkey. Despite its prevalence, its pathophysiology still remains poorly understood. There is a significant need for more studies to improve our understanding about diverticular disease.

Underwater Colonoscopic Diagnosis of an Unusual Colonic Lesion

A 66-year-old man was referred for screening colonoscopy because of a positive fecal occult blood test. His medical history includes hypertension. He underwent a colonoscopy and multiple polypoid lesions were found in the transverse colon (Figure A). These polypoid lesions are soft with normal pit patterns on close view with chromoendoscopy (Figure B, Video 1). There was no fluid drainage out of these polypoid lesions after the biopsy. Instead, these lesions became deflated after biopsy (Video 1) and we performed an underwater colonoscopy.

1457 Cocaine-Induced Colonic Ischemia

INTRODUCTION: Cocaine use is associated with arterial vasoconstriction and enhanced thrombus formation. Rarely, these effects on the intestinal blood supply result in intestinal ischemia. Cocaine-induced ischemic colitis is a relatively poorly-defined variant of this phenomenon, but some studies suggest it may be associated with higher morbidity and mortality than other etiologies. Therefore, timing is critical in both diagnosis and initiating treatments to prevent poor outcomes. We present a case of a middle-aged patient who had an unusual presentation for ischemic colitis due to cocaine abuse. CASE DESCRIPTION/METHODS: A 49-year-old male with a history remarkable only for alcohol and cocaine use disorders presented with a two day history of hematemesis with syncope and severe abdominal pain. Urine drug screen was positive for cocaine on admission, and initial workup with EGD was grossly unremarkable. An abdominal CT scan showed extensive circumferential submucosal fat but without colonic wall thickening or other signs of acute process, and a mesenteric angiography was similarly unrevealing. However, his clinical condition continued to deteriorate over the next 48 hours with worsening abdominal pain, and he began passing large melanic stools with occasional frank red blood. He subsequently became septic; due to concern for ischemic bowel, a colonoscopy was emergently performed. Diffuse severe ischemic changes with deep cratered ulcers in the descending, transverse, and ascending colon were noted. Emergent laparotomy was performed for a near-total colectomy, after which the patient began to stabilize. DISCUSSION: Long-term cocaine abuse is associated with multiple vascular morbidities, including bowel ischemia. Our patient presented in extremis due to bowel ischemia of both SMA and IMA territories requiring intensive care and emergent colectomy. Interestingly, despite the widespread vascular compromise, initial symptoms were nonspecific without blood per rectum and imaging was unremarkable, including CT and angiography. This illustrates the importance of maintaining clinical suspicion and the utility of colonoscopy in diagnosis, as his unusually diffuse disease eventually necessitated a colectomy in this middle-aged man with otherwise unremarkable medical history.

276 Low Rates of Colonoscopic Surveillance Among Patients With High Risk Adenomas

INTRODUCTION: There have been a myriad of efforts to address suboptimal colorectal cancer (CRC) screening rates in the United States (US). Individuals with high-risk colon polyps detected during screening colonoscopy have 2- to 5-fold increased risk for the future development of CRC; however, there are few efforts directed towards optimizing risk reduction in this group. We examined surveillance uptake for patients with high-risk polyps in a large, academic healthcare system. METHODS: \We identified a cohort of patients: 1) age 50–75; 2) with a colonoscopic diagnosis of high-risk adenoma (HRA; 1 adenoma &gt;1 cm, adenoma with villous histology, adenoma with high-grade dysplasia, or 3 or more adenomas) between January 2013 and January 2016; and 3) regular primary care (PC) at UCLA Health. We collected information from the electronic health record (EHR) on demographics, polyp histology, colonoscopy completion, and office visits. We determined the proportion of patients that completed surveillance colonoscopy each year and used Student's t-tests and chi-square tests to evaluate univariate associations between patient characteristics and colonoscopy completion. RESULTS: Our cohort included 203 individuals with HRA. Mean age was 62.5 (SD = 7.6), 62.6% were male, and 75.3% were White (Table 1). There were 153 (75.4%) patients who did not complete surveillance within 3 years. Surveillance completion increased from 24.6% to 40.4% by 3.5 years. 110 (54.2%) completed surveillance by the end of 5 years (Table 2). In all, 202 (99.5%) patients had documentation of a PC visit and 165 (81.3%) had documentation of a GI visit before surveillance was due. There were 121 (59.6%) patients with a documented history of adenoma in the EHR problem list. Patients with ≥1 GI visit after HRA diagnosis (165, 81.3%) were more likely to complete surveillance than patients without a GI visit after HRA diagnosis (38, 18.7%) (P &lt; 0.001). CONCLUSION: Overall uptake of surveillance colonoscopy was low at 3 years for patients with HRA. There was notable improvement in follow-up by 3.5 years; however, adherence remained suboptimal at 40%. Clinical implications of this delay are unknown. Documentation of adenoma history was low. Individuals with HRA represent a group that has been largely neglected in CRC prevention/control research and that warrants evidence-based strategies to ensure appropriate follow-up to reduce CRC burden.

Clinicopathologic Features of Colorectal Polyps in Shahid Beheshti University of Medical Sciences (SBMU).

Aim:This study was designed to report epidemiologic findings of polyps in Iranian patients, and predict histology of polyp regarding to demographic and colonoscopic findings. Background:Classification of colorectal polyps had been revised in the past two decades and there is a need for polyp categorization in the Iranian Health System. Patients and methods: In this retrospective study, the medical records of patients with colonoscopic diagnosis of polyp in pathology departments of SBMU affiliated teaching hospitals were reviewed. Patient’s slides evaluated and demographics findings were assessed. The anatomical location, macroscopic appearance including size and histological assessment of all polyps were recorded. Results:From total number of 1106 polyps (detected in 862 patients), adenomatous polyps (638 [57.7%]) were the most prevalent findings, followed by colon mucosal tag (184[16.6%]), hyperplastic and serrated polyps (122[11%]), inflammatory polyps (110[9.9%]), hamartomatous (21[1.9%]), and malignant lesions (13[1.2%]). Multivariate logistic regression showed age (each one year increasing age; odds ratio [OR] = 1.026, 95%confidence interval [CI] = 1.016–1.036, p < 0.0001), location of polyp (right colon; OR = 1.905, 95%CI = 1.366–2.656, p < 0.0001), and polyp size of 5-10 mm (OR = 1.662, 95%CI = 1.214–2.276, p = 0.002), and polyp size of >10 mm (OR = 2.778, 95%CI = 1.750–4.411, p< 0.0001) were independently associated with neoplastic polyps. Also, polyp size of >10 mm (OR= 2.613, 95%CI= 1.083-6.307, p=0.033), tubulovillous pattern of polyp (OR= 3.508, 95%CI= 1.666-7.387, p=0.001) and villous pattern of polyp (OR= 10.444, 95%CI= 4.211-25.905, p<0.0001) were associated with high grade dysplasia in neoplastic polyps. Conclusion:Increased age, location of polyp (right colon), increased size of polyp and villous component of polyp could classify patients in high risk groups.

Diagnostic Value of 128-slice Spiral CT Combined with Virtual Colonoscopy for Colorectal Cancer.

The objective of this study was to evaluate the diagnostic value of 128-slice spiral CT combined with virtual colonoscopy in diagnosis of colorectal cancer. We retrospectively analyzed 45 patients of colorectal diseases who underwent definition AS+128-slice spiral CT combined with virtual colonoscopy after bowel preparation and gas injection to evaluate the clinical diagnostic value of this technology. All the patients received electronic colonoscopy and were confirmed by pathology. In total, colorectal cancer was confirmed in 42 cases and inflammation in 3 cases. Diagnostic results shows: there were 17 cases of lump, 10 cases of infiltration, 6 cases of ulcer, 9 cases of mixed type, 4 cases of liver metastases, and 36 cases of lymph node metastasis. There was no significant difference between 128-slice spiral CT combined with virtual colonoscopy and electronic colonoscopy in detection, localization and characterization of colorectal tumors. CT virtual endoscopy has great advantages in observing the invasion around the lesion and the presence or absence of metastasis in distant organs and lymph node metastasis. It is also possible to understand the shape of the lesion in the intestinal lumen and the length of the lesion involving the lumen of the intestine.

Histopathological Spectrum of Colorectal Cancer

Background The large bowel is affected by a variety of lesions which include both neoplastic and non-neoplastic lesions. Colorectal cancer is the fourth most common cancer worldwide and one of the leading cause of cancer related deaths. Aims To study the histopathological spectrum of colorectal cancer and evaluate them in relation to the age and sex of the patients and the site of the lesion. Materials and Method Histopathological study of cases of colorectal cancer was carried out in the Department of Pathology, AMCH, Dibrugarh from January 2018 to December 2018. Results Out of a total of 39 cases, 21 were reported in females and 18 in males with the commonest age group involved being 41–60 years. The most common histological type was found to be well differentiated adenocarcinoma and most common site was rectum. Conclusion Early detection of colorectal carcinoma through colonoscopic examination and diagnosis by histopathologic examination is very necessary for proper treatment.