Colorectal Adenomas Research Articles

Giant adolescent tubular adenoma of the breast mimicking giant fibroadenoma: a case report

Tubular adenomas are a rare benign breast neoplasm, often clinically indistinguishable from fibroadenomas or phyllodes tumors. We present a case of the largest adolescent tubular adenoma reported in the literature, measuring 12.5 cm. Radiological evaluation and histopathological assessment of the core biopsy sample was consistent with a giant fibroadenoma. However, the final histopathological analysis of the excisional biopsy sample confirmed a tubular adenoma. This case highlights the clinical conundrum of reaching the definitive diagnosis in a patient with a tubular adenoma. A contemporary review of the clinical features, radiology, histopathology and management options for tubular adenoma of the breast was undertaken.

Retrospective study evaluating association of colorectal tumors and hepatitis C virus.

Chronic hepatitis C virus (HCV) has been associated with hepatic and extrahepatic malignancies. Limited studies have shown an association between colorectal adenomas and HCV populations. To study the prevalence of colorectal adenomas in patients with HCV compared to the general population and to evaluate if it is an independent risk factor for colorectal adenomas. Patients were divided into HCV and non-HCV based on their HCV RNA titers. Patients with alcoholic liver disease, hepatitis B infection, and inflammatory bowel disease were excluded. Continuous variables were analyzed using the Mann-Whitney U test, and categorical variables using χ 2 with P < 0.05 were considered statistically significant. The significant covariates (independent variables) were matched in both groups by propensity score matching, followed by multivariate regression analysis. Of the 415 patients screened, 109 HCV patients and 97 non-HCV patients with colonoscopy results were included in the study. HCV patients were older, had a smoking history, had less frequent aspirin use, and had a lower body mass index (BMI) (P < 0.05). The HCV cohort had a significantly increased number of patients with adenomas (adenoma detection rate of 53.2% vs 34%. P = 0.006). We performed a propensity-matched multivariate analysis where HCV infection was significantly associated with colorectal adenoma (OR: 2.070, P = 0.019). Our study shows a significantly higher rate of adenomas in HCV patients compared to the general population. Prospective studies would help determine if the increase in adenoma detection lowers the risk for colorectal cancer.

Visceral Fat Thickness, Serum Adiponectin, and Metabolic Syndrome in Patients with Colorectal Adenomas.

Most cases of colorectal cancer (CRC) arise from adenomatous polyps. Identifying risk factors for colorectal adenoma (CRA) is critical for CRC prevention. Emerging evidence suggests a link between metabolic syndrome (MetS) and an elevated risk of CRA and CRC, potentially mediated by visceral obesity and adiponectin (APN). We aimed to evaluate the association between different markers of visceral obesity, serum APN, MetS, and the presence of CRA. A cross-sectional study was conducted at the University Clinical Center of Vojvodina, involving 120 patients, aged 40-75 years, who underwent colonoscopy between January 2022 and January 2023. Sixty patients with CRA were compared to 60 controls with normal colonoscopy findings. Visceral fat thickness (VFT) was measured using ultrasound (US), and bioelectrical impedance analysis (BIA) was used to assess visceral fat area (VFA). Serum APN levels, anthropometric measures, and MetS components were also evaluated. Patients with CRA had significantly higher VFT measured by US (p < 0.05), but no significant differences were found in VFA measured by BIA, waist circumference (WC), or waist-to-hip ratio (WHR). MetS was significantly more prevalent in the CRA group (55% vs. 31.6%, p < 0.05), and logistic regression confirmed MetS as a significant predictor of CRA presence (OR = 2.6). Serum APN levels were inversely correlated with visceral fat measurements and MetS (p < 0.01), but no significant difference in APN levels was observed between patients with and without CRA. This study highlights the importance of VFT measured by US and the presence of MetS as significant factors associated with CRA.

Association of late eating with colorectal adenomas: a cross-sectional study.

Colorectal cancer (CRC) is linked to lifestyle exposures. However, changes in the CRC rates among younger populations remain poorly understood and suggest the existence of yet unidentified factor(s) that may contribute to colon carcinogenesis. Here, we investigated the potential role of time of eating in the risk of pre-cancerous colonic neoplasms (tubular adenoma: TA). We enrolled 663 participants undergoing screening colonoscopies. Data on food timing, dietary intake, sleep/wake patterns, and chronotype were collected through structured questionnaires. Late eating was defined as the consumption of food or snack within a 3-hour window of sleep onset for at least four days a week. Pathology reports confirmed the histology of colonic polyps, and adenomas were further classified into risk categories. A total of 644 patients met criteria for our study. There were 270 (42.2%) participants classified as late eaters. Compared to non-late eaters, the odds of TA were higher in late eaters (OR = 1.46, 95% CI = 1.05-2.03, p = 0.023), an association which was strengthened after adjusting for multiple confounders (OR 1.98, 95% CI 1.19-3.28, p = 0.008). Late eating remained an independent risk factor for high-risk as well as multiple TAs. This study proposes late eating as a risk factor for colon tubular adenomas and underscores the potential role of less studied forms of circadian disruption imposed by time of eating in the development of colon neoplastic formation.

Plasma concentrations of multiple oxysterols and risk of colorectal adenomas.

Oxysterols are metabolites of cholesterol that regulate homeostasis of cholesterol, fatty acids, and glucose. These metabolites are generated throughout the body, either enzymatically or from oxidative stress, and are detectable in peripheral circulation. We previously reported that circulating 27-hydroxycholesterol (27-OHC), an endogenous selective estrogen receptor modulator, may be a risk factor for colorectal adenomas. Here, in addition to 27-OHC, we report on four other circulating oxysterols: 25-hydroxycholesterol (25-OHC), 24(S)-hydroxycholesterol (24(S)-OHC), 7ɑ-hydroxycholesterol (7ɑ-OHC), and 4β-hydroxycholesterol (4β-OHC). Oxysterol concentrations were measured using liquid chromatography-mass spectrometry from fasting plasma collected at baseline from 1,246 participants of the Vitamin D/Calcium Polyp Prevention Study, a multicenter adenoma chemoprevention trial. To evaluate multiple oxysterols simultaneously, we used both log-linear regression and Bayesian kernel machine regression (BKMR) models developed for analyses of complex mixtures adjusted for potential confounding factors. Higher circulating 7ɑ-OHC was associated with higher adenoma risk (BKMR-based multivariable-adjusted risk ratios, RR, for the 75th vs. 25th percentile, 1.22; 95% credible interval, CI, 1.04-1.42). In contrast, higher circulating 4β-OHC was associated with lower risk of these polyps (RR, 0.84; 95% CI, 0.71-0.99). The positive association with advanced adenoma risk that we previously reported for circulating 27-OHC persisted when controlling for other oxysterols (RR, 1.26; 95% CI, 0.98-1.62), including among those with advanced adenomas at baseline (RR, 1.75; 95% CI, 1.01-3.06).

Pseudoinvasion and squamous metaplasia/morules in colorectal adenomatous polyp: a case report and literature review

BackgroundSubmucosal pseudoinvasion and squamous metaplasia (SM) are incidental and special morphological findings in colorectal adenomas, and both can mimic invasive carcinoma. The coexistence of these two findings further increases the risk of misdiagnosis, posing a great diagnostic challenge to pathologists. From 1979 to 2022, only 8 cases have been reported, which was extremely rare. In this report, we presented a case of sigmoid colon adenoma accompanied by pseudoinvasion and SM. Additionally, relevant literature was analyzed to summarize the clinical and pathological characteristics.Case presentationA 51-year-old Chinese male patient presented with fresh blood after defecation. Electronic colonoscopy revealed multiple polyps, which were removed using a snare and subjected to high-frequency electrocoagulation resection. The largest polyp, located in the sigmoid colon, was a thick pedunculated and lobulated polyp with a maximum diameter of 2.8 cm. The surface of the polyp showed slight ruggedness and redness, and it was sent for pathological examination. Grossly, the polyp had a lobulated and slightly rough surface. Microscopically, it showed a tubulovillous adenoma with focal high-grade dysplasia and mucosal muscle hyperplasia. Glandular elements were observed in the submucosal layer, forming a well-defined lobular structure. Some of the glands displayed cystic change, and focal SM could be seen within the adenoma. SM could manifest as discrete solid cell nests of varying sizes or cribriform-morular-like structures. Immunohistochemical staining showed that SM cells were diffusely positive for cytokeratin 5/6 (CK5/6); p40, p63, and cytokeratin 20 (CK20) were negative; while caudal type homeobox 2 (CDX2) was weakly positive. β-catenin showed abnormal nuclear expression, and an extremely low Ki67 proliferation index was observed.ConclusionsCoexistence of SM and pseudoinvasion in colorectal adenomas is highly rare. It is more commonly observed in males and tends to occur in the sigmoid colon. It primarily manifests in tubulovillous adenoma and tubular adenoma, with a majority of cases exhibiting a pedicle. Histologically, it is similar to invasive lesions. The cystic dilation of the submucosal glands, hemosiderin deposition, and the presence of a lamina propria around the submucosal glands without adjacent desmoplastic reaction, suggest pseudoinvasion rather than cancer. The bland cytological morphology and Immunohistochemical markers play a crucial role in distinguishing SM from true invasive lesions.

The value of SDC2 and Septin9 combined with serum tumor markers in early diagnosis of colorectal cancer

ObjectiveThe aim of this study is to evaluate the significance of combined detection of Septin9 and syndecan-2 (SDC2) methylation markers and serum tumor markers for the early diagnosis of colorectal cancer.MethodsA total of 116 patients diagnosed with colorectal cancer between December 2022 and February 2024 were designated as the colorectal cancer group. Additionally, 31 patients with colorectal adenoma were assigned to the adenoma group, while 44 individuals undergoing routine physical examinations were included in the control group. Concentrations of Septin9, SDC2, fecal occult blood (FOB), and four tumor markers—carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125), and carbohydrate antigen 724 (CA724)—were measured. Diagnostic performance was assessed using receiver operating characteristic (ROC) curves for Septin9, SDC2, the four tumor markers, FOB, the combination of Septin9 and SDC2, and the combined use of all seven indicators (CEA, CA19-9, CA125, CA72-4, FOB, Septin9, and SDC2).ResultsThe colorectal cancer group exhibited the highest positive rates for Septin9, SDC2, the four tumor markers, the combined detection of Septin9 and SDC2, and the combined detection of all seven indicators, compared to both the adenoma and control groups (P < 0.05). The adenoma group also showed higher positive rates than the control group (P < 0.05). For patients with stage I–III colorectal cancer, the positive rates for the combined detection of Septin9 and SDC2 were 81.3%, 78.9%, and 90.2%, respectively, surpassing those for the combined detection of the four tumor markers (43.8%, 55.3%, and 61.0%). Additionally, the positive rates for the two-gene combination in stage III colorectal cancer were higher than those for FOB (P < 0.05). The sensitivity and area under the curve (AUC) for SDC2 were 73.3% and 0.855, respectively, exceeding the sensitivity and AUC for the combined four tumor markers, which were 60.3% and 0.734 (P < 0.05). The combined detection of the two methylated genes demonstrated a sensitivity of 86.2% and an AUC of 0.908, outperforming both FOB and the combined detection of the four tumor markers (P < 0.05).ConclusionThe detection of SDC2 exhibits high sensitivity for colorectal cancer, and when combined with Septin9, it significantly enhances the diagnostic accuracy for early-stage colorectal cancer, offering substantial clinical value.

Species-level verification of Phascolarctobacterium association with colorectal cancer.

We have previously demonstrated an association between increased abundance of Phascolarctobacterium and colorectal cancer (CRC) and adenomas in two independent Norwegian cohorts. Here we seek to verify our previous findings using new cohorts and methods. In addition, we characterize lifestyle and sex specificity, the functional potential of the Phascolarctobacterium species, and their interaction with other microbial species. We analyze Phascolarctobacterium with 16S rRNA sequencing, shotgun metagenome sequencing, and species-specific qPCR, using 2350 samples from three Norwegian cohorts-CRCAhus, NORCCAP, and CRCbiome-and a large publicly available data set, curatedMetagenomicData. Using metagenome-assembled genomes from the CRCbiome study, we explore the genomic characteristics and functional potential of the Phascolarctobacterium pangenome. Three species of Phascolarctobacterium associated with adenoma/CRC were consistently detected by qPCR and sequencing. Positive associations with adenomas/CRC were verified for Phascolarctobacterium succinatutens and negative associations were shown for Phascolarctobacterium faecium and adenoma in curatedMetagenomicData. Men show a higher prevalence of P. succinatutens across cohorts. Co-occurrence among Phascolarctobacterium species was low (<6%). Each of the three species shows distinct microbial composition and forms distinct correlation networks with other bacterial taxa, although Dialister invisus was negatively correlated to all investigated Phascolarctobacterium species. Pangenome analyses showed P. succinatutens to be enriched for genes related to porphyrin metabolism and degradation of complex carbohydrates, whereas glycoside hydrolase enzyme 3 was specific to P. faecium.IMPORTANCEUntil now Phascolarctobacterium has been going under the radar as a CRC-associated genus despite having been noted, but overseen, as such for over a decade. We found not just one, but two species of Phascolarctobacterium to be associated with CRC-Phascolarctobacterium succinatutens was more abundant in adenoma/CRC, while Phascolarctobacterium faecium was less abundant in adenoma. Each of them represents distinct communities, constituted by specific microbial partners and metabolic capacities-and they rarely occur together in the same patients. We have verified that P. succinatutens is increased in adenoma and CRC and this species should be recognized among the most important CRC-associated bacteria.

Using Remotely Operated Suction Irrigation System in da Vinci SP Submucosal Dissection.

Submucosal dissection using the da Vinci SP® system (Intuitive Surgical, Sunnyvale, CA, USA) is an emerging approach for treating premalignant lesions in the colon and rectum. The endoluminal space is tight and small, and during the procedure, this tight space is accessed by the 40 mm GelPOINT® Path transanal platform (Applied Medical, Rancho Santa Margarita, CA, USA). Most of the trocar space is occupied by the 25 mm port of the da Vinci SP® system. There is limited space for an additional trocar, and the full mobility of this trocar is restricted; hence there is a need for an effective suction irrigator during these procedures. Although the da Vinci SP® system has four instrument capabilities, it does not have a suction irrigation instrument. To address this issue, we tested a Remotely Operated Suction Irrigation System (ROSI™) (VTI, Nashua, NH, USA) in three patients undergoing da Vinci SP® submucosal dissection. The impact of innovation is the evaluation of a flexible suction irrigator during endorobotic submucosal dissection (ERSD), addressing space constraints and enhancing surgical precision. This was a single-center retrospective observational study involving three patients who underwent ERSD, between February 2023 and May 2023. ROSI™ was used selectively for rectal lesions. The first patient was a 67-year-old male with a 30 mm tubulovillous adenoma found in the rectum at 4 cm. The second patient was a 49-year-old female, referred after a screening colonoscopy, with a 40 mm rectal mass 12 cm from the anal verge. A biopsy revealed a tubular adenoma without dysplasia. The last patient was a 66-year-old male with a 25 mm tubulovillous adenoma with a focal high-grade dysplasia at 10 cm. There was no evidence of invasive carcinoma or lymph node metastasis on MRI in any of the patients. The patients were placed in a modified lithotomy position, and the GelPOINT® Path was inserted. A silk suture was attached at the proximal end of ROSI™ to facilitate tubing manipulation. ROSI™ was freely passed into the endoluminal space through the gel using a surgical clamp. Any bleeding during the operation was aspirated and irrigated using ROSI™ with the assistance of bipolar forceps. All surgeries were completed without complications and the patients were discharged on the same day. ROSI™ is a flexible foot pedal-controlled suction irrigator that can facilitate da Vinci SP® submucosal dissection. The flexibility and controllability of ROSI in the surgeon's hand may qualify it as an essential tool for performing ERSD and possibly other TAMIS procedures.

FP4.9 - Adherence to post Colonic polypectomy surveillance guidelines

Abstract Aims The British Society of Gastroenterology updated its guidelines in 2020 regarding polyps follow-up following colonoscopy. The surveillance depends on type, size, number, and histology criteria. Our aim was to assess adherence of our hospital's endoscopy department to these new guidelines. Methods A retrospective analysis of all consecutive adult patients who underwent colonoscopy were included between January and March 2022 at our hospital. Data were collected and analyzed on excel. The endoscopy report was identified from MediLogik-EMS.Histology from PICS system. Demographics including the specialty of endoscopist was also included. Non-parametric data were expressed in their Median and IQR. Results Out of the 108 patients examined 50/108 (49%) were found to have polyps and were included in the analysis. F: M =1:2, median age 64 with IQR 18.5(59-77.5). Tubular adenoma was found in 58%, hyperplastic polyps in 12%, sessile serrated polyps in 10%, tubulovillous adenoma in 8%, adenocarcinoma in 8%, and inflammatory polyps in 4%. Histopathology revealed tubular adenoma with LGD in 58%, inflammatory polyps in 16%, adenocarcinoma in 8%. Polyps were removed using cold biopsy in 58% and hot snare in 38%. BSG guidelines were followed in 92% (46/50). The reason for not adherence was either histologically incomplete excision, requiring a site check within 2-6 months which was not performed in6%(3)or high-risk features requiring 3 yearly surveillance colonoscopy follow-ups not requested in 2%(1). Conclusion There is high adherence to the guidelines but still not 100%. Our aim is to achieve 100% adherence in the re-audit.

FP2.12 - 'To Evaluate Lower Threshold of Polyp Size for Tattooing Routinely, a Single Trust Observational Study.'

Abstract Aim The goal of the study is to establish the lowest polyp size for clinically effective tattooing routinely. Method Retrospective data collection of colonoscopy and flexible sigmoidoscopy for bowel screening and non-bowel screening patients; 450 patients underwent polypectomy of &amp;lt;20mm from September 2021 to September 2022 in MTW NHS Trust. Patients were included according to 'single patient single polyp' criteria. We excluded 20+ mm polyps, multiple polyp, known FAP, lynch syndrome and other genetic predisposed colorectal polyps. Histology was obtained from electronic patient records (Allscripts). SPSS version 25.0 was used for the statistical analysis, which also included ROC curve analysis and Chi-Square test. Results A total of 450 participants, 288 males (64.0%) and 162 females (36.0%), were enrolled. Polyp sizes: 0-9mm (42.2%) and 10-19mm (57.8%). 8.0% were tattooed. Polyps found in right- hemicolon, transverse, left-hemicolon, sigmoid and rectum accordingly 29.78%, 20.5%, 9.1%, 28.4% and 12.22%. Pedunculated polyps were found in 143 individuals (31.8%), while sessile polyps were observed in 256 individuals (56.9%). Furthermore, in histological analysis, 251 individuals (55.8%) exhibited tubular adenomas and the majority of the cohort (77.6%) presented with low-grade dysplasia. Malignant invasion was detected in 27 subjects (6%). Receiver operating system (ROC) curve analysis indicated that polyp size was a predictive factor for malignancy development, with a cut-off lower point identified at 8.5 mm. Conclusions The findings confirm the advice to tattoo polyps bigger than 8-9 mm to make tracing and follow- up easier.

Discovery and validation of colorectal cancer tissue-specific methylation markers: a dual-center retrospective cohort study

Background and purposeEarly detection, diagnosis, and treatment of colorectal cancer and its precancerous lesions can significantly improve patients’ survival rates. The purpose of this research is to identify methylation markers specific to colorectal cancer tissues and validate their diagnostic capability in colorectal cancer and precancerous changes by measuring the level of DNA methylation in stool samples.MethodWe analyzed samples from six cancer tissues and adjacent normal tissues and fecal samples from 758 participants, including 62 patients with interfering diseases. Bioinformatics databases were used to screen for candidate biomarkers for CRC, and quantitative methylation-specific PCR methods were applied for identification. The methylation levels of the candidate biomarkers in fecal and tissue samples were measured. Logistic regression and random forest models were built and validated using fecal sample data from one of the centers, and the independent or combined diagnostic value of the candidate biomarkers in fecal samples for CRC and precancerous lesions was analyzed. Finally, the diagnostic capability and stability of the model were validated at another medical center.ResultsThis study identified two colorectal cancer CpG sites with tissue specificity. These two biomarkers have certain diagnostic power when used individually, but their diagnostic value for colorectal cancer and colorectal adenoma is more significant when they are used in combination.ConclusionThe results indicate that a DNA methylation biomarker combined diagnostic model based on two CpG sites, cg13096260 and cg12587766, has the potential for screening and diagnosing precancerous lesions and colorectal cancer. Additionally, compared to traditional diagnostic models, machine learning algorithms perform better but may yield more false-positive results, necessitating further investigation.

Selenium, Zinc, and Plasma Total Antioxidant Status and the Risk of Colorectal Adenoma and Cancer.

Selenium (Se), zinc (Zn), and copper (Cu) are known to be involved in carcinogenesis and participate in the defence against reactive oxygen species (ROS). This study aimed to evaluate the clinical utility of serum Se, Zn, and Cu concentrations and plasma total antioxidant status (TAS) in the diagnosis of colorectal cancer (CRC) and colorectal adenoma (CRA) in a population of low Se and borderline Zn status. Based on clinical examination and colonoscopy/histopathology, the patients (n = 79) were divided into three groups: colorectal cancer (n = 30), colorectal adenoma (n = 19), and controls (CONTROL, n = 30). The serum Se concentration was lower in the CRC group than in the CRA group (by 9.1%, p < 0.0001) and the CONTROL group (by 7.9%, p < 0.0001). In turn, the serum Zn concentration was decreased in the CRA group (by 17.9%, p = 0.019) when compared to the CONTROL group. Plasma TAS was lower in the CRC group (by 27.8%, p = 0.017) than in the CONTROL group. In turn, the serum Zn concentration was decreased in the CRA group when compared to the CONTROL group. Plasma TAS was lower in the CRC group than in the CONTROL group. ROC (receiver operating characteristic) curve analysis revealed that the Se level was of the highest diagnostic utility for the discrimination of the CRC group from both the CRA group (area under ROC curve (AUC) 0.958, sensitivity 84.21%, specificity 100%) and the CONTROL group (AUC 0.873, sensitivity 100%, specificity 66.67%). The Zn and TAS levels were significantly accurate in the differentiation between the groups. An individualised risk of colorectal adenoma and cancer approach could comprise Se, Zn, and TAS assays in the population.

Colorectal Cancer Complicated with Chronic Schistosoma Japonicum Infected: A Case Report.

Colonic schistosomiasis is a significant health issue in endemic areas, presenting diagnostic challenges due to its nonspecific clinical symptoms and radiographic features. This case report highlights a patient with concomitant colorectal cancer and chronic Schistosoma japonicum infection, emphasizing the need for a comprehensive diagnostic approach. A 67-year-old male from an endemic region presented with a six-month history of intermittent hematochezia. Initial colonoscopy revealed multiple mucosal elevations in the sigmoid colon and rectum. Subsequent investigations, including CT scans and endoscopic ultrasonography, indicated high echogenic changes and multiple lesions. The patient underwent endoscopic submucosal dissection (ESD), revealing adenocarcinoma of the rectal mucosa and tubular adenoma in the sigmoid colon, both with extensive deposition of Schistosoma japonicum eggs. Postoperative pathology confirmed the diagnosis of moderately differentiated adenocarcinoma with chronic schistosomiasis. This case underscores the diagnostic complexity of colonic schistosomiasis, particularly when coexisting with malignancy. The integration of colonoscopy, histopathology, and auxiliary tests is crucial for accurate diagnosis. Clinicians should maintain a high index of suspicion for schistosomiasis in patients from endemic areas presenting with gastrointestinal symptoms. Regular screening and detailed medical histories are essential for early detection and treatment, improving patient outcomes and reducing the risk of misdiagnosis.

Metachronous Colorectal Neoplasia in Young Adults With Advanced Neoplasia Undergoing Colonoscopy: A Comparison of Risk by Age

The risk of metachronous advanced colorectal neoplasia (mACRN) in young adults with advanced lesions at baseline colonoscopy is not well defined. To examine the risk for (mACRN) in adults <50 years old who had advanced neoplasia (AN) at baseline colonoscopy and determine factors associated with mACRN in these patients. Patients 18 to 49 years of age with ≥1 AN [tubular adenoma (TA) ≥10mm or with villous features or high-grade dysplasia (HGD), sessile serrated lesion (SSL) ≥10mm or with dysplasia, traditional serrated adenoma (TSA)] on baseline colonoscopy between 2011 and 2021 who had surveillance colonoscopy >6 months after their baseline examination were included. Outcomes were assessed based on age at baseline colonoscopy, <45 years versus 45 to 49 years, and by follow-up colonoscopy findings: (1) normal, (2) nonadvanced neoplasia (NAN), and (3) AN. Three hundred sixty-six patients with AN underwent ≥1 surveillance colonoscopy: 310 (84.7%) <45 years versus 56 (15.3%) 45 to 49 years. The mean follow-up time was longer for the <45-year-olds versus the 45 to 49-year-olds (43±26.4 vs. 28.4±12.8mo respectively, P<0.001). The absolute risk of mACRN was 13.5% in the <45 age group versus 16.1% in the 45 to 49 age group, P=0.28. The 3-year cumulative incidence rates of mACRN were comparable for patients <45 and 45 to 49 years old: 10% (95% CI: 10% to 42%) versus 20% (95% CI: 7% to 15%), P=0.065. BMI was the only risk factor associated with mACRN OR 1.045 [95% CI (1.001 to 1.09)]. In our cohort of patients <50 years old with AN at baseline, mACRN occurred at a similar rate to that reported by guidelines in 50 years and older, suggesting that current recommended post polypectomy surveillance is appropriate for this age group. BMI was independently associated with mACRN. Future studies should examine how weight management in patients with high BMI mitigates the recurrence of advanced neoplasia.

A National Cancer Database Analysis of the Characteristics and Outcome of Colon Cancer According to Type of Preexisting Adenoma

BackgroundThe vast majority of colon cancers occur in pre-existing adenomas. Little is known about the impact of adenoma type on behavior and outcome of subsequent carcinomas. The present study aimed to assess characteristics, behavior, and outcome of colon adenocarcinoma based on histologic type of pre-existing adenoma. MethodsUS-National Cancer Database was searched between 2005 and 2019 for patients with colonic adenocarcinoma with known adenoma type who underwent colectomy. Patients were divided into 3 groups according to type of adenoma in which carcinoma developed: tubular adenoma (TA), villous adenoma (VA), and tubulovillous adenoma (TVA)-associated carcinomas. The main outcome of the study was 5-year overall survival (OS). Results66,854 patients were included. 79.3% of carcinomas originated from TVA, 10.2% from VA, and 0.5% from TA. Patients with adenocarcinoma in VA were more often female whereas carcinomas in TA affected patients of Asian race more often. Approximately one-third of carcinomas in villous and tubulovillous adenomas were in the cecum whereas one-third of carcinomas in tubular adenomas were in the sigmoid colon. More TA-associated carcinomas were of clinical T1-2 stage (30.2% vs. 20.8%; P < .001), clinical N0 stage (69% vs. 62.2%, P < .001), and high grade (15.9% vs. 11.5%, P < .001) compared to VA-associated carcinomas. Patients with TA-associated carcinomas had longer mean OS than patients with VA and TVA-associated carcinomas (130.1 vs. 116.9 vs. 123.5 months, P < .0001). ConclusionsAdenocarcinomas that arose in TA had more T1-2 stage and N0 stage, higher grade, and longer OS than did adenocarcinomas that arose in VA and TVA.

Optimal visual gaze pattern of endoscopists for improving adenoma detection during colonoscopy (with video)

Background and aimsVisual gaze pattern (VGP) analysis quantifies endoscopists’ specific eye movements. VGP during colonoscopy may be associated with polyp detection. However, the optimal VGP to maximize detection performance remains unclear. This study evaluated the optimal endoscopic VGP that enabled the highest colorectal adenoma detection. MethodsThis randomized controlled trial was conducted between July and December 2023. We developed an eye-tracking and feedback (ETF) system that instructed endoscopists to correct their gaze toward the periphery of an endoscope screen with an audible alert. Patients who underwent colonoscopy were randomly assigned to four groups: three intervention groups in which the endoscopist’s gaze was instructed to a different level of the peripheral screen area using the ETF system (the periphery of 4×4, 5×5, and 6×6 divisions of the screen) and a control group in which the endoscopist did not receive instructions. The primary outcome was the number of adenomas detected per colonoscopy (APC). ResultsIn total, 189 patients were enrolled. APC and adenoma detection rate were significantly higher in the 6×6 group than in the control group (1.82±2.41 vs. 0.59±1.17, P=0.002; 68.9% vs. 30.8%, P=0.002). The APC and the number of screen divisions were positively correlated (R=0.985, P=0.0152). The rate at which the endoscopist gazed at the periphery of the screen was positively correlated with the number of divisions (R=0.964, P=0.0363). ConclusionsColorectal adenoma detection was improved by correcting the endoscopist’s gaze to the periphery of the screen, especially by dividing the screen into 6×6 segments.

Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines.

Clinical guidelines should ideally be formulated from data representative of the population they are applicable to; however, historically, studies have disproportionally enrolled non-Hispanic White (NHW) patients, leading to potential inequities in care for minority groups. Our study aims to evaluate the extent to which racial minorities were represented in the United States Colorectal Cancer Surveillance Guidelines. We reviewed US guidelines between 1997 and 2020 and all identified studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps, and hyperplastic polyps. We analyzed the proportion of studies reporting race, and among these studies, we calculated the racial distribution of patients and compared the proportion of Non-NHW patients between each subtype. For all guidelines, we reviewed 75 studies encompassing 9,309,955 patients. Race was reported in 24% of studies and 14% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for adenomas, 22% for sessile serrated polyps, and 15% for hyperplastic polyps. For the 2020 guidelines, we reviewed 33 studies encompassing 5,930,722 patients. Race was reported in 15% of studies and 21% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for tubular adenomas. Race was not cited for any other 2020 guideline. Racial minorities are significantly underrepresented in US Colorectal Cancer Surveillance Guidelines, which may contribute to disparities in care. Future studies should prioritize enrolling a diverse patient population to provide data that accurately reflects their population.

Body mass index and the prevalence of high-risk colorectal adenomas in a population undergoing screening colonoscopy in Alberta, Canada.

There is limited evidence regarding body mass index (BMI) as an early marker of high-risk adenoma (HRA) at the time of screening colonoscopy. Because high-risk adenomas (HRA) can develop into colorectal cancer (CRC), BMI could serve as an important clinical predictor of future risk of CRC. We examined data from 1831 adults undergoing screening colonoscopy at the Forzani & MacPhail Colon Cancer Screening Center in Alberta, Canada. We fit multivariable logistic regression models to examine the association between BMI and HRA. Non-linear relationships for BMI on HRA were also evaluated using restricted cubic splines. The mean BMI in patients with HRA was 28.2kg/m2 compared to 27.4kg/m2 in patients without adenomas (t test: p=0.003). In the adjusted models, those with a BMI over 30kg/m2 had 1.45 (95% CI 1.05-2.00) times the odds of HRA detected during colonoscopy compared to those with a BMI below 25kg/m2. Examining BMI as continuous, the odds of HRA were 1.20 (95% CI 1.04-1.37) times higher for every 5kg/m2 increase in BMI. The findings of this study suggest that excess body mass is associated with higher risk of HRA among a screening population and may be useful an early marker of future disease.

Predictive modeling of colorectal cancer using exhaustive analysis of microbiome information layers available from public metagenomic data.

This study aimed to compare the microbiome profiles of patients with colorectal cancer (CRC, n = 380) and colorectal adenomas (CRA, n = 110) against generally healthy participants (n = 2,461) from various studies. The overarching objective was to conduct a real-life experiment and develop a robust machine learning model applicable to the general population. A total of 2,951 stool samples underwent a comprehensive analysis using the in-house MetaBakery pipeline. This included various data matrices such as microbial taxonomy, functional genes, enzymatic reactions, metabolic pathways, and predicted metabolites. The study found no statistically significant difference in microbial diversity among individuals. However, distinct clusters were identified for healthy, CRC, and CRA groups through linear discriminant analysis (LDA). Machine learning analysis demonstrated consistent model performance, indicating the potential of microbiome layers (microbial taxa, functional genes, enzymatic reactions, and metabolic pathways) as prediagnostic indicators for CRC and CRA. Notable biomarkers on the taxonomy level and microbial functionality (gene families, enzymatic reactions, and metabolic pathways) associated with CRC were identified. The research presents promising avenues for practical clinical applications, with potential validation on external clinical datasets in future studies.