Diagnosis Of Colorectal Adenoma Research Articles

Neighborhood homicide rate and odds of colorectal adenoma among adult patients seeking colonoscopy.

Chronic exposure to ambient stressors, including neighborhood crime, may have a detrimental impact on the body's stress response system with implications for colorectal carcinogenesis. We examined associations between the mean neighborhood homicide rates from 2000 and 2018 and diagnosis of colorectal adenoma among patients at the University of Illinois Health and Hospital System in Chicago, Illinois, between 2015 and 2018. Of the 5,225 patients who underwent colonoscopy and were included in the analytic dataset, 60% had colorectal adenoma. Older age, male sex, and higher body mass index (BMI) were associated with greater odds of colorectal adenoma. The neighborhood homicide rate was associated with identifying as Black and Hispanic and higher BMI. A mediation analysis showed that the neighborhood homicide rate effects on colorectal adenoma were mediated through BMI. The study concluded that older age, male sex, and higher BMI significantly increase the odds of colorectal adenoma, with neighborhood homicide rate indirectly influencing this risk through its association with BMI, particularly among Black and Hispanic individuals.

The Role of Exhaled Hydrogen Sulfide in the Diagnosis of Colorectal Adenoma.

Purpose Exhaled determination can detect metabolite hydrogen sulfide in the intestine. We aim to analyze the predictive value of hydrogen sulfide in the diagnosis of colorectal adenoma. Methods We recruited seventy patients diagnosed with colorectal adenoma as the observation group and sixty-six healthy subjects as the control group. The colorectal adenoma was diagnosed by colonoscopy at the Endoscopy Center of Huashan Hospital affiliated to Fudan University from June 2018 to November 2019. Exhaled gas was collected through the nose and mouth, respectively, and hydrogen sulfide in exhaled gas was determined according to the manufacturer's instructions. Results Receiver operating characteristic (ROC) curve was analyzed based on the exhaled data of the observation group and the control group. The ROC curve showed an area under ROC curve (AUC) 0.724 for nasal exhaled H2S, which had a diagnostic value. When nasal exhaled H2S was >13.3 part per billion (ppb), the sensitivity and the specificity of predicting colorectal adenoma were 57% and 78%, respectively. The exhaled H2S of the observation group was significantly different from that of the control group. The AUC value was 0.716 as a prognostic factor of colorectal adenoma. As exhaled H2S was >28.8 ppb, the sensitivity and the specificity of predicting colorectal adenoma were 63% and 77%, respectively. Conclusion Exhaled and nasal H2S determination has a predictive value for colorectal adenoma as a novel and noninvasive method. Therefore, it is worth conducting more research to analyze exhaled and nasal H2S.

468 - A Novel Fecal Bacterial Marker for the Non-Invasive Diagnosis of Colorectal Adenoma

468 - A Novel Fecal Bacterial Marker for the Non-Invasive Diagnosis of Colorectal Adenoma

A Review of Outcomes for Colorectal Adenomas.

Using data from former reports, this study reviews and analyzes the outcomes of tumor recurrence, tumor progression, and tumor-specific survival of patients with colorectal adenomas. Data were collected from 32 longitudinal studies of outcomes after the first diagnosis of colorectal adenoma and collected as individual patient results, that is, as failure times from the first tumor to the three outcomes. Altogether, there were 45,286 patients, including 22,148 for the outcome of additional adenomas, 23,796 for the outcome of progression to invasive carcinoma, and 2,602 for the outcome of disease-specific survival (some patients were available for more than one outcome). In these data, the mean time to additional adenomas was 6 years, the mean time to invasive carcinoma was 15.9 years, and the mean tumor-specific survival time was 21.9 years. Although greater than 50% of those with colorectal adenomas will have additional adenomas, few progress to invasive tumor or die of colorectal cancer.

Enhancing adherence in trials promoting change in diet and physical activity in individuals with a diagnosis of colorectal adenoma; a systematic review of behavioural intervention approaches.

BackgroundLittle is known about colorectal adenoma patients’ ability to adhere to behavioural interventions promoting a change in diet and physical activity. This review aimed to examine health behaviour intervention programmes promoting change in diet and/or physical activity in adenoma patients and characterise interventions to which this patient group are most likely to adhere.MethodsSearches of eight databases were restricted to English language publications 2000–2014. Reference lists of relevant articles were also reviewed. All randomised controlled trials (RCTs) of diet and physical activity interventions in colorectal adenoma patients were included. Eligibility and quality were assessed and data were extracted by two reviewers. Data extraction comprised type, intensity, provider, mode and location of delivery of the intervention and data to enable calculation of four adherence outcomes. Data were subject to narrative analysis.ResultsFive RCTs with a total of 1932 participants met the inclusion criteria. Adherence to the goals of the intervention ranged from 18 to 86 % for diet and 13 to 47 % for physical activity. Diet interventions achieving ≥ 50 % adherence to the goals of the intervention were clinic based, grounded in cognitive theory, delivered one to one and encouraged social support.ConclusionsThe findings of this review indicate that behavioural interventions can encourage colorectal adenoma patients to improve their diet. This review was not however able to clearly characterise effective interventions promoting increased physical activity in this patient group. Further research is required to establish effective interventions to promote adherence to physical activity in this population.

Lower gastrointestinal endoscopies results

Objectives: Endoscopic examinations have great potential in early diagnosis of colorectal adenomas and carcinomas with reducing to colorectal cancer incidence and mortality. We aimed to evaluate for diagnostic purposeful lower gastrointestinal endoscopic procedures in the second step state hospital retrospectively Methods: Between June 2010 and June 2013, we evaluated 278 patients with rectal bleeding, constipation and abdominal pain detected by lower gastrointestinal endoscopic procedures retrospectively. Results: The mean age of the patients was 54.8 p 16.8 (15-90) year, respectively. 172 (61.9%) of the patients were male and 106 (38.1%) of the patients were female. 116 (41.7%) of the patients was performed rectosigmoidoscopy and 162 (58.3%) of the patients was performed colonoscopy. 51(18.3%) of our patients were normal. 10 (3.6%) of patients had colorectal cancer, 11(3.9%) of patients had inflammatory bowel disease, 8 (2.9%) of patients had parasitosis, 31(11.1%) of patients had colorectal polyps, 12 (4.3% ), in patients had diverticular disease, 2 (0.7%) patients had rectal ulcer, 25 (9%) patients had anal fissure and 159 (57.2%) of the patients had hemorrhoidal disease. Conclusion: Lower gastrointestinal endoscopy is a method been the gold standard with a low complication rate and that can be easily applied in the evaluation to pathology of colorectal and anal canal. J Clin Exp Invest 2014; 5 (4): 580-582

Impact of Organised Screening Program By Fecal Occult Blood Test on the Diagnosis Rate of Colorectal Adenomas: a Population-Based Study

ABSTRACT Aim: Pilot colorectal cancer screening programs using a biennial fecal occult blood test (FOBT) started in France in 2003. A population-based Registry of adenomas, covering one of the pilot areas, gave the opportunity to describe time trends in the rate of diagnosis of colorectal adenomas, before and after the beginning of the screening program. Methods: The study relies on the only Registry which has been collecting since 1976 data on all cases of colorectal adenomas diagnosed in a well-defined administrative area (Cote-d'Or, France). This population-based study included all residents aged 50–74 years, with a first adenoma diagnosed between 01/1997 and 12/2008 and compared “pre- screening period” (1997-2002) with “post-screening period” (2003-2008). Standardized diagnosis rates were calculated by 5-year age group, gender and calendar year. Annual percentage changes were estimated using a Poisson regression model. Results: Over the study period, 4,908 men and 3,133 women were first-diagnosed with colorectal adenoma. High-risk adenomas (>1cm, villous component and/or high grade dysplasia) were found in 38.7% of them. For high-risk adenomas, age-standardized diagnosis rates were 136/100,000 before screening program and 257/100,000 after, with a percentage change of 89%. The corresponding rates for non-advanced adenomas were respectively: 235 and 392/100,000, with a percentage change of 68%. Data obtained on participation and positivity of tests for included individuals allowed to examine results according to these parameters. Conclusions: In actual conditions of clinical practice, we showed a marked increase in the rate of first adenoma diagnosis after 3 biennial colorectal cancer screening rounds, especially for high-risk adenomas. These results reinforce the interest of extending organized mass screening program. Using immunochemical FOBT, which showed better performance than guaiac-FOBT, will also improve results in the future. Disclosure: All authors have declared no conflicts of interest.

Su1083 Predictors of Outcome At Surveillance Colonoscopy Following a Diagnosis of Colorectal Adenoma

Background. Post polypectomy surveillance colonoscopies are a huge burden on healthcare systems. Improved risk assessment could result in reduced colonoscopy use. Our aim was to identify patient, polyp and program factors associated with incidence of new neoplasia at first surveillance colonoscopy following an initial diagnosis of colorectal adenomaMethods. We reviewed colorectal cancer (CRC) surveillance outcome data contained in a colonoscopy recall database. Findings at first surveillance colonoscopy in people who had been diagnosed with advanced (high risk, HRA) adenoma ( ≥ 3 polyps, size ≥10mm, villous component, serration, high grade dysplasia) at diagnostic colonoscopy were compared to those with non-advanced (low risk, LRA) adenomas at diagnosis. Data included patient age and sex, polyp features and location, and interval between colonoscopies. Outcomes were compared using bivariate (Fisher's exact) and multivariate (multinomial logistic regression) analyses. Results. Among 457 eligible patients, 266 (58%) were males, and mean age at diagnostic colonoscopy was 63 years. Mean time between diagnostic and surveillance colonoscopy were 43 and 31 months (median 40 and 35 months) for HRA and LRA respectively. There was a significant difference between groups for outcome at surveillance (Table, p=0.014). At the multivariate level, significant associations between outcome at surveillance and polyp features at diagnosis were limited. Controlling for age, gender and colonoscopy interval, those with LRA at diagnosis were more likely to have LRA at surveillance (RRR=1.91, p= 0.023, 95% CI 1.09-3.34). There was a non-significant trend towards increased risk for advanced neoplasia (HRA plus cancers) at surveillance in those originally diagnosed with HRA (RRR=1.31). Age and sex were significant predictors of adenoma incidence at surveillance. Relative risk ratios for HRA increased with each year of age for both males (RRR 1.04, p=0.007, 95% CI 1.01-1.07) and females (RRR 1.04, p=0.019, 95% CI 1.01-1.07), while the relative risk ratio for LRA increased significantly per year of age for males only (RRR 1.03, p=0.007, 95% CI 1.01-1.06). Conclusions: While features of polyps at diagnostic colonoscopies remain key predictors of findings at surveillance, age and sex are additional variables that predict worse outcome. Reduced risk of LRA at surveillance in patients previously diagnosed with HRA may reflect a more conscientious approach by proceduralists at diagnosis. Post polypectomy surveillance could focus more towards older patients. Table. Surveillance outcomes following a diagnosis of low or high risk adenoma.

Matrix metalloproteinase 2 and tissue inhibitor of matrix metalloproteinases 2 in the diagnosis of colorectal adenoma and cancer patients.

The aim of the study was to assess the importance of the measurement of matrix metalloproteinase 2 (MMP-2) and tissue inhibitor of matrix metalloproteinases 2 (TIMP-2) in patients with colorectal cancer (CRC) in relation to clinicopathological features of tumor and patients' survival. Additionally, we determined serum MMP-2 and TIMP-2 in colorectal adenoma (CA) patients and healthy controls and compared them with tumor markers, CEA and CA 19-9. The serum levels of MMP-2 and TIMP-2 in 91 CRC patients, 28 CA subjects and 91 healthy controls were determined by ELISA method, but concentrations of CEA and CA 19-9 using MEIA method. Nonparametric statistical analyses were used. Serum levels of MMP-2 and TIMP-2 were significantly lower in CRC patients than in healthy subjects and decreased with tumor stage. Additionally, MMP-2 concentrations were significantly lower in patients with CRC than in CA group. Diagnostic sensitivity of TIMP-2 (59%) was the highest among biomarkers tested and increased in combined use with CEA (79%). Moreover, the area under ROC curve (AUC) of TIMP-2 was larger than AUC of MMP-2 in differentiation between CRC and healthy subjects, but lower than AUC of matrix metalloproteinase 2 in differentiation between colorectal cancer and adenoma. Our findings suggest clinical usefulness of TIMP-2 as a biomarker in the diagnosis of CRC, especially in combination with CEA. However, further investigation is necessary.

Rate and risk factors of missed diagnosis of colorectal adenoma with colonoscopy

Objective To investigate the miss rate of adenoma with colonoscopy and assess the features and risk factors for missed diagnosis.Methods Patients with colorectal adenoma received a second colonoscopy within 120 days after adenoma was detected and removed on the initial colonoscopy.The findings of two colonoscopies were reviewed and analyzed.The features of adenoma （including size, location, shape, number and pathology） , clinical characteristics of patients （including age, sex, reasons of colonoscopy, history of diverticular disease, history of abdominal or pelvic surgery and colonoscopy with sedation） and endoscopists were recorded.Miss rate and features of different types of missed adenoma were analyzed.We also assessed the effects of adenoma features, patients＇ characteristics and endoscopists on missed diagnosis of adenoma.Results Adenoma missed diagnosis was found in 271 patients out of 809 recruited subjects （33% ）.A total of 425 adenomas were missed out of 2134 （20% ） adenomas detected by repeated colonoscopy.A large diameter was associated with a decrease in the miss rate for adenoma （P 〈 0.01）.Conversely , sessile or flat shape （P 〈 0.01） , locations at sigmoid, hepatic flexure, cecum and ascending colonic （ P 〈 0.05） were significantly associated with a higher miss rate of adenoma, as was the number of adenomas （P 〈0.01）.A higher adenoma missed diagnosis rate was observed in beginner colonoscopists, as compared with experienced ones （P 〈 0.01）.Conclusion A marked miss rate of adenoma exists on colonoscopy, which is significantly associated with the size, shape, location and number of adenomas and endoscopists. Key words: Colonoscopy; Adenomatous polyposis coli; Miss rate

T2013 Deregulated Expression of MicroRNA-143, -145, -7, -21 and -34a in Colon Tumor Development

G A A b st ra ct s polarity, minor vascular abnormalities. Inflammatory infiltrates were detected in all inflammatory (pseudo)polyps. In Vivo histology predicted the ex vivo data with sensitivity of 96%, specificity of 93% and accuracy of 95%. Interobserver agreement for diagnosis of colorectal adenomas was high (K coefficients: pathologist, 0.90, endomicroscopist, 0.80). Conclusion: C-CLE enables accurate differentiation between adenomatous and non-adenomatous colorectal polyps during ongoing endoscopy. Systematic, reproducible classifications are needed to comprehensively classify all types of colorectal polyps. This approach may ultimately save time, reduce pathology costs and allow individualized endoscopic management.

Abstract LB-78: A randomized trial on folic acid supplementation and risk of recurrent colorectal adenoma

Abstract Results from two recently published randomized trials (Logan et al., 2008 and Cole et al., 2007) found little evidence for a protective effect of folic acid supplementation on the recurrence of colorectal adenomas. In one trial (Cole et al., 2007) folic acid supplementation even appeared to be non-significantly associated with higher risk of advanced adenoma. This following paper reports on results from another randomized controlled trial of folic acid (1000 micrograms/day) versus placebo among participants of two large prospective cohorts, the Health Professionals Follow-up Study (HPFS) and the Nurses’ Health Study (NHS), who had a previous diagnosis of colorectal adenoma. The primary endpoint of interest was any new diagnosis of adenoma during the study period (May, 1996 to March, 2003). 346 subjects were randomized to folic acid and 346 subjects to placebo for a period of three to up to 6 1/2 years. The incidence of at least one recurrent adenoma was not associated with folic acid supplementation (RR=0.86, 95% CI=0.64-1.16, p=0.32). There was some suggestion of an inverse association between folic acid supplementation and recurrent distal adenoma (multivariate adjusted relative risk (RR) =0.67, 95% confidence interval (CI)=0.39-1.15, p=0.14), and early stage adenoma (small and tubular) (RR=0.74, 95% CI=0.48-1.15, p=0.19), but none of the associations reached statistical significance. Advanced adenoma (large or adenomas with villous component) was not associated with folic acid supplementation, but the number of advanced cases was low (16 cases folate group, 18 cases placebo group; RR=0.96 95% CI=0.50-1.84, p=0.90). However, when associations were examined by folate blood concentrations drawn prior to time of randomization (<=7.5 ng/mL vs. >7.5 ng/mL) significant inverse associations were found for total recurrent adenoma (43 cases placebo, 32 cases folate, RR=0.64 (95% CI=0.43-0.96, p=0.03), distal adenoma (20 cases placebo, 9 cases folate, RR=0.36 (95% CI=0.14-0.61, p=0.001), early adenoma (22 cases placebo, 10 cases folate, RR=0.36 (95% CI=0.17-0.76, p=0.007), advanced adenoma (14 cases placebo, 9 cases folate, RR=0.48 (95% CI= 0.22-1.06, p=0.07) among those with low folate levels. No associations were found for participants with higher folate levels at baseline (at least one adenoma: 30 cases placebo, 30 cases folate, RR=1.30 (95% C=0.83-2.03, p=0.25). Occurrence of deaths, cancer and cardiovascular disease did not differ by treatment status. Our results do not support a protective effect of folic acid supplementation on the recurrence of colorectal adenomas; however, there may be some benefit on adenoma recurrence among those with a lower folate levels at baseline. The role of additional folic acid supplementation as a potential preventive measure for colorectal adenomas/cancer needs to be reevaluated especially with regard to dose and timing.

Novel Optical Imaging Techniques for Diagnosis of Colorectal Adenoma - A Prospective Case Study On Detection of Colorectal Adenomas Using AFI Compared with NBI

Novel Optical Imaging Techniques for Diagnosis of Colorectal Adenoma - A Prospective Case Study On Detection of Colorectal Adenomas Using AFI Compared with NBI

Time trends in first‐diagnosis rates of colorectal adenomas: a 24‐year population‐based study

Little is known about the descriptive epidemiology of colorectal adenomas diagnosed in the population. To describe time trends in the rate of first diagnosis of colorectal adenomas and estimate the proportion of adenoma-bearing individuals detected over a 24-year period. A total of 11,027 patients were first-diagnosed with colorectal adenomas among Côte-d'Or residents (France) between 1976 and 1999. Annual percentage changes were estimated using a Poisson regression model. The proportion of diagnosed adenoma-bearing individuals was estimated using the prevalence of adenomas in an autopsy study performed in the area. Standardized diagnosis rates were 89.6/100,000 men and 50.3/100,000 women. During the period 1976-1993, diagnosis rates significantly increased with annual percentage changes in men and women of respectively +17.1% and +22.3% for proximal adenomas, +7.5% and +9.1% for distal adenomas and +7.2% and +8.0% for advanced adenomas. Changes were less marked during the period 1994-1999. The estimated proportion of adenoma-bearing individuals diagnosed during the 24-year period was 20.0% in men and 16.0% in women. Despite a marked increase in the rate of first adenoma diagnosis, the proportion of diagnosed adenoma-bearing individuals seems too low to induce a significant decrease in colorectal cancer incidence.

Arylamine N-acetyltransferase type 2 and glutathione S-transferases M1 and T1 polymorphisms in familial adenomatous polyposis.

Familial adenomatous polyposis (FAP) exhibits a variable phenotype even in carriers of the same adenomatous polyposis coli germline mutation. Xenobiotic-metabolizing enzymes such as N-acetyltransferases (NATs) and glutathione S-transferases (GSTs) were reported to modify the individual risk for colorectal cancer. We examined whether the polymorphisms of the NAT2, GSTM1, and GSTT1 enzymes affect age at diagnosis of first colorectal adenomas or extracolonic manifestations in 411 FAP patients. Neither age at diagnosis of colorectal adenomas nor occurrence of extra-intestinal tumors differed significantly between genotypes at the NAT2 and GSTM1 loci, whereas GSTT1 polymorphism showed an uncertain association with extra-intestinal manifestations. Combinations of supposed at risk genotypes of the three enzymes showed no significant differences either. Thus, NAT2, GSTM1, or GSTT1 are unlikely to modify the disease phenotype in FAP patients.