Early Detection Of Adenomatous Polyps Research Articles

559 Patients' Descriptions of Their Last Bowel Movement Before Colonoscopy, Converted to a Standardized Score, Shows Strong Correlation With Their Boston Bowel Preparation Scale (BBPS) Score

INTRODUCTION: Colorectal cancer is the third most common cancer worldwide. Early detection of adenomatous polyps and adenocarcinoma reduces mortality. The effectiveness of colonoscopy for colorectal cancer screening is reliant on the quality of bowel preparation. Patients with inadequate bowel preparation may require repeat colonoscopy; this exposes patients to further risks while placing financial stress on individuals and healthcare systems. The purpose of this study is to assess if a patient's description of their last bowel movement, converted to a standardized score, correlates to the quality of bowel cleansing. METHODS: This is a cross-sectional study performed at two hospitals with data collected over two months. On the day of the colonoscopy, prior to the procedure, outpatients were asked by a resident physician to describe their last bowel movement. The description was converted to a standardized score: “fully solid”, assigned a score of 0; “liquid with solid pieces”, assigned a score of 1; “brown liquid”, assigned a score of 2; and “clear / yellow liquid”, assigned a score of 3. Subsequently, each patient's total and segmental Boston Bowel Preparation Scale (BBPS) score was determined and recorded by the clinician performing the colonoscopy. The nurses and clinicians performing the procedure were blinded to the patient's last bowel movement description. Data analysis using bivariate Pearson's Correlation was used to assess the strength of correlation between the patients' descriptions and BBPS scores. RESULTS: Study population characteristics: N = 121, 66 F and 55 M; mean age 56.16 with Std. Dev. of 16.12; mean total BBPS 7.74 with Std. Dev. of 1.87. Bivariate Pearson's Correlation showed a strong correlation (r = 0.738; P < 0.001) between the patients' descriptions and total BBPS score. Patients' descriptions versus segmental BBPS scores showed: a strong correlation with Left Colon BBPS (r = 0.702; P < 0.001); a moderate correlation with Transverse Colon BBPS (r = 0.632; P < 0.001); and a moderate correlation with Right Colon BBPS (r = 0.667; P < 0.001). CONCLUSION: A patient's description of their last bowel movement, converted to a standardized score, shows a strong correlation with their BBPS score. One implication of identifying a patient with inadequate bowel preparation before a colonoscopy is potentially rescheduling the procedure. Alternatively, it may be possible to provide patients with extra time and medication for colon cleansing before the colonoscopy is attempted.

Applying simple linear combination, multiple logistic and factor analysis methods for candidate fecal bacteria as novel biomarkers for early detection of adenomatous polyps and colon cancer

BackgroundColorectal cancer (CRC) is the third leading cause of cancer, and presents a considerable disease burden, worldwide. Recently, the gut microbiota has been proposed as a potential risk factor for CRC, and even adenomatous polyps (AP). Here, the aim of this study was to investigate the role of selected gut bacteria as fecal bacterial biomarkers, in early detection of CRC and AP. Material and methodsFecal samples (n = 93) were collected from Taleghani Hospital, Tehran, Iran, between 2015 and 2017, from normal controls (NC), AP cases and CRC stage I patients, who were undergoing screening for colonoscopy. Absolute quantitative real time PCR (qPCR) assays were established for the quantification of bacterial marker candidates, in all cases and control groups. In order to evaluate the diagnostic value of bacterial candidates in distinguishing CRC from a polyp, receiver operating characteristic curve (ROC) was performed. Multiple logistic regressions were used to find the best combinations of the bacterial candidates, then, combinations were analyzed based on three methods, including linear combination, multiple logistic and factor analysis models. ResultsAccording to the logistic model, combination of Fusobacterium nucleatum, Enterococcus feacalis, Streptococcus bovis, Enterotoxigenic Bacteroides fragilis (ETBF) and Porphyromonas spp. showed improved diagnostic performance, compared to each bacterium alone, as area under the receiver operating characteristic (AUROC) increases to 0.97, with 95% confidence interval. It was found that a simple linear combination was an appropriate model for discriminating AP and CRC cases, compared to the NC, with a sensitivity of 91.4% and specificity of 93.5%. ConclusionOur results indicated that based on fecal bacterial candidates, statistical simple linear combination model and ROC curve analysis, early detection of AP and CRC might be possible.

Polypektomie am Kolon – und dann?

Colorectal cancer (CRC) is the most frequent gastrointestinal tumour. Most CRC appear to arise from adenomas of the colon in a period of 10 or 15 years. The ultimately progression of benign adenomas to malignant CRC is known as the adenoma-carcinoma sequence. In addition, the description of the "serrated pathway" has shifted the focus of interest also towards to sessile serrated adenomas and traditional serrated adenomas in the development of CRC. It has been proven that the screening colonoscopy might prevent CRC by early detection of adenomatous polyps as precursors for colorectal cancer and polypectomy. Thus, disease-associated mortality of CRC could be reduced. Colonoscopy, the gold standard in CRC diagnosis, is recommended to men and women from the age of 55. On the one hand, there are requirements to the endoscopists. On the other hand there are also essential requirements to pathologists' findings. After polypectomy a risk stratification for aftercare based on endoscopic and histological findings is necessary. Endoscopic follow-up of high-risk patients (≥ 3 tubular adenomas, ≥ 1 adenoma ≥ 1 cm, tubulovillous or villous adenoma, ≥ 1 adenoma with high-grade intraepithelial neoplasia, ≥ 10 adenoma no matter what size or histological findings) should be done sooner (< 3 years). In contrast, colonoscopy in low-risk patients (1 or 2 [tubular] adenomas, size < 1 cm) should be performed later rather than sooner (> 5 years). Colonoscopic surveys under 12 months should be done only in exceptional and very serious situations. Pharmaceutical chemoprevention of adenomas or CRC are still part of clinical trails. More data are necessary.

Colon Cancer: An Update and Future Directions

Colon Cancer: An Update and Future Directions

Emerging technologies in screening for colorectal cancer: CT colonography, immunochemical fecal occult blood tests, and stool screening using molecular markers.

The American Cancer Society's (ACS) Colorectal Cancer Advisory Group held a workshop on new technologies for the early detection of colorectal cancer and adenomatous polyps as part of a regular review of ACS guidelines for colorectal cancer screening. The Advisory Group formally reviewed CT colonography, immunochemical fecal occult blood tests (FOBT), and stool screening using molecular markers, and also addressed other technologies including capsule video endoscopy. With the exception of immunochemical stool testing, the ACS has determined that at this time there is insufficient evidence to recommend these technologies for routine colorectal cancer screening. Based on recommendations of the Advisory Group, only a minor modification has been made to the ACS's Recommendations for Screening and Surveillance of the Early Detection of Adenomatous Polyps and Colorectal Cancer.