Colonoscopic Findings Research Articles

Low Incidence of Colorectal Advanced Neoplasia During Surveillance in Individuals with a Family History of Colorectal Cancer

BackgroundFamily history of colorectal cancer (CRC) is used to stratify individuals into risk categories which determine timing of initial screening and ongoing CRC surveillance. Evidence for long-term CRC risk following a normal index colonoscopy in family history populations is limited.AimsTo assess the incidence of advanced neoplasia and associated risk factors in a population undergoing surveillance colonoscopies due to family history of CRC.MethodsSurveillance colonoscopy findings were examined in 425 individuals with a family history of CRC, a normal index colonoscopy and a minimum of 10 years of follow-up colonoscopies. Advanced neoplasia risk was determined for three CRC family history categories (near-average, medium and high-risk), accounting for demographics and time after the first colonoscopy.ResultsThe median follow-up was 13.5 years (IQR 11.5–16.0), with an incidence of advanced neoplasia of 14.35% (61/425). The number of affected relatives and age of CRC diagnosis in the youngest relative did not predict the risk of advanced neoplasia (p > 0.05), with no significant differences in advanced neoplasia incidence between the family history categories (p = 0.16). Patients ≥ 60 years showed a fourfold (HR 4.14, 95% CI 1.33–12.89) higher advanced neoplasia risk during surveillance than those < 40 years at index colonoscopy. With each subsequent negative colonoscopy, the risk of advanced neoplasia at ongoing surveillance was reduced.ConclusionsThe incidence of advanced neoplasia was low (14.35%), regardless of the family history risk category, with older age being the main risk for advanced neoplasia. Delaying onset of colonoscopy or lengthening surveillance intervals could be a more efficient use of resources in this population.

Histopathological Study of Colorectal Lesions and Its Correlation with Colonoscopic Findings

Introduction: Colorectal lesions are diverse and have variety of symptoms which overlap with benign and malignant conditions. Cancerous conditions are common in this region, thus early diagnosis influences the response to management. Colonoscopy and histopathological study of lesions is crucial in diagnosis and management of neoplastic conditions.&#x0D; Aims: To study the correlation of the colonoscopic and histopathological findings in colorectal lesions and spectrum of colorectal lesions.&#x0D; Methods: This is a hospital based prospective cross-sectional study conducted over the period of 16 months from January 2021 to June 2022 in department of Pathology, Nepalgunj Medical College Teaching Hospital (NGMCTH), Kohalpur, Nepal. Informed verbal consent from the patient was obtained. Patients who have undergone colonoscopy were included in the study whose corresponding histopathological samples were also received in the form of either large or small biopsies.&#x0D; Results: Total 95 cases were included in the study which showed male preponderance overall as well as in malignant conditions. Adenocarcinoma was most common histopathological finding followed by nonspecific chronic colitis. Most common clinical complain was bleeding per rectum and most common colonoscopic finding was ulceroproliferative lesion. The correlation between colonoscopy and histopathology done as benign and malignant was statically significant.&#x0D; Conclusion: The current study revealed a good correlation between colonoscopic and histopathological findings. Morphological study helps in identification of disease for early diagnosis and management, especially in malignancy.

980 The Impact of Anticoagulant, Antiplatelet, and Nonsteroidal Anti-Inflammatory Drug (Nsaid) Use on Faecal Immunochemical Testing Measurements in Fast Track Referral Patients

Abstract Aim Faecal immunochemical testing (FIT) has been used as a prioritisation tool and diagnostic adjunct for detection of colorectal cancer (CRC) patients on the fast-track pathway. Many patients referred through the pathway are on medications associated with gastrointestinal bleeding. We chose to study the impact of such medications on FIT measurements. Method A retrospective review of patients between March 2020 and August 2022 was conducted. Data on patient demographics, medication use, FIT results and colonoscopy findings were gathered. Patients who did not undergo further investigations and patients diagnosed with CRC were excluded. Patients with a FIT measurement greater than 7μg of haemoglobin/gram of faeces were deemed positive. Chi squared test was used to compare the proportion of patients with a positive FIT in those who were and were not on the above medications. A p-value of &amp;lt;0.05 was deemed significant. Results There were 1668 (778 male) patients. Median age was 71 (IQR 62-78) years. CRC was detected in 92 patients. In the 1576 patients without cancer, 164 (10.4%) were on anticoagulants, 242 (15.4%) were on antiplatelets and 82 (5.2%) were on NSAIDs. A significantly greater proportion of patients had a positive FIT when on anticoagulants compared with those who were not (40% vs. 23%, p-value = 0.00). Use of antiplatelets or NSAIDs had no impact on FIT measurements (29% vs 24%, p-value = 0.32 and 18% vs 25%, p-value = 0.36). Conclusions Anticoagulants can impact FIT measurements, hence thresholds for a positive result may need to be altered for these patients. We seek to study this further.

626 To assess the appropriateness of colonoscopy in patients below the age of 60 in a District General Hospital

Abstract Aim To assess the indications of colonoscopy on the basis of symptoms in patients below the age of 60 using Epage 2 guidelines. Correlate them with colonoscopic and pathologic findings to determine the appropriateness to improve patient selection in district general hospital. Methods This is a retrospective study including 296 patients below the age of 60. They were referred from Gastroenterology and Surgical department. Data includes age, sex, indications, colonoscopic and pathologic findings. The Epage 2 online guidelines were used. Results 43% of patients were male and 57% were female. The most indication for colonoscopy was abdominal pain and bleeding PR (20% each) and diarrhoea (19.6%). Colitis was found in only 14.9%, with diverticulosis 11%, polyp 4% and haemorrhoidal disease 6%. Using the EPAG 2 Criteria 80.5% were appropriate indications, 12.5% were uncertain and only 7% were inappropriate indications. Conclusion This study confirmed that the majority of indications for colonoscopy were appropriate. Cancer was only found in 2% of patients and majority of the colonoscopy findings were normal. The most common diagnosis in this age group was colitis (14.5%).

Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit

Objective Geriatric cancer population is growing. Both cancer and geriatric conditions are associated with some degree of inflammatory burden. To comprehensively present our five years of experience in patients with suspicion of a malignancy, signs and symptoms that are more prominent as indicator of malignancies, conditions that cause malignancy-like symptoms, and common malignancies and newly diagnosed malignancies in geriatric patients with a history of cancer. Methods Patients hospitalized with suspected malignancy in a geriatric inpatient unit were included. Demographic data, hospitalization symptoms, clinical findings, smoking history, laboratory and further examinations, comprehensive geriatric assessment scores, length of hospital stay and discharge diagnoses were examined. Endoscopy and colonoscopy findings were also recorded. Results Of the 1,104 patients hospitalized for various reasons in the five-year period, 197 (106 women) were suspected of having a malignancy. Mean age was 78.22 ± 7.27. A total of 65 (33%) patients were diagnosed with a malignancy. Amount of smoking (pack/year) and geriatric depression scale (GDS) scores were significantly higher in malignant group (p = .009; p < .001; respectively). Of the hospitalization symptoms, frequency of lumbar-hip-back pain was significantly higher in the malignant group (p = .043). The three most common cancers were hematologic (32%), lung (15%), and gastrointestinal cancers (15%). Gastritis was the most common pathological finding from gastroscopies (58%), and adenoma from colonoscopies (24%). Malignancies were detected in 40% of patients with a history of malignancy, and 55% of the newly detected malignancies were new primaries. Immunoglobulin G4-related disease was one of the detected interested benign conditions. Conclusion The frequency and presentation patterns of malignancies may differ in older adults. Depressive symptoms are common in geriatric cancer patients. Geriatric patients with a history of malignancy should be evaluated in detail for new primary malignancies.

Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging.

Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake. Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions. Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions. Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation.

Unusual Duodenal Ulcer: Metastatic Urothelial Carcinoma of the Renal Pelvis.

Metastatic urothelial carcinoma of the renal pelvis (MUCP), a type of metastatic upper tract urothelial carcinoma (MUTUC), is a rare malignancy, and some patients with MUCP present with distant metastasis at the time of diagnosis. MUCP in the gastrointestinal tract is even rarer. Herein, we report a 78-year-old man with MUCP that presented as a duodenal ulcer. He complained of anorexia, dizziness, and melena for one month. Endoscopic examination at a local clinic revealed a duodenal hemorrhagic and ulcerative lesion, and the patient was referred. He noted dark-colored stools with increasing frequency, but he denied hematochezia, coffee ground emesis, weight changes, or abdominal pain. Gastroduodenoscopic examination at our hospital demonstrated an ulcerofungating lesion of the second portion of the duodenum. Colonoscopic findings showed no abnormality. Computed tomography showed a 6.7 cm sized mass abutting the inferior vena cava, second portion of the duodenum, lower pole of the right kidney, and right iliopsoas. The mass showed heterogeneous enhancement and internal hemorrhagic necrosis and infiltrated the perinephric soft tissues, the second portion of the duodenum, the right psoas muscle, the right renal vein, and the right adrenal gland. Duodenal biopsy showed moderately differentiated squamous cell carcinoma. Immunohistochemistry (IHC) showed diffuse and strong positivity for CK5/6. Tissue from the liver biopsy showed similar histopathologic features and showed GATA3 positivity on IHC. The imprint cytology smears of the liver tissue showed "cercariform" cell features. We confirmed the diagnosis as MUCP. This case illustrated a rare cause of a secondary duodenal tumor, MUCP.

Histopathological Outcome of Colonoscopic Biopsies in a Tertiary Hospital in Southwestern Nigeria: A 7-Year Retrospective Study.

Colonoscopy with histopathological analysis of mucosal biopsy samples remains the gold standard procedure for diagnosing lower gastrointestinal disorders. This study aimed to determine the pattern of histopathological findings of mucosal biopsies obtained at colonoscopy over a 7-year period and to correlate the histological findings with the clinical profile of the patients. This was a retrospective study conducted in a healthcare facility in southwestern Nigeria. The Histology reports from January 1, 2016, to December 31, 2022, were retrieved from the histopathology department of the institution to obtain the following information for analysis: age, gender, year of the test, presenting complaint, provisional clinical diagnosis, colonoscopy diagnosis, and histological diagnosis. The data of a total number of 81 patients were analyzed; 51 males (63.0%) and 30 females (37.0%) with a male-to-female ratio of 1.7-1. The age range of the patients was 30-86 years with a mean (±standard deviations) age of 59.87 ± 14.44. The most common indication for colonoscopy was hematochezia (23 (28.4%)) followed by change in bowel habit (16 [19.8%]), constipation (11 [13.6%]), and tenesmus (10 [12.3%]). Large bowel masses suggestive of cancers were the most common colonoscopy finding in the study subjects (36 [44.4%]). Colorectal cancer was the most common histologic abnormality in the study subjects (26 [32.1%]) followed by chronic nonspecific colitis (8 [9.9%]), polyps (7 [8.6%]), adenomas (5 [6.2%]) and acute on chronic colitis (5 [6.2%]). Twenty-two (27.2%) patients had normal histologic findings. Patients aged between 45 and 64 years had the highest prevalence of colorectal cancer (13 [50.0%]). Colorectal cancer was the most common histopathological finding in this study and the patients were mostly within the middle-age group. Early screening colonoscopy is therefore recommended and histopathological analysis of the mucosal specimens obtained is essential for early detection of premalignant lesions.

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.

Incidence and Imaging of Colorectal Cancer Between 2015-2020 in Somalia: A Review of 585 Colonoscopy

The aim of the study is to determine the frequency and distribution of all colonoscopic pathologies, especially colorectal cancer (CRC), in Somalia between 2015 and 2020. For this retrospective and descriptive study, a total of 760 colonoscopy results were analyzed from the medical records of Somalia Turkey Recep Tayyip Erdoğan Training and Research Hospital. We excluded 175 patients with incomplete colonoscopy findings and medical records. Patient characteristics, presence of normal mucosa, presence, characteristics, localization, and histopathology of the lesion were recorded. Abdomino-pelvic computed tomography (CT) scans were evaluated. The median age of 585 patients (male; n=384, 65.6%) included in the study was 44 years (range; 19-94). 20.5% (n=120) had normal colonoscopy findings and 31.8% (n=186) had benign perianal pathologies (most common hemorrhoids; n=139, 23.8%). In 40.9% (n=239/585) of patients, lesions were detected in the colorectum and biopsy was performed. The number of cases with CRC on colonoscopy was 50 (8.5%), the most common histopathological type was adenocarcinoma (n=40/50; 80%) and the most common localization was rectosigmoid colon (n=37/50; 74%). The median age of CRC cases was 53 years (range, 29-85) and 72% (n=36) were male. The most common morphologic type of adenocarcinoma on CT image was mass-forming (n=35/40; 87.5%). In all patients, the tumor had invaded the bowel wall and periintestinal fat infiltration was present. Lymph node metastases were present in 38% (n=19/50) and distant organ metastases in 18% (n=9/50) of patients with CRC. Our study reveals that colonoscopies in Somalia mostly find perianal lesions (most commonly hemorrhoids), the incidence of CRCs is 8.5%, all CRCs are diagnosed at an advanced stage and require neoadjuvant chemoradiotherapy. Community education and screening programs should be developed to detect CRCs early in the precancerous stage and reduce mortality.

Mechanism of intestinal injury induced by WNT2B high-expressed fibroblasts in Crohn's disease

Objective: To explore the mechanism of intestinal tissue damage induced by macrophages activated by WNT2B high-expressed fibroblasts. Methods: This study involved biological information analysis, pathological tissue research and cell experimental research. The biological information of the colon tissue from the children with inflammatory bowel disease in previous study was analyzed again with single-cell sequencing. The pathological tissues were collected by colonoscopy from 10 children with Crohn's disease treated in the Department of Gastroenterology of Guangzhou Women and Children's Medical Center from July 2022 to September 2022. According to the findings of colonoscopy, tissues with obvious inflammation or ulceration were classified as the inflammatory group, while tissues with slight inflammation and no ulceration were classified as the non-inflammatory group. HE staining was performed to observe the pathological changes of the colon tissues. Macrophage infiltration and CXCL12 expression were detected by immunofluorescence. In terms of cell experiments, fibroblasts transfected with WNT2B plasmid or empty plasmid were co-cultured with salinomycin treated or non-treated macrophages, respectively; the expression of proteins through Wnt classical pathway were detected by western blotting. Macrophages treated with SKL2001 were used as the experimental group, and those with phosphate buffer as the control group. The expression and secretion of CXCL12 in macrophages were detected by quantitative Real-time PCR and enzyme-linked immunosorbent assay (ELISA). T-test or rank sum test were used for the comparison between groups. Results: Single-cell sequencing analysis suggested that macrophages were the main cells in inflammatory bowel disease colon tissue, and there was interaction between WNT2B high-expressed fibroblasts and macrophages. HE staining of the 10 patients ((9.3±3.8) years old, 7 males and 3 females) showed that the pathological score of colon tissue in the inflammatory group was higher than that in the non-inflammatory group (4 (3, 4) vs. 2 (1, 2) points, Z=3.05, P=0.002). Tissue immunofluorescence indicated that the number of infiltrating macrophages in the inflammatory group was significantly higher than that in the non-inflammatory group under high power field of view (72.8±10.4 vs.8.4±3.5, t=25.10, P<0.001), as well as the number of cells expressing CXCL12 (14.0±3.5 vs. 4.7±1.9, t=14.68, P<0.001). In cell experiments, western blotting suggested an elevated level of glycogen synthase kinase-3β phosphorylation in macrophages co-cultured with fibroblast transfected with WNT2B plasmid, and salinmycin could reverse this change. Real-time PCR suggested that the transcription level of CXCL12 in the experimental group was higher than that in the control group (6.42±0.04 vs. 1.00±0.03, t=183.00, P<0.001), as well as the expression and secretion of CXCL12 by ELISA ((465±34) vs. (77±9) ng/L, t=13.21, P=0.006). Conclusion: WNT2B high-expressed fibroblasts can secrete WNT2B protein and activate the Wnt classical signaling pathway thus enhancing the expression and secretion of CXCL12 in macrophages, inducing the development of intestinal inflammation of Crohn's disease.

Identifying the need for a UK colorectal cancer screening programme for patients with cystic fibrosis (CF): 10-year retrospective review of colonoscopy and colorectal cancer outcomes at a single CF centre

ObjectivePatients with cystic fibrosis (pwCF) have a high incidence of early colorectal cancer (CRC). In the absence of a UK CRC screening programme for pwCF, we evaluated the utility and...

Spectrum of Colonoscopy in Children: A Tertiary Centre Experience from Bangladesh

Background: Pediatric colonoscopy is a safe, sensitive and crucial tool for diagnosing as well as treating children with lower gastrointestinal diseases. In resource-limited countries like Bangladesh, the practice of pediatric colonoscopy remains rudimentary, lacking in trained professionals and appropriate instrumentation.&#x0D; Objectives: The aim of the study was to find out the indications, common colonoscopic findings along with histopathologic evaluation and immediate post procedure complications of colonoscopy in children.&#x0D; Methods: This was a retrospective study; the records of all the patients whose age was less than 18 years and who underwent colonoscopy from January 2017 to December 2021 were studied.&#x0D; Results: Among the total of 196 children (8.23±4.12), the most common indications were lower gastrointestinal bleeding (LGIB) in 107 (54.6%) patients followed by chronic diarrhea in 33 (16.8%), recurrent abdominal pain (RAP) in 16 (8.2%), follow up Inflammatory bowel diseases (IBD) in 14 (7.1%), chronic constipation, weight loss, recurrent oral ulcer, intestinal tuberculosis (TB) and melena. The most common pathologic findings were polyps in 81 (61.4%) children followed by non-specific colitis in 19 (14.4%), IBD in 17 (12.9%) and infectious colitis in 09 (6.8%) cases. Minor adverse events occurred in only 2.0% of children.&#x0D; Conclusion: The commonest indication for pediatric colonoscopy was LGIB and the most common findings were colonic polyps. Pediatric colonoscopy is safe and effective diagnostic as well as therapeutic option for lower GI diseases.&#x0D; DS (Child) H J 2021; 38(1): 8-16

Evaluation of plasma Short chain fatty acid levels as markers for Inflammatory bowel disease

Background Specific variations of short chain fatty acids in fecal samples have been shown for patients with inflammatory bowel disease. The aim of this study was to assess if Crohn’s disease and ulcerative colitis are associated with altered concentrations of short chain fatty acids also in blood plasma. Method Between 2016-2019, Swedish adults referred to a tertiary center for colonoscopy were asked to participate in a cross-sectional study. Individuals with Crohn’s disease or ulcerative colitis as well as individuals with no findings on the colonoscopy (defined as clean colon) were included in the study. Data on colonoscopy findings, blood samples (including haemoglobin, C-reactive protein and short chain fatty acid analysis) as well as a validated lifestyle questionnaire including 277 questions were collected from all participants. Linear regression was used to compare mean concentrations of short chain fatty acids between Crohn’s disease, ulcerative colitis and clean colon. Results The cohort consisted of 132 individuals with Crohn’s disease, 119 with ulcerative colitis and 205 with clean colon. In the crude model, succinic acid was significantly lower (p < 0.05) among patients with Crohn’s disease (mean 3.00 µM SE 0.10) and ulcerative colitis (mean 3.13 µM SE 0.10) in comparison to clean colon (mean 3.41 µM SE 0.08), however when adjusting for sex, age and diet the results did not remain statistically significant. No differences in plasma concentration of the other measured short chain fatty acids were detected. Conclusion Crohn’s disease and ulcerative colitis are not associated with altered short chain fatty acid concentrations in plasma. Further research is needed to confirm or refute our findings.

A Case of Multiple Myeloma with Extremely Rare Manifestation

Introduction: Multiple myeloma (MM) is a neoplastic proliferation of immunoglobulin-producing plasma cells that have multiple presentations due to the infiltration of plasma cells in the bone marrow and other organs. Common manifestations include anemia, bone pain, fatigue, and hypercalcemia. MM presented with rectorrhagia is very rare. Case Presentation: A 74-year-old woman with a history of rectorrhagia episodes from about nine months ago presented with severe anemia, weakness, and lethargy. The findings of endoscopy and colonoscopy did not justify the patient's manifestation, and finally, due to thrombocytopenia and anemia, a bone marrow biopsy was performed, and multiple myeloma was diagnosed. Conclusions: Although GI bleeding in Multiple myeloma is a very rare manifestation, this diagnosis must be considered in the differential diagnosis of patients with unexplained and refractory GI bleeding.

Revised algorithmic approach to differentiate between non-specific and specific etiologies of chronic terminal Ileitis.

/Aims-Chronic isolated terminal ileitis(TI) may be seen in Crohn's disease(CD) and Intestinal tuberculosis(ITB) in addition to other etiologies that may be managed symptomatically. We developed a revised algorithm to distinguish patients with a specific etiology from a non specific etiology. Patients with chronic isolated TI following-up from 2007 to 2022 were retrospectively reviewed. A specific(ITB or CD) diagnosis was made based on standardized criteria and other relevant data was collected. Using this cohort, validation of a previously suggested algorithm was conducted. Further, based on the results of a univariate analysis, a multivariate analysis with bootstrap validation was used to develop a revised algorithm. We included 153 patients(mean age-36.9+14.6 years, males-70%, median duration-1.5 years, range:0-56 years) with chronic isolated TI of whom 109(71.2%) received a specific diagnosis(CD-69, ITB-40). On multivariate regression and validation statistics with a combination of clinical, laboratory, radiological and colonoscopic findings, an optimism corrected c-statistic of 0.975 and 0.958 was obtained with and without histopathological findings respectively. Revised algorithm, based on these, showed a sensitivity, specificity, positive and negative predictive value, and overall accuracy of 98.2%(95%CI:93.5 - 99.8), 75.0%(95%CI:59.7 - 86.8), 90.7%(95%CI:85.4 - 94.2), 94.3%(95%CI:80.5 - 98.5) and 91.5%(95%CI:85.9 - 95.4), respectively. This was more sensitive and specific than the previous algorithm(accuracy 83.9%, sensitivity 95.5%, and specificity 54.6%). We developed a revised algorithm and a multi-modality approach to stratify patients with chronic isolated TI into specific and non-specific etiologies with an excellent diagnostic accuracy which could potentially avoid missed diagnosis and unnecessary side effects of treatment.

Characterization of Colonoscopies in Preschool Children.

The indications, diagnostic yield, complications, and cecal and ileal intubation rates (CIR and IIR) for colonoscopies in children aged <6 years, denoted preschoolers, is unclear since there is limited information for this group. We aimed to describe the above parameters in our cohort of preschoolers undergoing a colonoscopy. Retrospective review of all colonoscopies in a tertiary pediatric hospital between December 1, 2014 to December 31, 2020 was undertaken. Demographic factors, indication for colonoscopy, extent of colonoscopy, CIR, IIR, and histologic findings were noted. Preschoolers were further subdivided into those aged <2 years, and those aged 2 to <6 years. One thousand six hundred seventy-one total colonoscopies were performed, of which 13% (n = 219) were in preschoolers with median age 3.9 (range 0.3-5.9) years. Most common indications in preschoolers were rectal bleeding 35% (n = 78), inflammatory bowel disease 24% (n = 53), diarrhea 13% (n = 30), iron-deficiency anemia 11% (n = 25), and abdominal pain 7% (n = 16). IIR and CIR were lower in preschoolers compared to older children, 81% vs 92% ( P = 0.0001), and 93% vs 96.4% ( P = 0.02), respectively, and even lower in those aged <2 years, 48.1% IIR ( P = 0.0001) and 85.1% CIR. Juvenile polyps, 31% (n = 27), were the most common positive finding in preschool children. Rectal bleeding was the most common indication and juvenile polyps the most common finding at colonoscopy in preschoolers. A high IIR is achievable in young children but rates are increasingly lower the younger the child.

Hemorrhoids as a risk factor for colorectal adenomas on colonoscopy

Background and study aims Colorectal premalignant polyps and hemorrhoids are important findings in colonoscopy; however, the association between them is unclear. Therefore, we investigated the association between the presence and severity of hemorrhoids and the detection of precancerous colorectal polyps on colonoscopy. Patients and methods This retrospective, single-center, cross-sectional study enrolled patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May 2017 and October 2020. The association between hemorrhoids and other outcomes (patient age, sex, withdrawal time for colonoscopy, expert endoscopist, number of adenomas per colonoscopy, detection rates of adenoma, advanced neoplasia, clinically significant serrated polyp, and sessile serrated lesion) was assessed using a binomial logistic regression model. Results A total of 12,408 patients were enrolled in this study. Hemorrhoids were identified in 1,863 patients. Univariable analysis showed that patients with hemorrhoids were older (61.0 vs. 52.5 years, P < 0.001), had a higher number of adenomas per colonoscopy (1.16 vs. 0.756, P < 0.001) than those without hemorrhoids. Multivariable analyses also demonstrated that hemorrhoids were associated with a higher number of adenomas per colonoscopy (odds ratio [OR]: 1.061; P = 0.002), regardless of patient age, sex, and expert endoscopist. Among patients with hemorrhoids, severe hemorrhoids with a mucosal elevation ≥ 10 mm were associated with a higher number of adenomas per colonoscopy than mild hemorrhoids (OR: 1.112, P = 0.044), regardless of patient age, sex, and expert endoscopist. Conclusions Hemorrhoids, especially severe ones, are associated with a high number of adenomas. Complete colonoscopy should be performed in patients with hemorrhoids.

High frequency of colorectal neoplasia in patients with sporadic adenomas or adenocarcinomas of the papilla of Vater: The same adenoma-carcinoma sequence?

Data on the frequency of colorectal neoplasia in sporadic ampullary tumors remains scarce. We retrospectively reviewed 135 patients undergoing endoscopic ampullectomy from January 2018 to July 2021, and identified 95 patients with sporadic ampullary adenoma who underwent total colonoscopy. Colonoscopy findings were compared with 380 asymptomatic controls using the chi-squared test. Whole-exome sequencing (WES) was performed on one patient with synchronous adenomas of the ampulla of Vater and ascending colon. Colorectal polyps were present in 60% of Cases vs. 34.7% of Controls (P=0.001), advanced adenoma in 20% vs. 5.5%, and adenocarcinoma in 4.2% vs. 0.8%. Cases tended to have larger polyps than Controls (P<0.001), while there was no difference in polyp location and histology between the two groups. The odds ratio of all the colorectal lesions, advanced colorectal adenoma and adenocarcinoma in Cases was 1.7, 4.2, and 4, respectively. WES in one patient revealed that both of ampullary adenoma and colonic adenoma shared somatic ABCB1 mutation. The frequency of colorectal polyps or neoplasia was significantly higher in Cases than Controls. We proposed that ampullary neoplasia is analogous to colon lesions and warrants total colonoscopy screening in patients diagnosed with ampullary tumors.

Upper and Lower Gastrointestinal Bleeding: A Retrospective Study on 10 Years Experiences in Southeastern Iran.

Background: Gastrointestinal bleeding (GIB) is an emergency medical situation that is very common, although often benign but can cause considerable morbidity and mortality and health care costs. The aim of this study was to analyze the endoscopic evaluation of upper GIB (UGIB) and lower GIB (LGIB) in Sistan and Balouchestan, southeast Iran. Methods: Data from patients with GIB in a referral university-affiliated hospital in Zahedan, Southeastern Iran during a 10-year period, were obtained. A total of 21884 reports of adult patients' endoscopy and colonoscopy from 2011 to 2020 who were admitted to Ali-Ibn-Abitaleb hospital were studied of which 5862 reports were related to GIB. Incomplete files were excluded. Information on age, sex, and endoscopic diagnosis of the 5053 reports was analyzed and compared using chi-square statistical test. Results: There were 3310 men (65.6%) and 1743 women (34.4%) with a mean (±SD) of age 48.4 (±19.83) years. 3079 patients had UGIB (60.8%) and 1974 patients had LGIB (39.2%). Peptic ulcer (72.8% duodenal ulcer and 27.2% gastric ulcer) was seen as the main reason for UGIB (29.7%) and hemorrhoids were the main reason for LGIB (44.2%). Mallory-Weiss syndrome was significantly common in the age<40 years old, and the incidence rate of malignancy was significantly higher in those aged>40 years old than in the younger age group (P<0.001). Conclusion: Peptic ulcer was the most common etiological factor and it was more common in men than in women. Gastroesophageal varices were the second most common cause of UGIB. Hemorrhoids and anal fissures were observed as the most common colonoscopic findings of LGIB. The prevalences of UGIB and LGIB are more common in men than women and increase with age. It is important for physicians to constantly update their information about the spectrum of diseases in their region and their changing over time to provide accurate diagnosis and management timely.