Incidence Of Polyps Research Articles

Association between Helicobacter pylori Infection and Nasal Polyps: A Systematic Review and Meta-Analysis.

Helicobacter pylori (H. pylori) has definite or possible associations with multiple local and distant manifestations. H. pylori has been isolated from multiple sites throughout the body, including the nose. Clinical non-randomized studies with H. pylori report discrepant data regarding the association between H. pylori infection and nasal polyps. The aim of this first systematic review and meta-analysis was the assessment of the strength of the association between H. pylori infection and incidence of nasal polyps. We performed an electronic search in the three major medical databases, namely PubMed, EMBASE and Cochrane, to extract and analyze data as per PRISMA guidelines. Out of 57 articles, 12 studies were graded as good quality for analysis. Male-to-female ratio was 2:1, and age ranged between 17-78 years. The cumulative pooled rate of H. pylori infection in the nasal polyp group was 32.3% (controls 17.8%). The comparison between the two groups revealed a more significant incidence of H. pylori infection among the nasal polyp group (OR 4.12), though with high heterogeneity I2 = 66%. Subgroup analysis demonstrated that in European studies, the prevalence of H. pylori infection among the nasal polyp group was significantly higher than in controls, yielding null heterogeneity. Subgroup analysis based on immunohistochemistry resulted in null heterogeneity with preserving a statistically significant difference in H. pylori infection prevalence between the groups. The present study revealed a positive association between H. pylori infection and nasal polyps.

Adenoma Detection Rate Benchmarks: An Updated Analysis.

Early-onset colorectal cancer prompted organizations to reduce the recommended screening initiation age from 50 to 45 years. The American Society for Gastrointestinal Endoscopy Quality Assurance in Endoscopy Committee recommends 3 priority quality indicators for colonoscopy services. The adenoma detection rate is considered the most important measure with the established benchmark based upon studies of patients 50 years or older. The incidence of polyps increases with age, so this change has an as-yet-unknown effect on the new benchmark. Five studies were reviewed. Based upon the results, 45- to 50-year-old patients should be included in facilities' adenoma detection rate calculations using the currently recommended benchmarks of 25% for women and men combined, or 20% for women and 30% for men when the genders are calculated separately. Males consistently had more adenomas than females in each of the 3 studies that separated genders, a detail that might merit gender-based adenoma detection rate determinations in some practices. One study indicated caution is advised; it recommends males and females be calculated separately and different benchmarks be used for each gender. The adenoma detection rate has been shown to increase over time. More studies are needed to guide screening quality metrics.

WS08.04 Faecal Immunochemical Testing – ‘FIT’ for purpose for bowel screening in older cystic fibrosis patients?

Objectives: Cystic Fibrosis (CF) patients have a high incidence of premalignant polyps and colorectal cancer (CRC). We aimed to evaluate the incidence of CRC at our centre and establish the diagnostic yield of colonoscopy and faecal immunochemical testing (FIT) in CF patients.

Characterization of Severe Uncontrolled Asthma in Japan: Analysis of Baseline Data from the PROSPECT Study.

Treatment patterns and patient characteristics are not well elucidated among Japanese patients with severe uncontrolled asthma who currently have various treatment options, including biologics. We analyzed baseline characteristics of patients who did/did not initiate biologic treatment in PROSPECT, a 24-month observational study. Patients with severe uncontrolled asthma were prospectively enrolled at 34 sites in Japan from December 2019 to September 2021. The enrolled population was divided based on initiation/non-initiation of biologic treatment within 12 weeks after enrollment. Patient demographics, clinical characteristics, biomarker levels, and asthma-related treatment were assessed at enrollment. Of 289 patients meeting the enrollment criteria, 127 patients initiated biologic treatment (BIO group: omalizumab, n = 16; mepolizumab, n = 10; benralizumab, n = 41; and dupilumab, n = 60) and 162 patients did not (non-BIO group). The proportion of patients with ≥2 asthma exacerbations was higher in the BIO group than the non-BIO group (65.0% vs 47.5%). Patients receiving omalizumab had the highest frequency of allergic rhinitis (87.5% vs other BIOs: 40.0%-53.3%). Patients receiving benralizumab and dupilumab had the highest incidence of nasal polyps (benralizumab: 19.5%, dupilumab: 23.3%, other BIOs: 0.0%). The proportion of patients with blood eosinophils ≥300 cells/μL was higher with benralizumab (75.6%) than other BIOs (26.7%-42.9%). This analysis of baseline data from the PROSPECT study is the first to clarify the characteristics of Japanese patients with severe uncontrolled asthma. BIOs were not necessarily prescribed to patients in whom they were indicated; however, for patients who received them, selection appeared to be made appropriately based on asthma phenotypes.

Extended delay in endoscopic mucosal resection is not associated with adverse outcomes: Findings from the COVID-19 pandemic.

Abstract Background and study aims The aim of this study was to investigate the impact of delayed endoscopic mucosal resection (EMR) of colorectal polyps on health outcomes. Patients and methods A bidirectional cohort study was completed. A baseline group consisting of all EMRs performed within a 15-month period before a province-wide, government-mandated cessation of EMR procedures due to the global pandemic was compared to EMRs impacted by the shutdown, defined as the COVID-19-delayed group. The primary outcome was the incidence of malignant polyps. Secondary outcomes included technical success, polyp recurrence at follow-up colonoscopy, advanced polyp histology, probability of meeting endoscopic criteria for adequate resection for malignant polyps, metastatic colorectal cancer, and complications. Results A total of 268 EMR procedures were included in the study cohort, of which 208 formed the baseline group and 60 were in the COVID-19-delayed group. The median (IQR) patient age was 72 (13.0) and 113 (41.2 %) were females. The median (IQR) wait time was 92 days (87.8) in the baseline group and 191 days (127.8) in the COVID-19-delayed group (P < 0.001). Overall, there were no significant differences in the incidence of malignant polyps, technical success, polyp recurrence on follow-up colonoscopy, advanced polyp histology, adequate endoscopic resection for malignant polyps, metastatic colorectal cancer, or complications between the two groups (P > 0.05 for all outcomes). Conclusions A longer wait time for EMR of colorectal polyps, increasing from a median of 92 to 191 days, was not associated with worse outcomes.

¿Es precisa la ecografía para el diagnóstico de pólipos vesiculares? Revisión de las piezas de colecistectomía de pacientes diagnosticados de pólipo vesicular durante un periodo de 14 años

IntroductionThe incidence of gallbladder polyps is 0,3-12%. It is important to differentiate pseudopolyps (cholesterol polyps, adenomyomatosis, inflammatory polyps), which do not have the potential to become malignant, and true polyps (adenomas and adenocarcinomas). The main risk factors for malignancy are size>6-10mm, rapid growth, sessile morphology, Indian ethnicity and primary sclerosing cholangitis. Ultrasound is the gold standard for diagnosis. However, most polyps diagnosed by ultrasound are pseudopolyps. The main objective of this study is to analyze whether ultrasound is accurate for diagnosing true polyps in patients undergoing surgery for this reason. MethodsWe conducted a retrospective observational study with prospective data entry of patients undergoing elective cholecystectomy for gallbladder polyps from 2007 to 2021. Surgery was indicated in symptomatic patients and in those with risk factors. The study was approved by the Clinical Research Ethics Committee of our hospital. ResultsOur study included 124 patients who had undergone elective laparoscopic cholecystectomy. Mean age was 55.4 years, and 61% were women. In total, 65% were symptomatic at diagnosis. Only 3 patients had true polyps (2.4%), all of which were tubular adenomas. The remainig patients were false positives (97.6%). The adenoma sizes were 11, 6 and 5mm, respectively. The surgical indication was due to polyp size or due to associated biliary symptoms. ConclusionUltrasonography is not accurate for the diagnosis of gallbladder polyps. The validation of other complementary tests for the diagnose gallbladder polyps in asymptomatic patients could be relevant to avoid unnecessary surgeries.

Abstract 5247: The effect of aspirin on the transcriptional landscape of the colon

Abstract Colorectal cancer (CRC) remains the second leading cause of cancer mortality in the United States. Aspirin is the most promising CRC prevention agent with significant data supporting long-term use with a reduction in the incidence of adenomatous polyps and colorectal cancer. The adoption of aspirin as a preventive agent has been limited by an incomplete understanding of aspirin’s mode of action in humans. To elucidate the mechanism of aspirin prevention, we sought to identify aspirin-associated transcriptional changes within the colon. To accomplish this objective, we performed RNA sequencing of biopsy-derived colonic epithelial cells from participants enrolled (N=180) in our ongoing aspirin randomized placebo-control trial (RCT) program, “ASPirin Intervention for the REDuction of colorectal cancer risk” (ASPIRED). Individuals with a recent resection of an adenoma were eligible. Participants for whom epithelial cells from rectosigmoid mucosal biopsies were successfully obtained at both pre- and post-treatment timepoints (n=130) were included in this analysis. Participants were randomized to once-daily placebo (n=45), low-dose aspirin (81 mg) (n=46), or standard-dose aspirin (325 mg) (n=39) for 8-12 weeks. For each timepoint, we performed Illumina RNA 100-bp paired-end sequencing of 4,000 fluorescence-activated cell-sorted (FACS) colonic epithelial cells (CD45-; EpCAM+). Transcriptomic read alignment and read counts per gene were obtained using STAR and Salmon. Quality control measures removed 52 participants (20 placebo, 18 low-dose aspirin, and 14 standard-dose aspirin) from the analysis. No significant differences in age, gender, ethnicity, or BMI were observed between placebo and aspirin-treated participants. We then identified genes whose expression is modulated by aspirin exposure (low and standard dose aspirin) while controlling for baseline gene expression differences between placebo and aspirin-exposed patients and for intra-sample gene expression variability using Dream. We found 57 genes were significantly differentially expressed in aspirin-treated participants at an FDR < 0.10. AGR2, which is a CRC oncogene that is upregulated by prostaglandin E2 (PGE2), was significantly downregulated by aspirin treatment suggesting aspirin modules the expression of PGE2 responsive genes in the colonic epithelium. Gene enrichment analysis found aspirin significantly downregulated scaffold proteins (e.g. KRT8, KRT18, and ACTB) and structural ribosomal RNA binding proteins. These pathways are critical processes in epithelial cell differentiation. This finding supports previous in vitro evidence that aspirin results in cell composition changes within the colonic epithelium favoring stem-like cell states, which may underlie its preventive effect. Citation Format: Jonathan M. Downie, Connor M. Geraghty, Thaddeus S. Stappenbeck, Ömer H. Yilmaz, David A. Drew, Andrew T. Chan. The effect of aspirin on the transcriptional landscape of the colon. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5247.

Irritable Bowel Syndrome Is Not Associated with an Increased Risk of Polyps and Colorectal Cancer: A Systematic Review and Meta-Analysis

ObjectivesColorectal cancer (CRC) is the third most common malignancy in the US. Several factors are associated with increased/decreased CRC risk and often linked to adenomatous colorectal polyps (CRP). Recent studies suggest a lower risk of neoplastic lesions among irritable bowel syndrome (IBS) patients. We aimed to systematically assess the occurrence of CRC and CRP in IBS patients.MethodsSearches of the Medline, Cochrane, and EMBASE databases were performed, blindly and independently, by two investigators. Studies of CRC or CRP incidence in IBS patients (diagnosed by Rome or other symptom-based criteria) were eligible for inclusion. CRC and CRP effect estimates were pooled in meta-analyses using random models.ResultsOf 4941 non-duplicate studies, 14 were included, comprising 654,764 IBS patients and 2,277,195 controls in 8 cohort studies, and 26,641 IBS patients and 87,803 controls in 6 cross-sectional studies. Pooled analysis revealed a significantly decreased prevalence of CRP in IBS subjects vs. controls, with a pooled odds ratio (OR) of 0.29 (95% CI (0.15, 0.54)). There was significant heterogeneity between studies (I2 = 96%, p < 0.01). This finding persisted when studies which did not report pre-cancerous polyps separately were excluded (OR 0.23, 95% CI (0.15, 0.35), I2 = 85%, p < 0.01). CRC prevalence was lower in IBS subjects, but this did not reach statistical significance (OR 0.40, 95% CI (0.09, 1.77]).ConclusionOur analyses reveal a decreased incidence of colorectal polyps in IBS, although CRC did not reach significance. Mechanistic studies with detailed genotypic analysis and clinical phenotyping are needed to better elucidate the potentially protective effect of IBS on CRC development.

Helicobacter pylori eradication reduces risk for recurrence of gastric hyperplastic polyp after endoscopic resection.

Little is known about the effect of Helicobacter pylori eradication on the recurrence of gastric hyperplastic polyps after endoscopic resection. Thus, we evaluated the recurrence rate of gastric hyperplastic polyps based on H. pylori eradication following endoscopic resection. We retrospectively reviewed the medical records of 201 patients with H. pylori infection who underwent endoscopic resection for gastric hyperplastic polyps at six medical centers. H. pylori status was assessed by histological analysis and a rapid urease test. A total of 149 patients underwent successful H. pylori eradication (eradication group), whereas 52 patients had persistent H. pylori infections (non-eradication group). The recurrence rate of gastric hyperplastic polyps and the risk factors according to H. pylori status were analyzed. During the mean follow-up period of 18.3 months, recurrent gastric polyps developed after endoscopic resection in 10 patients (19.2% [10/52]) in the non-eradication group and 12 patients (8.1% [12/149]) in the eradication group. The cumulative incidence of recurrent gastric hyperplastic polyps was significantly higher in the non-eradication group than in the eradication group (p = 0.041, log-rank test). In the adjusted analysis, H. pylori eradication reduced the recurrence of gastric hyperplastic polyps (hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.18 to 0.99), whereas anticoagulation therapy increased the risk of recurrence of gastric hyperplastic polyps (HR, 4.91; 95% CI, 1.39 to 17.28). Successful eradication of H. pylori may reduce the recurrence of gastric hyperplastic polyps in patients after endoscopic mucosal resection.

Analysis of risk factors for postoperative bleeding and polyp recurrence in adolescents with gastric polyps treated with endoscopic mucosal resection: a retrospective cohort study.

The incidence of gastric polyps in adolescents has been increasing every year in recent years. Endoscopic mucosal resection (EMR) is one of the most common treatments for adults, but there are few reports on the association between EMR of gastric polyps and the occurrence of bleeding and recurrence after the procedure in adolescents. This study sought to analyze the independent risk factors for postoperative bleeding and polyp recurrence after EMR to provide a reference for reducing the occurrence of postoperative complications. We retrospectively analyzed the data of 579 adolescent patients who developed gastric polyps from June 2016 to June 2021. Postoperative follow-up was conducted for 1 year by telephone, e-mail, and outpatient review. The general characteristics of the study population were compiled using a general information questionnaire designed by the investigators. The relationship between the patients' clinical characteristics and postoperative bleeding or recurrence was analyzed using the chi-square test. A binary logistic regression analysis was conducted to analyze the independent risk factors for the occurrence of postoperative bleeding and polyp recurrence in patients. The results of the binary logistic regression analysis showed that being female [odds ratio (OR) =0.306, P=0.009], polyps >1 cm in diameter (OR =2.557, P=0.029), polyps in gastric sinus (OR =3.889, P=0.032), sessile lesions (OR =0.398, P=0.036), the need for additional intraoperative sedation (OR =3.469, P=0.005), concurrent diverticulum (OR =3.570, P=0.004), and intraoperative bleeding (OR =4.855, P=0.001) were independent risk factors for postoperative bleeding. We also found that polyps >1 cm in diameter (OR =2.134, P=0.003), multiple polyps (OR =2.117, P=0.005), adenomatous polyps (OR =2.684, P=0.041), combined Helicobacter pylori infection (OR =2.036, P=0.009), the occurrence of postoperative gastrointestinal reflux (OR =1.998, P=0.015), and an operative time ≥40 min (OR =2.021, P=0.010) were independent risk factors for the recurrence of polyps. There is still a high probability of postoperative bleeding and polyp recurrence after EMR in adolescents with gastric polyps. Clinicians should pay close attention to the clinical features of polyps, such as polyp size, number, morphology, and pathological type, to identify the related risk factors as early as possible and reduce the probability of postoperative bleeding and polyp recurrence in patients.

Clinical characteristics and histopathological findings in colorectal polyps among colonoscopy patients at a sub-Saharan hospital.

Colonic polyps, especially adenomatous polyps, are clinically significant because they are precursors to colorectal cancer (CRC) [1]. The incidence of colorectal polyps is rapidly increasing worldwide [2]. A report from sub-Saharan African countries showed that colonic polyps are rare in the African colon [3] Recent evidence, however, from most sub-Saharan African countries has shown a sharp rise in the incidence of CRC [4].

Obesity and incidence of colorectal polyps: a case-controlled study.

Eligible patients based on study criteria who were candidates for total colonoscopy examination enrolled in this case-controlled trial. Controls had normal colonoscopy reports. A positive colonoscopy for any kind of polyp was followed by a histopathological study. Demographic data also was registered, and patients were categorized according to the calculated BMI. Groups were matched by both gender and status of tobacco abuse. Finally, the outcomes of colonoscopy and histopathological studies were compared between groups. A total of 141 and 125 persons investigated, respectively, as patients and controls. Possible effects of gender, tobacco abuse, and cigarette smoking were declined by participants matching. Hence, we found no significant difference between groups regarding the latter variables (P>0.05). Colorectal polyps were found absolutely more in BMI>25 kg/m-2 rather than in lesser values (P<0.001). However, there was no obvious difference in the incidence of colorectal polyps between groups categorized as overweight and obese (P>0.05). Namely, even weighing over could be the risk for colorectal polyp development. Additionally, it was more expected to find neoplastic adenomatous polyp(s) with high-graded dysplasia in BMI>25 kg/m-2 (P<0.001). Even little changes in BMI further than the normal values can independently increase the risk of developing dysplastic adenomatous colorectal polyp(s) significantly.

Colon Adenoma After Diagnosis of Immune Checkpoint Inhibitor-mediated Colitis.

Purpose: While the occurrence of colitis during immune checkpoint inhibitor (ICI) treatment is recognized as a sign of robust immune activation and correlates with better oncological outcomes, the long-term impact of ICI-mediated colitis on the colonic mucosa has not been studied. We thus aim to describe the colonoscopy and histology findings in patients at a follow-up time of ≥ 6 months post initial colitis event. Methods: This retrospective analysis included adult cancer patients diagnosed with ICI colitis at a tertiary cancer center between October 2013 and June 2020. The study group included patients diagnosed with immune mediated colitis who had also undergone a follow up colonoscopy or flex sigmoidoscopy. The control group was patients exposed to ICI without immune mediated colitis. We reported patients' colitis clinical course, treatment, outcomes, and endoscopic and histologic features at diagnosis and at follow-up time of ≥ 6 months. Results: Total 39 patients met the study criteria, with 82% being male, and 35.8% having melanoma. Most patients received a combination of CTLA-4 and PD-1/L1 inhibitors (82%). On initial endoscopic evaluation, inflammation without ulceration was reported in 76.9% of patients and active inflammation on histologic examination in 79.3% of patients. Most patients (79.4%) received corticosteroids, and 56.4% received add-on selective immunosuppressive therapy. Four patients received fecal microbiota transplantation. On follow-up, new incidence of colonic polyps was reported in 51.2% of patients, including adenomas in 33.3% among the colitis patients with median follow up duration of 12 months. The incidence of adenoma polyps 12 months after the colitis event was significantly higher compared to the control group without colitis based on the time-to-event analysis (p=0.041). Conclusion: At a median follow up of 12 months after their initial colitis diagnosis, 51.2% of the patients had new incidence of colonic polyps, including a third with adenoma, at a significantly higher incidence than the control group without colitis. Studies with larger sample sizes are needed to further define the long-term impact of colitis and its treatments on colon health and to refine recommendations for surveillance of colonic adenomas and colorectal cancer.

The relationship between colon polyps and colonic diverticulosis: a retrospective review.

Colonic diverticulosis and colon polyps are common findings on colonoscopy. There is currently no consensus regarding a possible connection between the development of polyps and diverticulosis. Multiple research studies have sought to analyze whether the presence of both conditions is associated with the development of colorectal cancer. Our study aims to add to this body of data and to better assess the relationship between diverticulosis and colon polyps. A retrospective chart review was performed of all patients who underwent screening and diagnostic colonoscopies between January 2011 and December 2020. Data collection included patient demographics; number, pathology, and location of colon polyps; incidence of colon cancer; and presence and location of colonic diverticulosis. Our study demonstrated that the overall presence of diverticulosis in any location increases the likelihood of having nearby colon polyps, regardless of subtype. The presence of left colonic diverticulosis was particularly associated with adjacent adenomatous and non-adenomatous colon polyps. Colonic diverticulosis in any location may lead to an increased incidence of adenomatous colon polyps. It is important to perform careful examination of the mucosa surrounding colon diverticulosis to avoid missing colon polyps.

Pattern of Colorectal Polyps among Sudanese Patients: a Single Centre Experience

Background: Polyps are masses projecting into the bowel lumen beyond the surface of the epithelium with or without a pedicle/stalk and it can be taken to mean a protuberant growth which can be either benign or malignant. The objective of the study was to study the pattern of colorectal polyps among Sudanese patients at Soba university hospital. Patients and methods: The study was a prospective, descriptive, cross sectional hospital based study. Conducted at Soba University Hospital department of endoscopy, in a period from Oct 2017 to August 2018.The study was conducted on Patients with colorectal polyps finding in colonoscopy or flexible Sigmoidoscopy. All the patients have been followed for duration not less than 3 months to assess the outcome. The main objective was to study the pattern of colorectal polyps among Sudanese population. Results: A total of (120) patients with colorectal polyps out of (626) patients underwent lower GI endoscopy during the period of the study, with male to female ratio of 1.8:1.0.The age ranged between (4) to (94) years. The incidence of polyp at the study was (19%). Thirty nine patient (32.5%) are smoker, while (6.7%) of the patients were alcohol consumers. NSAIDs consumptions were found in (40%) of the patients. Considering the consumption of fiber diet the study showed most of the patients were using the moderate fiber diet (53%). Schistosomasis found in 4 patients (3.3%) and these patients had polyps showing inflammatory polyps of schistosomasis origin. Presenting complains includes bleeding per rectum, altered bowel habit, mucus per rectum, abdominal pain, weight loss, abdominal distension, anorexia and anaemic symptoms. The most common co-morbidities were DM in (17.5%), IBD in (11.7%), FAP (6.7.4%) and diverticular diseases in (1.7%). The mode of the diagnosis was either through sigmoidoscopy or colonoscopy, and the NBI was used in (7.5%). The most common type was sessile polyps (67.5%) followed by pedunclated polyps (29.2%). Most of the polyps are within the left side, mainly at the rectum, anal canal and sigmoid colon. The size of the polyps lies between (1 mm to 50mm).The most common modes intervention was snare polypectomy (66.7%), followed by excision via biopsy forceps (62.7), while other treatment options are less frequent. Histopathology showed that most of the polyps were benign polyps (74.2%). (10.8%) were of high degree dysplasia and the rest was less frequent. Thirty three patients showed inflammatory polyps (27.5%) followed by tubulovilous adenomatous polyps (20.8% ), tubuloadenomatus polyp (11.7), juvenile polyp (10.8),hyperplastic polyps (9.2%), villous adenomatus polyp (5%), tubularadenomatus polyp (4.2%), schistosomal polyp (3.3%), hamratomatous polyp (2.5%) , fibroepithelial polyp (2.5%), invasive adenocarcinoma (1.7%) and granulomatus polyp (8%). Conclusion: The pattern of Colorectal polyps among Sudanese patients at our study was in line with international pattern in age, gender, common presentation, risk factors, types, shape and histopathology and most of them were of benign nature..

Urinary phthalate metabolites and the risk of endometrial polyp: A pilot study from the TREE cohort

Phthalates, as endocrine disrupting chemicals that can alter the endogenous hormones, may be involved in the incidence of endometrial polyp, a benign hormone-dependent condition. We conducted a pilot case-control study from the Tongji Reproductive and Environmental (TREE) cohort to investigate the associations between phthalate exposures and the risk of endometrial polyp. A total of 40 endometrial polyp patients were matched to 80 controls by age and body mass index in the ratio of 1:2. Two spot urine samples from each subject were quantified for eight phthalate metabolites to enhance exposure assessment. The conditional logistic regression and quantile-based g-computation models were separately used to explore the associations between individual and mixture of urinary phthalate metabolites and the risk of endometrial polyp. After adjusting for covariates, individual chemical analyses showed that urinary monobenzyl phthalate (MBzP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono(2-ethylhexyl) phthalate (MEHHP) and the sum of di(2-ethylhexyl) phthalate (ΣDEHP) were associated with increased risks of endometrial polyp, with adjusted odds ratios ranging from 2.62 (95% CI: 0.88, 7.84) for MECPP to 6.96 (95% CI: 1.87, 25.87) for ΣDEHP comparing the extreme exposure categories (all P for trends <0.05 or = 0.057). These associations still persisted when these exposures were modeled as continuous variables. Chemical mixture analyses showed that a simultaneous one-quartile increase in concentrations of eight phthalate metabolites was associated with an elevated odds ratio of 3.14 (95% CI: 1.49, 6.60) in endometrial polyp. Our data suggests that exposure to individual benzylbutyl phthalate (BBzP) and DEHP, as well as mixture of phthalates is associated with increased risk of endometrial polyp. This may inform public health recommendations and policies to avoid phthalate exposures for improving female reproductive health.

Association of Genre of Singing and Phonotraumatic Vocal Fold Lesions in Singers.

To determine if (1) the likelihood of presenting with phonotraumatic lesions differs by singing genre in treatment-seeking singers and (2) if the distribution of phonotraumatic lesion types differs by singing genre. Retrospective. Records of singers who presented with a voice complaint over the course of 2.5 years (June 2017-December 2019) were reviewed to determine the proportion of those with phonotraumatic lesions as a function of genre (Study 1). Separately, the lesion types and genres of singers diagnosed with phonotraumatic lesions over a 9-year period (July 2011-March 2020) were determined (Study 2). In Study 1, 191 of 712 (26.8%) dysphonic singers were diagnosed with phonotraumatic lesions. Country/folk, gospel/jazz, and musical theater singers were more likely to present with phonotraumatic lesions. In Study 2, in 443 singers with phonotraumatic lesions, polyps and pseudocysts, but not nodules, were found to be distributed unequally across genres (χ2 p=0.006, p < 0.0001, p=0.064, respectively). Praise/worship singers had significantly higher proportions of polyps compared to choral singers (OR 4.8 [95% CI 1.9-12.5]) or compared to musical theater singers (OR 7.2 [95% CI 2.5-20.8]). Opera singers had significantly higher proportions of pseudocysts than choral singers (OR 3.1 [95% CI 1.5-6.1]) or musical theater singers (OR 3.7 [95% CI 1.8-7.6]). The higher incidence of polyps in praise/worship singers likely reflects the more emphatic nature of singing and the tendency for acute injury. The higher incidence of pseudocysts in opera singers may reflect a more chronic nature of injury. 4 Laryngoscope, 133:1683-1689, 2023.

S212 Incidence Rates of Adenoamtous Polyps, Clinically Significant Serrated Polyps and Advanced Neoplasia in Adults Age 18-45 in a Community Hospital in the Upper Midwest Over a 15-Year Period: A Retrospective Review

Introduction: Increasing incidence of early onset colorectal cancer over time has been well described. Temporal trends regarding precursor lesions in young adults are less clearly defined. The aim of this study was to investigate trends in the rates of adenomatous colon polyps, clinically significant serrated polyps and advanced neoplasia in young adults over a 15 year period. Methods: We performed a retrospective review of all colonoscopy examinations performed in two community hospitals and an ambulatory surgery center in northern Minnesota between January 1, 2006 and December 31, 2020 in adults age 18-45. Exclusion criteria were incomplete colonoscopy exams or exams with inadequate bowel preparation. A total of 2655 colonoscopy exams were included in our review. We measured the incidence rates of adenomas, clinically significant serrated polyps (sessile serrated polyps, traditional serrated adenomas, proximal hyperplastic polyps > 4 mm and hyperplastic polyps > 9 mm) and rates of advanced neoplasia (adenoma > 9 mm, villous histology, high grade dysplasia, colon cancer) for each year in the study period. The relationship between time (as measured by year) and incidence of adenomatous polyps, clinically significant serrated polyps, advanced neoplasia and non-malignant advanced neoplasia was investigated using Spearman Rank Order Correlation (rho). Preliminary analyses were performed to ensure no violation of the assumptions. Results: There were a total of 291 cases with at least one adenoma detected (11.0% incidence rate), 63 cases with at least one clinically significant serrated polyp (2.4% incidence rate), 60 cases with advanced neoplasia (2.3% incidence) and 8 cases of colorectal cancer (0.3% incidence rate). The incidence rate of adenomatous polyps increased over the course of the study period (rho = .88, n = 15, = p < .001). The incidence of clinically significant serrated polyps increased over the study period, however this finding was not statistically significant. The incidence of advanced neoplasia increased over the course of the study period and trended towards significance (rho = .50, n = 15, p = .056). (Figure) Conclusion: Incidence rates of adenomatous colon polyps in young adults increased over the study period while rates of advanced neoplasia appeared to increase over the study period. More complete understanding of temporal trends in different precursor colon lesions in young adults may help guide endoscopists caring for young adults with lower GI symptoms.Figure 1.: Incidence of adenomatous colon polyps in young adults over time

S2055 Intra-Diverticular Polyp Associated With Acute Diverticulitis

Introduction: The incidence of both colon polyps and diverticulosis increases with age. Intra-diverticular polyps are a very rare findings despite the relatively high prevalence of both colon polyps and diverticulosis. Acute diverticulitis happens in approximately 5-10% of patients with diverticulosis. Risk factors for acute diverticulitis have been well described including age, NSAIDs, and dietary factors. There is limited evidence on the incidence of diverticulitis associated with colon polyps. Case Description/Methods: A 44-year-old woman with no significant medical history was referred for evaluation after a recent episode of acute uncomplicated diverticulitis confirmed on CT. She was treated with a short course of antibiotics in the outpatient setting. The patient had a normal BMI and was not using any NSAIDs previously. The patient subsequently underwent a diagnostic colonoscopy and was found to have sigmoid diverticulosis. A single 5 mm semi-pedunculated polyp was found arising from the base of a diverticulum (Figure). The polyp was resected using forceps to evert the diverticulum and fully visualize the polyp. Histologic examination revealed an inflammatory polyp. Discussion: Here we present a case of a patient who was found to have an intra-diverticular polyp after an episode of acute diverticulitis. The patient had no other risk factors for acute diverticulitis which suggests the polyp may have been the underlying cause of the diverticulitis. Intra-diverticular polyps are rare. To the best of our knowledge, diverticulitis caused by such polyps is exceedingly rare. Polyp location or growth in the diverticulum may led to obstruction, inflammation or erosion of the thin diverticular wall. Because the polyp was inflammatory, we cannot rule out the possibility that it may have developed after the episode. Whether the polyp was the trigger or the result of diverticulitis, this rare association highlights the importance of a colonoscopy after an episode of acute diverticulitis to rule out other pathology.Figure 1.: Left: Intra-diverticular polyp. Right: Forceps were used to fully visualize and resect the polyp.

Endometrial polyps and their insinuation in the pregnancy rates of patients undergoing ICSI-FET cycles: A retrospective cohort study

To study the effect of endometrial polyps in infertility patients and their insinuation in pregnancy rates in patients undergoing ICSI-FET cycles following polypectomy.This is a retrospective study in 345 infertility patients attending Reproductive center of Sudha Hospital, Erode. Infertile women with endometrial polyps diagnosed by transvaginal ultrasound were subjected to hysteroscopic polypectomy. Vitrified embryo transfer was done one to three months following polypectomy and the clinical pregnancy rates were analysed. The age, body mass index, the type of infertility (primary or secondary), duration of infertility, pattern of menstruation, were precisely evaluated. An endometrial polyp based on their location inside the uterine cavity is assessed by hysteroscopy and the significance of the polyp location with pregnancy rates is evaluated.Of the 345 women who underwent hysteroscopic polypectomy 229 became pregnant and 116 women were non pregnant in ICSI-FET cycles. There is a strong positive association between endometrial polypectomy and pregnancy rate in ICSI-FET cycles. The incidence of Endometrial Polyps in pregnant and non-pregnant group was not related to the age, gravida and parity. Pregnancy rate after polypectomy based on polyp location is statistically insignificant. Multiple polyps are common compared to solitary polyp. Polyps are more common in posterior uterine wall than anterior, lateral walls and uterotubal junction.Hysteroscopic polypectomy gives promising results in infertility patients undergoing ICSI cycles prior to vitrified embryo transfer and location of polyps does not determine the pregnancy outcomes.