Colonic Lesions Research Articles

What is the optimal treatment strategy of salvage line treatment after progression on anti-epidermal growth factor receptor monoclonal antibody in patients with tissue RAS/BRAF wild-type metastatic colorectal cancer?

138 Background: Trifluridine/tipiracil (FTD/TPI) plus bevacizumab (BEV) and anti-epidermal growth factor receptor (EGFR) monoclonal antibody (mAb) re-challenge are treatment options for tissue RAS/BRAF wild-type (WT) metastatic colorectal cancer (mCRC) in salvage line, although the optimal treatment sequence of salvage line remains unclear. Methods: RAS/BRAF WT mCRC patients refractory to anti-EGFR mAb were retrospectively enrolled at a single cancer institute from November 2017 to April 2024. We compared responses, progression-free survival (PFS), and overall survival (OS) between Group A (anti-EGFR mAb re-challenge given first) and B (FTD/TPI plus BEV given first). We compared responses between Group C (treated with anti-EGFR mAb re-challenge at any line) and D (treated with FTD/TPI plus BEV at any line). We explored the clinical factors related to the treatment efficacy using multivariate analysis. Results: A total of 89 patients (median age, 63 years) were included. The cohort included 74 patients with a primary lesion in the left-sided colon, while 15 patients had a primary lesion in the right-sided colon. The response rate (RR) was 3.4%. The disease control rate (DCR) was 52.8%. The median PFS (mPFS) and OS (mOS) were 3.5 months (95% confidence interval [CI], 2.8-4.2) and 12.8 months (95% CI, 8.8-15.7) respectively. Two of 18 patients (11.1%) in Group A and 1 of 71 patients (1.4%) in Group B achieved partial response (PR). The RR of Group C was significantly higher than Group D (9.6% vs 1.2%; p = 0.031). Both PFS and OS showed no significant difference between Group A and B (mPFS: 3.3 vs 3.9 months; hazard ratio [HR], 1.08; 95% CI, 0.63-1.84; p = 0.79) (mOS: 12.8 vs 15.0 months; HR, 0.90; 95% CI, 0.49-1.65; p = 0.72). Multivariate analysis identified that primary tumor resection was associated with PFS (HR, 0.44; 95% CI, 0.25–0.80; p = 0.0068) and primary tumor resection (HR, 0.34; 95% CI, 0.18–0.65; p = 0.0010) and serum CA19-9 level (HR, 1.75; 95% CI, 1.02-3.00; p = 0.043) were associated with OS. Conclusions: No significant survival difference was observed between patients administered anti-EGFR mAb re-challenge first and those administered FTD/TPI plus BEV first, whereas the RR of anti-EGFR mAb re-challenge is significantly higher than that of FTD/TPI plus BEV.

Co-Delivery of Glycyrrhizin and Paclitaxel via Gelatin-Based Core-Shell Nanoparticles Ameliorates 1,2-Dimethylhydrazine-Induced Precancerous Lesions in Colon.

Colorectal cancer is a lethal malignancy that begins from acquired/inherent premalignant lesions. Thus, targeting these lesions at an early stage of the disease could impede the oncogenesis and maximize the efficacy. The present work underscores a combinatorial therapy of paclitaxel (PTX) and glycyrrhizin (GL) delivered via gelatin-derived core-shell nanoparticles [AC-PCL(GL + PTX)-GNPs] for effective management of precancerous lesions. The desolvation method was adopted to prepare GL-loaded gelatin nanoparticles (GL-GNPs), which were coated with PTX and AC-PCL. The prepared NPs exhibited optimal physical attributes and had spherical morphology, as analyzed by transmission electron microscopy and field-emission scanning electron microscopy. In vitro release studies revealed sustained release for ∼96 h. Cell culture studies in HTC 116, and HT-29 cells showed synergistic action with CI < 0.9 and DRI > 1. Moreover, AC-PCL(GL + PTX)-GNPs exhibited amplified intracellular uptake and thus significantly reduced IC50. Pharmacokinetic studies revealed substantiated pharmacokinetic parameters (AUC0-∞, Cmax, etc.). In vivo studies in a 1,2-dimethyl hydrazine-induced model revealed a decrease in the number of lesions, mucin depletion, and subside infiltrations. An immunohistochemical study revealed elevated expression of caspase-9 and suppressed expression of VEGF and Ki-67. Toxicity studies showed insignificant changes in systemic biomarkers along with no alterations in organ morphology and hemocompatibility. In essence, AC-PCL(GL + PTX)-GNPs render a competent and safer tactic to regulate early-stage precancerous lesions.

Hereditary colorectal cancer syndromes and inflammatory bowel disease: results from a registry-based study

PurposeIn this study, we investigated the progression of high-grade dysplasia (HGD)/CRC in patients with hereditary colorectal cancer syndromes (HCSS) and concomitant inflammatory bowel diseases (IBDs).MethodsWe described the natural history of a series of patients with confirmed diagnosis of hereditary colorectal cancer syndromes (HCCSs) and concomitant IBDs who were referred to the Hereditary Digestive Tumors Registry at the Fondazione IRCCS Istituto Nazionale dei Tumori of Milan.ResultsBetween January 1989 and April 2024, among 450 patients with APC-associated polyposis and 1050 patients with Lynch syndrome (LS), we identified six patients with IBDs (five with UC, one with ileal penetrating CD) and concomitant HCCSs (five with LS, one with APC-associated polyposis). Three patients developed CRC (two patients with stage IIA, and one with stage IIIA); in one patient, CRC occurred over a median follow-up of 12 months after IBD diagnosis, while in two, both conditions were diagnosed simultaneously. The median age at initial diagnosis of CRC was 33 years (range 27–41). Five patients (83.3%) underwent surgical procedures (three colonic resections for carcinoma and two for other reasons). Most of them progressed to precancerous or cancerous colonic lesions at a young age. Notably, all patients with CRC had a diagnosis of UC.ConclusionIBD patients with coexistent HCCSs can develop early CRC onset at an advanced stage. These patients should be always referred to tertiary referral centers for strict surveillance programs and early surgical management of advanced colorectal neoplastic lesions. Noninvasive biomarkers of neoplastic changes are advocated to further improve the management of IBD patients with HCCSs.

P0617 Feasibility and safety of endoscopic submucosal dissection in inflammatory bowel disease (ESDEUR-IBD): an interim analysis of European retrospective study

Abstract Background Colectomy is the primary treatment for dysplastic lesions in inflammatory bowel disease (IBD). Since the development of advanced endoscopic techniques, the management of dysplasia is evolving. Endoscopic submucosal resection (ESD) could be used in selected cases at referral centres as an alternative to colectomy. However, the feasibility and safety in IBD remains limited. Main aim: To evaluate en-bloc resection rate and the need of colectomy due to ESD failure in IBD. Secondary aims: to assess the complications of ESD, the local recurrence of dysplastic lesions, the presence of synchronous and metachronous lesions and the risk of IBD relapse following the procedure. Methods Multicentre, retrospective study of IBD patients who underwent ESD for suspected colonic dysplastic lesions at least one month before the inclusion date. Patients with total colectomy before ESD, invisible dysplasia at the time of ESD, or pregnancy were excluded. En-bloc resection rate and colectomy due to ESD failure at the short term were evaluated by logistic regression analysis. The risk of IBD relapse was evaluated by Cox regression analysis. Results Forty-eight patients from 16 centres were included: 36 with ulcerative colitis, 9 with Crohn’s disease and 2 with IBD-unclassified. The mean age at ESD was 63 years (SD 13). The majority of the lesions (n=28, 60%) were located in rectum. Forty lesions (87%) were located in areas previously inflamed. En-bloc and R0 were achieved in 45 (94%) and 37 patients (77%), respectively. Colectomy due to ESD failure was required in 4 patients (8.3%) (Figure 1A). No risk factors were associated with colectomy in multivariable analysis, including inflammatory activity, IBD treatments or characteristics of the lesions. Complications occurred in 16 patients (33%): 6 required pharmacologic therapy, 5 needed endoscopic or radiologic intervention, and 2 underwent surgery (Table 1). No deaths were reported. At least one surveillance colonoscopy after ESD was performed in 35 patients (73%). Local recurrence was observed in 2 patients while other dysplastic lesions were detected in 9 (29%) during the follow-up (median 2.5 years, IQR 0.5-4). All of these lesions were removed endoscopically. Synchronous and metachronous lesions were identified in 4 (25%) and 7 patients (26%), respectively. IBD relapse occurred in 8 patients during the follow-up, with an incidence rate of 7% person-year (CI 95%:3-15) (Figure 1B). Conclusion ESD avoids colectomy in 80% of IBD patients with dysplastic lesions. One-third of the patients experienced complications, all of them resolved with no sequelae. Given the risk of new dysplastic lesions, ongoing monitoring with surveillance colonoscopies is recommended.

P0247 Clinical and Colonoscopic Features of Colitis in HIV-Positive Patients Mimicking Inflammatory Bowel Disease Over the Past 12 Years

Abstract Background Not only the incidence of inflammatory bowel disease(IBD) but also that of HIV-positive colitis is increasing as individual freedom is emphasized, making the diagnosis of IBD more challenging nowadays. Methods We reviewed the data of 75 HIV-positive patient at Daehang Hospital, Seoul, from January 2012 to October 2024. Ten patients were filtered from retrospective medical records analysis who were suspected to have IBD before the HIV-positive diagnosis. Results Among the 10 patients suspected to have IBD, all were men with a median age of 27, ranging from 22 to 62. Symptom complaints started 2 week ago(2 men), 1 month ago(6 men), 2months ago(1 man), 6month ago(1 man). Initial diagnoses from personal history were ulcerative colitis(5 men), Crohn’s disease(3 men), irritable bowel syndrome(1 man), infectious colitis(1 man). Anal sex history could be obtained from 5 patients. Colonoscopy revealed rectal ulcers(4 men), whole colon ulcers or erosions(4 men), left colon erythema, edema (1 man), and anal abscess(1 man). One patient was found to have amebiasis from cecum tissue. Conclusion HIV-positive colitis is very rare but now increasing, necessitating differential diagnosis. Initial suspicion through careful history taking and close observation of colonic mucosal lesions could reduce the misdiagnosis of IBD. Further large-scale cases are needed to identify the characteristics of HIV-positive colitis to exclude the diagnosis of IBD.

Oral Akkermansia muciniphila Biomimetic Nanotherapeutics for Ulcerative Colitis Targeted Treatment by Repairing Intestinal Epithelial Barrier and Restoring Redox Homeostasis.

The structural disruption of intestinal barrier and excessive reactive oxygen/nitrogen species (RONS) generation are two intertwined factors that drive the occurrence and development of ulcerative colitis (UC). Synchronously restoring the intestinal barrier and mitigating excess RONS is a promising strategy for UC management, but its treatment outcomes are still hindered by low drug accumulation and retention in colonic lesions. Inspired by intestine colonizing bacterium, we developed a mucoadhesive probiotic Akkermansia muciniphila-mimic entinostat-loaded hollow mesopores prussian blue (HMPB) nanotherapeutic (AM@HMPB@E) for UC-targeted therapy via repairing intestinal barrier and scavenging RONS. After oral administration, the negatively charged AM@HMPB@E specifically bind to the positively charged inflamed colon lesions via electrostatic interactions and Akkermansia muciniphila membrane-mediated bioadhesion mechanism. Subsequently, the superoxide dismutase (SOD)-, and catalase (CAT)-like HMPB eliminated RONS, thereby alleviating RONS-mediated inflammation and intestinal epithelial damage. Meanwhile, the UC-site locally released entinostat could repair the damaged intestinal epithelial barrier by inhibiting intestinal endothelial cell apoptosis and up-regulating the expression of tight junctions. Both in vitro and in vivo results shown that AM@HMPB@E not only exhibited an exceptional retention in the colitis site but also demonstrated superior therapeutic efficacy compared to the first-line drug sulfasalazine, as evidenced by the longer colon, less rectal bleeding and body weight loss. Collectively, our findings highlight the clinical application prospects of this synchronous nanotherapeutic strategy for UC treatment, offering a paradigm for the rational design of oral nanomedicine.

Unifying terminology, reporting, and bowel preparation standards in colon capsule endoscopy: Nyborg Consensus

AbstractColon capsule endoscopy (CCE) is becoming increasingly popular in Europe. However, development of quality assurance and standardized terminology has not kept pace with clinical integration of this technology. As a result, there are significant variations in reporting standards, highlighting the need for a standardized terminology and framework. We used the RAND process to achieve a consensus of experts to determine the terminology in CCE, bowel cleansing assessment, and quality assurance reporting and future research priorities.A panel comprising 14 European CCE experts evaluated 45 statements during the international REFLECT symposium (Nyborg, Denmark) through three survey rounds and face-to-face and virtual discussions in the initial two rounds. Participants anonymously rated statement appropriateness.Twenty-eight consensus statements were developed. Eight statements focus on consistent terminology for confirming CCE-detected polypoid and inflammatory colonic lesions with colonoscopy. To ensure standardization and quality assurance, 13 mandatory fields were recommended for inclusion in a CCE report. Three endorsed reporting methodologies were suggested, emphasizing prompt notification for suspected malignant findings, recommending a generic disclaimer regarding stomach and small bowel visualization intentions, and establishing reporting timelines at an interdepartmental level based on urgency. Four bowel preparation scale-related statements led to the recommendation to adoptithe Colon Capsule CLEansing Assessment and Reporting (CC-CLEAR) scale as the preferred scale.This study established a framework for terminology, reporting, and assessment of bowel cleansing for CCE. Future research should focus on optimizing bowel preparation regimens and exploring artificial intelligence applications in CCE.

Diagnostic performance and clinical outcomes of computed tomography colonography in a sick inpatient population.

Though prior studies have proven CTC's efficacy in outpatients, its utility in the inpatient setting has not been studied. We evaluated the efficacy of a modified CTC protocol in the inpatient setting, primarily for patients awaiting organ transplantation. This retrospective study compared a group of inpatient CTCs from 2019 to 2021 and a randomly selected, age-matched 2:1 control group of outpatient CTCs. Both groups were assessed based on established criteria from literature. 10% (63/652) of CTCs were performed in the inpatient setting, of which 29 were excluded, yielding 34 inpatient cases. 90% (589/652) of CTCs were performed in the outpatient setting, from which 68 randomly selected, age-matched patients were selected as controls. Significantly more (24%, 8/34) inpatients expired due to extracolonic causes (vs. 1%, 1/68 outpatients, p<0.05). 62% (21/34) of inpatient CTCs were reported as diagnostic (vs. 74%, 50/68 outpatient, p=0.22). Significantly more inpatients (12%, 4/34) than outpatients (1%, 1/68) were unable to tolerate two imaging positions (p=0.02). Subsequent colonoscopy was performed in 24% (8/34) of inpatients, revealing pathologies including colonic polyps and non-bleeding ulcers. Inpatient CTCs had lower average quality scores, significant for one reviewer (p=0.009-0.054). Inpatients had a larger number of segments with: >25% residual fluid (1.22-1.28 inpatients vs. 0.60-0.73 outpatients, p=0.003-0.026) and inadequate fluid tagging (1.10 inpatients vs. 0.49 outpatients, p=0.046-0.0501). Distention was not significantly different between groups (p=0.317-0.410). Quality of inpatient CTC was inferior to outpatient CTCs across several metrics. 24% undergoing inpatient CTC died of extracolonic causes within 22months, and most did not have findings warranting intervention, questioning the value of this difficult exam in this patient population. Routine CT may be sufficient to exclude large or metastatic colonic lesions precluding transplant.

European multicentre analysis of the implementation of robotic complete mesocolic excision for right-sided colon tumours.

Complete mesocolic excision (CME) is an oncologically driven technique for treating right colon cancer. While laparoscopic CME is technically demanding and has been associated with more complications, the robotic approach might reduce morbidity. The aim of this study was to assess the safety of stepwise implementation of robotic CME. A multicentre retrospective analysis of prospectively collected data on robotic right colectomy was performed at five European tertiary centres. Patients were classified for type of surgery: R-RHC (standard right colectomy), R-impCME (learning cases towards robotic CME defined as R-RHC with one but not all the hallmarks of CME) or R-CME (robotic CME). Primary outcomes were overall and severe 30-day complication rates before and after propensity score matching (PSM) analysis. Five hundred and fifty-one consecutive patients undergoing robotic surgery for (pre)malignant lesions of the right colon between 2010 and 2020 were included: R-RHC (n = 101), R-impCME (n = 135) and R-CME (n = 315). Baseline characteristics differed for American Society of Anesthesiologists score (p = 0.0012) and preoperative diagnosis of adenocarcinoma (p < 0.001). Procedure time increased by surgical complexity (p < 0.001). Vascular event rates did not differ, with no superior mesenteric vein injuries. Conversion, complication and anastomotic leak rates, time to flatus/soft diet and length of stay (LOS) did not differ. While R-RHC was performed for a lower rate of malignancies (p < 0.001), lymph node yield was significantly higher in R-CME (p < 0.001). After PSM, analyses on 186 patients documented no differences in overall and severe 30-day complication rate, conversion rate, LOS or 30-day mortality. R-CME can be implemented without increasing the overall or 30-day severe complication rate.

Effects of Cordyceps cicadae Polysaccharide on Gut Microbiota, the Intestinal Mucosal Barrier, and Inflammation in Diabetic Mice.

Background: Polysaccharides produced by the edible fungus Cordyceps cicadae can regulate blood sugar levels and may represent a suitable candidate for the treatment of diabetes and its complications. However, there is limited information available about the mechanism of how C. cicadae polysaccharide (CCP) might improve diabetic conditions. Methods: This study investigated its effects on the intestinal microbiota, intestinal mucosal barrier, and inflammation in mice with type 2 diabetes mellitus (T2DM) induced by streptozotocin, and its potential mechanisms. Results: Compared with the DC (diabetes model control group), CCPH oral treatment significantly increased the number of beneficial bifidobacteria, bifidobacteria, and lactobacilli (p < 0.01), restored the diversity of intestinal microorganisms in diabetic mice, and the proportions of Firmicutes and Bacteroidetes (34.36%/54.65%) were significantly lower than those of the DC (52.15%/32.09%). Moreover, CCPH significantly reduced the content of endotoxin (lipopolysaccharide, LPS) and D-lactic acid(D-LA) (p < 0.05), the activities of antioxidant enzymes and total antioxidant capacity were significantly increased (p < 0.01), and the content of proinflammatory cytokines TNF-α, IL-6, and IL-1β were reduced by 42.05%, 51.28%, and 52.79%, respectively, compared with the DC. The TLR4/NF-κB signaling pathway, as a therapeutic target for diabetic intestinal diseases, plays a role in regulating the inflammatory response and protecting the intestinal barrier function. Molecular mechanism studies showed that oral treatment with CCPH down-regulated the expression of NF-κB, TLR-4, and TNF-α genes by 18.66%, 21.58%, and 34.87%, respectively, while up-regulating the expression of ZO-1 and occludin genes by 32.70% and 25.11%, respectively. CCPH regulates the expression of short-chain fatty acid levels, increases microbial diversity, and ameliorates mouse colon lesions by inhibiting the TLR4/NF-κB signaling pathway. Conclusions: In conclusion, it is demonstrated that in this murine model, the treatment of diabetes with C. cicadae polysaccharide can effectively regulate intestinal microbiota imbalance, protect intestinal mucosal barrier function, and reduce inflammation in vivo, suggesting this natural product can provide a suitable strategy for the treatment of T2D-induced gut dysbiosis and intestinal health.

Enhanced precise therapy of ROS-sensitive dual-layer shell nanoparticles loading quercetin on DSS-induced ulcerative colitis mice

Ulcerative colitis (UC) is an intestinal condition, involving inflammatory response, apoptosis, and associated processes. As one of the traditional Chinese medicine treatments for UC, quercetin has received attention because it can attenuate inflammation. However, oral administration of quercetin does not perform well in colitis therapy. In this study, reactive oxygen species (ROS)-sensitive nanoparticles (Que@Gel-DA NPs) prepared by self-assembly and polymerization were proposed for the treatment of UC. Quercetin was encapsulated within a shell layer by the self-assembly of gelatin, followed by the polymerization of dopamine on the gelatin surface. Relative to the free form of quercetin, the dual-layer encapsulation enhanced the solubility and bioavailability of quercetin, achieved intragastric protection, and extended the resident time of quercetin in the gastrointestinal tract. Upon reaching the colon lesion, the dopamine shell underwent degradation in response to ROS, and the gelatin shell served to enhance biocompatibility and mitigate quercetin burst release. This resulted in controlled release of quercetin, which enabled precise therapy and exerted antibacterial and anti-inflammatory effects. Furthermore, Que@Gel-DA NPs significantly alleviated the UC symptoms in a dextran sodium sulfate (DSS)-induced UC mouse model. This was evidenced by a significant increase in body weight, a reduction in occult blood in the feces, and a recovery of the crypt structure. The stained results indicated that Que@Gel-DA NPs attenuate inflammation by promoting the polarization of M2 macrophages to reduce apoptosis and modulate immunity. Therefore, Que@Gel-DA NPs, a ROS-sensitive nano-drug delivery system, represent a novel therapeutic approach for the clinical intervention of UC.

Jejunal Intussusception Caused by Enteric Muco-submucosal Elongated Polyp: A Case Report

Muco-submucosal elongated polyp is a non-neoplastic growth composed of normal mucosa and submucosal tissue. It was first reported by Matake and his colleagues and has been found mainly in the colon. The term colonic muco-submucosal elongated polyp was proposed for colonic lesions. However, only a few cases have been reported in the duodenum and jejunum of the small intestine. These lesions are called enteric muco-submucosal elongated polyp, and intussusception is very rare. In this case report, I experienced a case of enteric muco-submucosal elongated polyp that occurred in the jejunum of the small intestine and caused intussusception.

Comparison of the pocket-creation method with the conventional method of endoscopic submucosal dissection for cecal and ascending colon lesion resection

Objective To compare the pocket-creation method (PCM) with the conventional method of endoscopic submucosal dissection (ESD) for cecal and ascending colon lesion resection. Methods The data of patients who underwent ESD for cecal or ascending colon lesions were retrospectively analyzed. The patients were divided into the PCM group and the conventional group according to the method of ESD. Baseline data, endoscopic characteristics, dissection speed, pathological results and adverse events were compared between the two groups. Dissection speed was also analyzed. Results Overall, 122 patients were included. The dissection speed in the PCM group was higher than in the conventional group (0.20 [0.11, 0.32] cm2/min vs. 0.12 [0.08, 0.20] cm2/min, Z = −2.813, p = 0.005). The proportion of patients with injury to the muscularis propria layer in the PCM group was lower than in the conventional group, though the difference was not significant (19.4% vs. 29.1%, χ2 = 1.215, p = 0.270). The univariate analysis showed that low body mass index (BMI), use of the PCM, long lesion diameter, large lesion area, and minimal fibrosis were independent risk factors for fast dissection (all p < 0.05). The logistic regression analysis showed that high dissection speed was associated with the choice to use the PCM, longer lesion diameter, and no fibrosis. Conclusion For cecal and ascending colon lesions, the PCM is a better choice than the conventional method, especially in patients with fibrosis, and large lesion area.

The Effect of the Second Forward View on the Detection Rate of Sessile Serrated Lesions in the Proximal Colon: A Single-Center Prospective Randomized Controlled Study.

The detection rate of proximal sessile serrated lesion (PSSLDR) is linked to the incidence and mortality of colorectal cancer. However, research on second forward view (SFV) examinations for PSSLDR remains limited. This first randomized controlled trial assessed the impact of the proximal SFV on the PSSLDR. Patients were randomized into two groups during proximal colonoscopy: standard colonoscopy (SC) and SFV. The SC group underwent a standard examination, whereas the SFV group underwent a second examination of the proximal colon (cecum to splenic flexure). The primary outcome was PSSLDR, with secondary outcomes, including the proximal polyp detection rate (PPDR), proximal adenoma detection rate (PADR), and lesion miss rate, compared between the two groups. Among 246 patients (SC=124; SFV=122), SFV significantly improved the PSSLDR by 7.4% compared to SC (9.8% vs. 2.4%, P=0.017). SFV increased the PPDR by 20.2% (55.7% vs. 35.5%, P=0.002) and PADR by 12.7% (37.7% vs. 25%, P=0.039). Multivariate analysis revealed that sessile serrated lesions (SSLs) (OR=7.70, 95% CI [1.58, 37.59]), inflammatory polyps (OR=4.24, 95% CI [1.73, 10.39]), and lesion size (OR=0.76, 95% CI [0.60, 0.96]) were associated with proximal missed lesions. The overall polyp miss rate was 52.9%, with miss rates of 61.0% for polyps <5 mm, 80% for SSLs, and 42.2% for adenomas. Furthermore, 12.3% of patients experienced changes in surveillance intervals from SFV examination. SFV examination of the proximal colon significantly improved the PSSLDR by 7.4%, PPDR by 20.2%, PADR by 12.7%, while shortening the detection interval by 12.3%, making it a valuable and cost-effective addition to routine colonoscopy.

Malakoplakia Associated with Diarrhoea and Colonic Lesions After Rituximab Treatment.

Malakoplakia, though rare, should be considered in immunosuppressed patients with atypical gastrointestinal lesions to prevent misdiagnosis as inflammatory bowel disease.Histopathological evidence, such as Michaelis-Gutmann bodies, is essential for diagnosing malakoplakia.Prompt discontinuation of immunosuppressants and targeted antibiotic therapy can lead to clinical and histological resolution.

High Joule heat as a risk factor for post-endoscopic submucosal dissection electrocoagulation syndrome: A multicenter prospective study.

Thermal damage may lead to inflammation of the peeled mucosal surface during endoscopic submucosal dissection (ESD). To determine the effect of Joule heat on the onset of post-ESD electrocoagulation syndrome (PECS). In this prospective study, PECS was characterized by in-hospital fever (white blood cell count: ≥ 10000 μ/L or body temperature ≥ 37.5 °C) and abdominal pain (visual analog scale score ≥ 30 mm during hospitalization or increased by ≥ 20 mm from baseline at admission). High Joule heat was defined as 15390 J. Between April 2020 and April 2024, 209 patients underwent colorectal ESD; those with intraoperative perforation or penetration were excluded. The remaining 202 patients were divided into the PECS and non-PECS groups. PECS occurred in 30 (14.9%) patients. Multivariate analysis revealed high Joule heat as an independent factor associated with PECS (odds ratio = 7.96; 95% confidence interval: 2.91-21.8, P < 0.01). The procedure time and presence of lesions in the right colon were not associated with PECS. Accumulated thermal damage on the peeled mucosal surface should be considered during PECS onset. This thermal damage is likely a major component of the mechanism underlying PECS.

Correlation between colonoscopy difficulty and personality traits: study protocol for a prospective, observational, multicentre study

BackgroundColonoscopy is widely used for screening and treatment of early colonic lesions and is critical for the early diagnosis of colorectal cancer. However, due to its invasive nature, colonoscopy can...

Renshen (Radix Ginseng) polysaccharide promotes repair of the mice intestinal mucosa through regulatory mechanisms based on polyamine and human antigen R.

To investigate the mechanism and effect of Renshen (Radix Ginseng) polysaccharide on the migration of intestinal epithelial cell line 6 (IEC-6), as well as the repair mechanism of Renshen (Radix Ginseng) polysaccharide on colonic injury induced by dextran sulfate sodium (DSS) in mice. Mice were fed 3% (w/v) DSS for 6 d to create colonic lesions. A cell-migration model was created using cell scratching. mRNA expression, protein expression, translation efficiency of mRNA, and nucleoplasmic distribution of human antigen R (HuR) were determined by real-time reverse transcription-quantitative polymerase chain reaction, western blotting, a dual luciferase reporter system, and immunofluorescence staining, respectively. Renshen (Radix Ginseng) polysaccharide promoted the migration of IEC-6 cells and affected expression of stromal interaction molecule 1 (STIM1) and cell division cycle 42 (Cdc42) at transcriptional and post-transcriptional levels. Renshen (Radix Ginseng) polysaccharide-induced repair of intestinal mucosal injury may be mediated by increased cell migration via polyamine-based regulatory mechanisms. In vitro and in vivo experiments suggest that Renshen (Radix Ginseng) polysaccharide-induced post-transcriptional regulation of STIM1 and Cdc42 may be related to differences in the regulation of different target genes by HuR. Taken together, these data provide a reference for further exploration of the protective effect of Renshen (Radix Ginseng) on the intestinal mucosa.

Exploration of the feasibility of the tunneling technique for colonic lesions originating from the muscularis propria.

Exploration of the feasibility of the tunneling technique for colonic lesions originating from the muscularis propria.

Post-polypectomy colorectal bleeding: current strategies and the way forward.

Post-endoscopic mucosal resection (EMR) bleeding, or clinically significant post-EMR bleeding, is influenced by factors such as polyp size, right-sided colonic lesions, laterally spreading tumors, anticoagulant use, and comorbidities like cardiovascular or chronic renal disease. The optimal prophylactic therapy for post-EMR bleeding remains unknown, with no consensus on specific criteria for its application. Moreover, prophylactic measures, including clipping, suturing, and coagulation, have produced mixed results. Selective clipping in high-risk patients is cost-effective, whereas universal clipping is not. Studies and meta-analyses indicate that routine prophylactic clipping does not generally reduce post-polypectomy bleeding but may be beneficial in cases of large proximal lesions. Some studies have revealed that the post-polypectomy bleeding risk after EMR of transverse colonic lesions is lower than that of the ascending colon and caecum, suggesting limited efficacy of clipping in the transverse colon. Cost-effectiveness studies support selective clipping in high-risk groups, and newer static agents such as PuraStat are alternatives; however, their cost-effectiveness is undetermined. Further research is required to establish clear guidelines and refine prophylactic strategies to prevent post-EMR bleeding.