Diagnosis Of Polyps Research Articles

Development and experiments of a continuum robotic system for transoral laryngeal surgery.

Currently, self-retaining laryngoscopic surgery is not suitable for some patients, and there are dead zones relating to surgical field exposure and operation. The quality of the surgery can also be affected by the long periods of time required to complete it. Teleoperated continuum robots with flexible joints are expected to solve these issues. However, at the current stage of developing transoral robotic surgery systems, their large size affects the precision of surgical operative actions and there are high development and treatment costs. We fabricated a flexible joint based on selective laser melting technology and designed a shallow neural network-based kinematic modeling approach for a continuum surgical robot. Then, human model and animal experiments were completed by master-slave teleoperation to verify the force capability and dexterity of the robot, respectively. As verified by human model and animal experiments, the designed continuum robot was demonstrated to achieve transoral laryngeal surgical field exposure without laryngoscope assistance, with sufficient load capability to finish the biopsy of vocal fold tissue in living animals. The designed continuum robotic system allows the biopsy of vocal fold tissue without laryngoscope assistance. Its stiffness and dexterity indicate the system's potential for applications in the diagnosis and treatment of vocal fold nodules and polyps. The limitations of this robotic system as shown in the experiments were also analyzed.

Colonic Chicken Skin Mucosa Surrounding Colon Polyps Is an Endoscopic Predictive Marker for Colonic Neoplastic Polyps.

Background/AimsNarrow band imaging provides an accurate diagnosis of colonic polyps. However, these diagnostic modalities are not used as standard endoscopic tools in most institutions. This study aims to investigate whether the chicken skin mucosa (CSM) surrounding the colon polyp yields additional information about colorectal polyps, including histological differentiation of neoplastic and non-neoplastic polyps, under conventional white light colonoscopy.MethodsThis study prospectively observed 173 patients who underwent endoscopic polypectomy and reviewed the clinical data and pathologic reports of 313 polyps from a university hospital. Two endoscopists each performed colonoscopy and polypectomy and assessed the CSM. The association between CSM surrounding colorectal polyps and histology was analyzed.ResultsThe majority (91.3%) of CSM-positive polyps were neoplastic (sensitivity, 37.90%; specificity, 86.15%; p<0.001). In logistic regression, the neoplastic polyps were associated with positive CSM (adjusted odds ratio [OR], 3.51; 95% confidence interval [CI], 1.45 to 9.25; p=0.007), protruded polyps (adjusted OR, 4.85; 95% CI, 1.65 to 17.23; p=0.008), and neoplastic histology–associated pit pattern (pit III, IV, and V) (adjusted OR, 10.14; 95% CI, 4.85 to 22.12; p=0.000). Furthermore, advanced adenomas were associated with positive CSM (adjusted OR, 5.64; 95% CI, 1.77 to 20.28; p=0.005), protruded polyps (adjusted OR, 3.30; 95% CI, 1.15 to 9.74; p= 0.026), and ≥10 cm polyp size (adjusted OR, 18.56; 95% CI, 3.89 to 147.01; p=0.001).ConclusionsNeoplastic and advanced polyps were associated with CSM-positive polyps. These findings suggest that CSM is a useful marker in differentiating neoplastic polyps and advanced polyps under conventional white colonoscopy.

Advanced Endoscopic Technologies to Improve the Diagnosis of Colorectal Polyps

AbstractColonoscopy is the gold standard for colorectal cancer (CRC) prevention. The main quality indicator of colonoscopy is the adenoma detection rate, which is inversely associated with the risk of interval CRC and the risk of death from this neoplasia. In the setting of CRC prevention, diagnostic colonoscopy has undergone a remarkable evolution in the past 20 years. Hand in hand with the implementation of CRC prevention programs and technological advances, we are now able to identify tiny and subtle neoplastic lesions and predict their histology with great efficiency. In this article, we briefly review the endoscopy technologies that can be used to improve the detection and characterization of colorectal polyps.

Diagnostic Value of Ultrasonography Combined with Hysteroscopy in Intrauterine Space-Occupying Abnormalities.

The aim of this study was to analyze the diagnostic significance of ultrasonography combined with hysteroscopy for intrauterine space-occupying abnormalities. A total of 99 patients with uterine space-occupying abnormalities treated in hospitals were enrolled. The patients were divided into three groups according to different disease types: the submucosal myoma group, endometrial polyp group, and placenta residue group, with 33 patients in each group. The differences and diagnostic effects in intrauterine ultrasound, hysteroscopic findings, and surgical histopathology were observed in each group. Outcome measures: it was to compare the sensitivity, specificity, and accuracy of intrauterine ultrasound and angiography for intrauterine space-occupying lesions using surgical and pathological examination methods as the gold standard; the relationship between the location, number, size, appearance, and serosal layer of intrauterine lesions was clearly shown; the location, number, appearance, and echogenicity of space-occupying abnormalities under hysteroscopy were observed. The results showed that the diagnostic rates of endometrial polyps, submucous myoma, and residual placenta were 90.9%, 80.8%, and 72.7%, respectively. However, the sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of endometrial polyps were 90.0%, 66.7%, and 87.9%, respectively; those of hysteroscopy in the diagnosis of endometrial polyps were 96.7%, 66.7%, and 93.9%, respectively; and combined diagnosis was 96.7%, 100.0%, 97.0%, 100.0%, and 75.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of submucous myoma of the uterus were 88.9%, 50.0%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of submucous myoma of the uterus were 96.3%, 83.3%, and 93.9%, respectively; and combined diagnosis was 100.0%, 83.3%, 97.0%, 96.4%, and 100.0%. The sensitivity, specificity, and accuracy of ultrasonography in the diagnosis of uteroplacental remnants were 87.5%, 66.7%, and 81.8%, respectively; those of hysteroscopy in the diagnosis of uteroplacental remnants were 91.7%, 77.8%, and 87.9%, respectively; and combined diagnosis was 95.8%, 88.9%, 93.9%, 95.8%, and 88.9%. In summary, ultrasonography combined with hysteroscopy can improve the diagnostic sensitivity and accuracy for intrauterine space-occupying abnormalities.

Juvenile Polyps in Bangladeshi Children and Their Association with Fecal Calprotectin as a Biomarker.

PurposeColonoscopy is considered the most reliable method for the diagnosis of juvenile polyps. However, colonoscopic screening is an invasive and expensive procedure. Fecal calprotectin (FCP), a marker of intestinal inflammation, has been shown to be elevated in patients with polyps. Therefore, this study aimed to evaluate FCP as a screening biomarker for the diagnosis of juvenile polyps.MethodsThis cross-sectional, observational study was conducted at the Pediatric Gastroenterology and Nutrition Department, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. For children with polyps, colonoscopic polypectomy and histopathology were performed. FCP levels were analyzed before and 4 weeks after polypectomy in all patients. Information was recorded in a datasheet and analyzed using the computer-based program SPSS.ResultsThe age of the children was between 2.5 and 12 years. Approximately 93% of the polyps were found in the rectosigmoid region. Children with juvenile polyps had elevated levels of FCP before polypectomy that subsequently normalized after polypectomy. The mean FCP levels before and after polypectomy were 277±247 µg/g (range, 80–1,000 µg/g) and 48.57±38.23 µg/g (range, 29–140 µg/g) (p<0.001), respectively. The FCP levels were significantly higher in patients with multiple polyps than in those with single polyps. Moreover, mean FCP levels in patients with single and multiple polyps were 207.6±172.4 µg/ g and 515.4±320.5 µg/g (p<0.001), respectively.ConclusionColonic juvenile polyps were found to be associated with elevated levels of FCP that normalized after polypectomy. Therefore, FCP may be recommended as a noninvasive screening biomarker for diagnosis of colonic juvenile polyps.

Characteristics of patients aged 50&#x2013;74 years with a request for an immunochemical faecal occult blood test in the Australian general practice setting.

Objective To support improving participation in the National Bowel Cancer Screening Program (NBCSP), we aimed to identify Medicare-subsidised test requests for immunochemical faecal occult blood tests (FOBT) in Australian general practice for patients aged 50-74 years, eligible for the NBCSP, and describe sociodemographics, risk factors, indications and outcomes. Methods A cross-sectional study was conducted using de-identified data from 441 Australian general practice sites in the MedicineInsight database, recorded from 1 January 2018 to 31 December 2019. Results Of the 683 625 eligible patients, 45 771 (6.7%) had a record of a general practitioner (GP)-requested FOBT, either to aid diagnosis in symptomatic patients, or for screening; 144 986 (21.2%) patients had only an NBCSP FOBT. A diagnosis of polyps, gastrointestinal inflammatory condition or haemorrhoids, or a referral to a gastroenterologist or general surgeon, was more commonly recorded in the 6 months after a GP-requested FOBT than after an NBCSP FOBT. Uptake of NBCSP FOBTs was lower among those with obesity, high alcohol consumption and current smokers, who are at higher risk of bowel cancer. Conclusions This study describes the patient characteristics, reasons and outcomes associated with GP-requested FOBTs, identifies under-screened population sub-groups, and suggests involvement of GPs to improve participation in the NBCSP.

Atypical uterine polyps show morphologic and molecular overlap with mullerian adenosarcoma but follow a benign clinical course

A subset of clinically benign uterine polyps shows atypical morphologic features worrisome for, but not diagnostic of, Mullerian adenosarcoma. We report clinicopathologic data for 63 polyps from 58 women with atypical morphologic features including abnormal architecture, abnormal periglandular stroma, stromal atypia, and mitoses >2 per 10 hpf. Four (11%) of 36 women with follow-up tissue sampling had residual/recurrent atypical polyp. Twelve (27%) of 44 women underwent hysterectomy subsequent to a diagnosis of atypical polyp. No patient developed adenosarcoma over median follow-up of 150 months. Twenty-one primary atypical polyps underwent molecular profiling. Five (24%) harbored chr 12q13-15 gain or amplification, 9/20 (45%) harbored chr 6q25.1 gain, and 7/21 (33%) had no significant copy number alterations. Gains of chr 1q, chr 8p12, and chr 10q11.21-23, amplifications of chr 12q24.12-13, chr 15p24.1-26.1, and chr 18q21.33, and loss of chr 7 and chr 11q21 were each seen in a single polyp. Mean tumor mutational burden was 3.1 (range, 0.76–8.365) mutations/Mb. Pathogenic point mutations were identified in 12/20 (60%) primary atypical polyps. We propose the term “atypical uterine polyps” for these lesions, which show biologic overlap with early Mullerian adenosarcoma but lack molecular alterations characteristic of clinically aggressive adenosarcoma and appear to follow a benign clinical course. Conservative management with close clinical follow-up and repeat sampling can be considered for these lesions, when clinically appropriate.

THE UTILITY OF NASAL SECRETION CYTOLOGY IN DIAGNOSIS OF ALLERGIC FUNGAL SINUSITIS- A CASE REPORT

INTRODUCTION-Allergic fungal sinusitis (AFS) is a condition commonly occurring in immunocompromised individual. It is commonly characterized by increase eosinophils and increased IgE. CASE DETAILS- A 48-year-old female presented with foul smelling discharge from right nostril and right nasal blockage for one year. A clinical diagnosis of right maxillary sinus polyp was given. CT scan revealed mucosal thickening in right maxillary wall with central area of hyper density and calcification. Nasal swabs were taken and subsequently stained with Pap and MGG stain. Smears revealed fungal hyphae and a provisional diagnosis of allergic fungal sinusitis was given. The patient was operated and the diagnosis was confirmed on histology. DISCUSSION- AFS is a relatively incompletely understood entity with characteristic clinical, radiological and histopathological finding. Fungal elements can be detected from nasal discharge by means of cytology. CONCLUSION- Nasal secretion cytology can be used as a preoperative as well as an intraoperative tool for or early rapid diagnosis of AFS.

Instrumental diagnosis of cholesterol polyps of the gallbladder

Gallbladder polyposis is a common pathology, the detection of which has increased significantly in recent years. The dominant form of this disease is cholesterol pseudopolyps, mainly found inwomen. Clinical manifestations of gallbladder cholesterol polyps are nonspecific,which presents certain difficulties in diagnosis.Ultrasonography is one of themost informative and accessible instrumental diagnostic methods.

Relationship of demographic and dietary hygiene factors with the pathology found in outpatient colonoscopies performed in a Castilla y León Health Service center

colorectal cancer (CRC) is one of the most frequent tumors in terms of incidence and mortality. Several elements, both inherited and environmental, have been related with its pathogenesis. to analyze the influence of age, gender and nutritional factors on the diagnosis of colonic polyps and CRC. a prospective, descriptive study over outpatients from the Health Area of León who took a colonoscopy between 09/09/2012 and 06/30/2013. Patients were asked to fill a semiquantitative food frecuency questionnaire with data such a sociodemographic, toxic and dietetic facts. Differences in diagnosis according to sociodemographic and hygiene-dietetic data were analyzed with a multivariate analysis by forward stepwise logistic regression. data were collected from 1390 patients. Mean age was 57.88 (15.17) years and 47.8 % were male. CRC was diagnosed in 5 % of colonoscopies, and polyps in 20.4 %, with 9.4 % of them being HRA. Risk of polyps and HRA was higher in males (26.9 % vs 14.5 %) and (12.6 % vs 6.3 %), respectively (p < 0.001). Mean age was significantly higher in patients who presented polyps (56.51 (15.45) vs 63.22 (12.69) years; p < 0.001). Among the group who reported intake of smoked and salted food, the risk of polyps doubled (2.9 % vs 6.7 %, p = 0.002). In relation to alcohol intake we found that subjects with daily alcohol consumption showed a higher incidence of polyps whe compared to occasional drinkers and teetotallers (32 % vs 20 % vs 18.6 %, p = 0.002) Conclusions: age correlated with higher risk of polyps, HRA and CRC. Moreover, male gender also was associated with a high risk of polyps and HRA. Alcohol and red and processed meat intake increased polyp risk.

Early diagnosis of colon polyps during medical examination of patients with risk factors

Early diagnosis of colon polyps during medical examination of patients with risk factors

Gallbladder polyps: Is a cancer phobia justified

Background: With better imaging technologies, the frequency of detecting GB polyps has increased, however, their effective management remains a clinical dilemma. Aims: This study was aimed to assess the true outcome of lesions suspected or diagnosed as gallbladder (GB) 'polyp' on ultrasound. Patients and Methods: Computerised hospital-based medical records between June 2008 and June 2014 at a medical sciences institute in Kerala were accessed to identify and review the follow-up of all cases identified as GB polyp on ultrasound. Results: Ultrasound examination was performed in 108 cases. Of these 46% had symptoms suggestive of gall bladder disease, 20% had nonspecific abdominal symptoms and for the remaining 34% it was part of routine health check-up. The mean polyp size was 4.7 mm. During follow-up, 20 (18.5%) patients underwent cholecystectomy and none of them came as true polyps on histopathology, 25 (23%) patients were lost to follow-up after primary ultrasonography and 10 (9.25%) patients died due to reasons unrelated to GB disease. Conclusion: Radiologists tend to over diagnose GB polyps due to the risk of malignant transformation of GB polyps and increased usage of imaging modalities. It is observed in this study that higher imaging modalities do not add significant specificity in the diagnosis of the true polyp. However, there is a need for a large cohort study to confirm the outcome.

Surgical Outcome of Brunner's Gland Hamartoma: A Single-Centre Experience.

Introduction Brunner's gland hamartomas (BGH) are rare benign lesions with an incidence of <0.01%, accounting for 5 to 10% of all benign tumors of the duodenum. It requires expeditious management by a multidisciplinary team. The aim of the study is to report our experience with surgery for BGH. Methodology Data of all patients who underwent surgical intervention for duodenal polypoidal mass between August 2007 and March 2020 were retrieved from our prospectively maintained gastrointestinal (GI) surgery database. All patients whose histopathology report of the resected specimen confirmed BGH ( n = 9) were included in the present study. Other pathological diagnosis like duodenal lipoma ( n = 2), ganglioneuroma ( n = 1), adenoma ( n = 10), and adenocarcinoma ( n = 4) were excluded. Results Nine patients had confirmatory histopathological diagnosis of BGH and met our inclusion criteria. Three (33.3%) of them were men with a median age of 45 (range: 24–61) years. The median interval between onset of symptoms and diagnosis of duodenal polyp was 14 (range: 4–180) days. Five patients (55.5%) presented with upper GI hemorrhage. Three (33.3%) patients presented with abdominal pain, and one (11.1%) patient presented with episodes of bilious vomiting. Diagnostic endoscopy could detect the lesion in all (100%) patients. Contrast-enhanced computed tomography detected duodenal polypoidal lesion in five (55.5%) patients. The mean size of tumor was 4.78 ± 1.36 cm. These lesions were symptomatic in all the patients and warranted intervention. In view of failed endoscopic intervention ( n = 7, 77.7%), or extramural extension of the tumor ( n = 2, 22.2%), surgical intervention was considered. Most commonly performed operation was duodenal polypectomy ( n = 6, 66.6%). Three postoperative complications developed in two (22.2%) patients. There was no surgery-related mortality. After a median follow-up of 60 (12 -78) months, no patient developed GI bleed or intestinal obstruction. Conclusion In this study, the clinical profile of BGH was explored from the surgeon's point of view. Although endoscopic management is the first-line treatment, surgery plays an important role, particularly, if this fails or is not feasible. In experienced hand, surgery can be performed with acceptable perioperative morbidity and mortality and long-term satisfactory outcomes.

An Overview on Nasal Polyps’ Diagnosis and Management Approach

The current management is still controversial and depends upon understanding the complex pathophysiological and etiological factors. There have been several theories that proposed the initial process regarding polyps&rsquo; formation. Confirming the diagnosis of nasal polyps requires endoscopic investigations or complex radiological investigations. However, currently available medications are mostly based upon clinical experience that describes these pathophysiological and etiological hypotheses

Inflammatory fibroid polyp causing ileo-ileal intussusception.

Inflammatory fibroid polyp (IFP) or Vanek´s tumor is a rare and idiopathic pseudotumor arising from the submucosa of the gastrointestinal tract. The underlying cause of IFP remains unclear. Many factors have been incriminated such as intestinal trauma or eosinophilic gastroenteritis. Small bowel involvement is the second most common location of IFP after the stomach. Intestinal IFP is most often revealed by intussusception or obstruction. The mainstay treatment is surgical, which consisted of a segmental intestinal resection. The histological appearance may be a differential diagnosis with other spindle cell lesions, especially with stromal tumors. The definitive diagnosis is confirmed by immunochemistry examination. Herein, we report the clinical case of a 62-year-old female, with no notable medical history, who presented with nausea and vomiting associated with abdominal acute pain and distension evolving for about seven days. The physical examination showed a heart rate of 90 beats per minute, blood pressure of 120/70 mmHg, and body temperature of 37.5°C. The abdominal examination revealed a slightly tympanic abdomen with diffuse tenderness. Computed tomography (CT) scan of the abdomen revealed dilated small bowel loops proximally of an ileo-ileal intussusception. The wall of the invaginated loop shows an irregular, symmetrical, and short parietal thickening, enhanced after contrast and measuring 36 x 24 mm. The patient underwent an urgent midline laparotomy. Surgical exploration revealed an ileo-ileal intussusception, localized at 70 cm proximal to the ileocecal valve and causing dilatation in the intestine proximal to the intussusception. Manual disinvagination revealed intraluminal polypoid mass (star) obstructing the lumen with parietal umbilication. Segmental resection of the intussuscepted ileum and side-to-side stapler ileal anastomosis were performed. The patient had an uneventful recovery. Histological findings showed bland spindled cells, small vessels, and eosinophil-rich mixed inflammatory infiltrates. Immunohistochemical staining was positive for CD34 and negative for CD 117, DOG1 and S-100 protein. Therefore, a final diagnosis of an inflammatory fibroid polyp was made.

Automated colorectal polyp detection based on image enhancement and dual-path CNN architecture

Colorectal Cancer (CRC) has the highest mortality rate of all cancers and is currently the third leading cause of cancer-related death worldwide. The early detection and diagnosis of colorectal polyps are necessary for early interventional therapies. The use of AI and ML techniques to analyse colonoscopy images has been gaining traction in recent years for early and accurate detection of polyps and other colorectal abnormalities. Existing deep learning classification and detection methods of polyps are computationally intensive, restrict memory potency, require extensive training, and affect the optimization of hyperparameters. This makes them unsuitable for real-time applications and applications with limited computing resources. This paper proposes a Dual-Path Convolutional Neural Network (DP-CNN) to classify polyp and non-polyp patches from the colonoscopy images. The proposed approach comprises image enhancement followed by the use of DP-CNN architecture and a sigmoid classifier for efficient detection of polyps. The publicly available database CVC ClinicDB is used to train the proposed network, and it is tested on ETIS-Larib and CVC ColonDB databases. The testing accuracy of the network on CVC ColonDB and ETIS-Larib are 99.60%, 90.81%, respectively. The performance measures are as follows: precision (100%), recall (99.20%), F1 score (99.60%) and F2 score (99.83%) on CVC ColonDB database and precision (89.81%), recall (92.85%), F1 score (91.00%) and F2 score (89.91%) on ETIS-Larib database. Compared with other existing methods, the proposed approach outperforms in precision, recall, F1-score, and F2-score in both databases. The number of learnable parameters of the proposed method is 8737. The proposed approach is promising as an accurate polyp detection technique. It is applicable for real-time applications due to lower complexity and fewer learnable parameters than required by other existing methods.

P-BN38 Patient Outcomes Following Laparoscopic Cholecystectomy after a Diagnosis of Gall Bladder (GB) Polyp over 10 Years

Abstract Background Gall Bladder (GB) polyps are elevations of the GB wall that project into the lumen. They are a rare incidental radiological finding with prevalence of 0.3% to 9.5%. Although the majority of these may be pseudopolyps correct follow up and management is essential as to ensure that true polyps, which may be malignant or have malignant potential, are not missed. We conducted a retrospective study assessing patient factors that may predispose to the finding of true polyps. Patient outcomes including histological findings as well as ongoing symptoms and further investigations or emergency attendances were also assessed. Methods Patients were identified for this retrospective ten year cohort study using International Statistical Classification of Diseases and Related Health Problems (ICD 10) code K 82.8, other specified diseases of gall bladder. Patients with other diagnoses such as gall bladder dysfunction were excluded after review of electronic patient record (EPR) (Sunrise, Allscripts). EPR allowed for review of emergency attendances, clinic letters, investigations and histological results for those diagnosed with a gall bladder polyp. Analysis was performed with Microsoft Excel. Results 35% patients had a laparoscopic cholecystectomy and the average wait time for surgery was 19 months but only 11% of patients were found to have true GB polyps on histology. Other histological findings included chronic cholecystitis (96%), cholesterolsis (33%) and stones 35%. Only 12% of those booked straight to laparoscopic cholecystectomy re-presented post operatively compared to 37% of those operated on after a period of surveillance. Patients booked straight for laparoscopic cholecystectomy, or diagnosed with polyps &amp;gt;10mm in size, were statistically more likely to have a true GB polyp (P &amp;lt; 0.05), however, gender, ethnicity, and whether an isolated polyp or multiple were diagnosed made no statistical difference to detection of a true polyp (P &amp;gt; 0.05). Conclusions From this series of patients true polyps are most likely to be identified if it is larger than 10mm at diagnosis and operated on straight away. 96% of all patients, however, displayed histological features of chronic cholecystitis. This suggests that proceeding to laparoscopic cholecystectomy straight from diagnosis of a GB polyp can be justified. Only 1patient in our cohort returned normal GB histology.. Following diagnosis of a GB polyp, the option of operation versus surveillance should be discussed wirth individual patients and decisions based on assessment of risks and benefits should be made. Further research will help identify those with a predisposition to high-risk true polyps.

P-BN31 Surveillance for Gallbladder polyps at a NHS District General Hospital – a retrospective analysis

Abstract Background Gallbladder polyps are encountered in 5% of ultrasound scans and continue to remain a dilemma in terms of management. Very few polyps progress to cancer. However, most cancerous polyps are usually found at an advanced stage. It is therefore important to identify the premalignant polyps. There is a lack of national consensus in UK for surveillance of gallbladder polyps. Many trusts in the UK either adopt the European guidelines or formulate local protocols. We aim to present our findings based on our local surveillance policy existent during the study period with a view to recommending new local guidelines. Methods A search from our radiology database being coded to gallbladder polyp identified patients. We identified 431 patients from 2017 – 2019 who had a total of 1014 scans. The data was collected from local hospital IT databases in terms of variables such as number of scans, polyp size, number of polyps, progression to surgery or discharge from surveillance and histology. The data was analysed on excel platform. Results Patient demographics revealed an incidence of 54% in females (males 46%) with an average age of 59.7 years. Pain was the dominant symptom prompting the first scan (48%). An average of 2.3 scans were performed per patient. 45% of the polyps were less than 5mm. Overall, 22% polyps demonstrated interval growth. Only 15% of polyps less than 5mm demonstrated interval growth and none required cholecystectomy. 6% patients proceeded to surgery mainly for symptoms (46%) compared to polyp progression (1.5%). No malignancy was identified in this study. 43% of patients with polyp diagnosis in primary care had no identified surveillance plan. Conclusions Our study demonstrates a low incidence of polyp progression. We would recommend stopping annual surveillance after 2 years from the index scan for multiple small (&amp;lt;5mm) polyps with little or no progression but continue with annual surveillance for polyps greater than 5mm. We would recommend reserving cholecystectomy for symptomatic polyps and polyps greater than 10mm. There is wide variation in surveillance practice particularly in primary care. We would recommend sharing the guideline widely with primary care for optimal surveillance.

Value of Conventional Ultrasound-based Scoring System in Distinguishing Adenomatous Polyps From Cholesterol Polyps.

Ultrasound has increased the detection of gallbladder polyps, but it has limitations in evaluating the nature of gallbladder polyps, especially the maximum size of 1.0 to 1.5 cm. We assessed the value of ultrasound scoring system based on independent predictive parameters in distinguishing adenomatous polyps from cholesterol polyps with the maximum size of 1.0 to 1.5 cm. We enrolled 163 patients with gallbladder polyps (1.0 to 1.5 cm) who underwent ultrasonography and cholecystectomy. Ultrasound image characteristics were compared between cholesterol polyps and adenomatous polyps in the training cohort from April 2018 to January 2020. An ultrasound scoring system was constructed in the training cohort, and its diagnostic performance was evaluated in the validation cohort from February 2020 to February 2021. Maximum size, height/width ratio, stone or sludge, vascularity, and hyperechoic spot were significantly different between cholesterol polyps and adenomatous polyps in the training cohort ( P <0.05). The independent predictive parameters for adenomatous polyps were lower height/width ratio, presence of vascularity and absence of hyperechoic spot. The total score was as follows: (height/width ratio, <0.9=4, ≥0.9=0) + (vascularity, present=3, absent=0) + (hyperechoic spot, absent=2, present=0). The sensitivity, specificity and accuracy of ultrasound scoring system ≥5 for diagnosis of adenomatous polyps in the validation cohort were 73.33%, 80.49%, and 78.57%, respectively. The ultrasound scoring system aids in distinguishing adenomatous polyps from cholesterol polyps, and effectively decreasing unnecessary cholecystectomy.

Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

BACKGROUND : The European Society of Gastrointestinal Endoscopy (ESGE) has developed a core curriculum for high quality optical diagnosis training for practice across Europe. The development of easy-to-measure competence standards for optical diagnosis can optimize clinical decision-making in endoscopy. This manuscript represents an official Position Statement of the ESGE aiming to define simple, safe, and easy-to-measure competence standards for endoscopists and artificial intelligence systems performing optical diagnosis of diminutive colorectal polyps (1 - 5 mm). METHODS : A panel of European experts in optical diagnosis participated in a modified Delphi process to reach consensus on Simple Optical Diagnosis Accuracy (SODA) competence standards for implementation of the optical diagnosis strategy for diminutive colorectal polyps. In order to assess the clinical benefits and harms of implementing optical diagnosis with different competence standards, a systematic literature search was performed. This was complemented with the results from a recently performed simulation study that provides guidance for setting alternative competence standards for optical diagnosis. Proposed competence standards were based on literature search and simulation study results. Competence standards were accepted if at least 80 % agreement was reached after a maximum of three voting rounds. RECOMMENDATION 1: In order to implement the leave-in-situ strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 90 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm in the rectosigmoid. Histopathology is used as the gold standard.Level of agreement 95 %. RECOMMENDATION 2: In order to implement the resect-and-discard strategy for diminutive colorectal lesions (1-5 mm), it is clinically acceptable if, during real-time colonoscopy, at least 80 % sensitivity and 80 % specificity is achieved for high confidence endoscopic characterization of colorectal neoplasia of 1-5 mm. Histopathology is used as the gold standard.Level of agreement 100 %. CONCLUSION : The developed SODA competence standards define diagnostic performance thresholds in relation to clinical consequences, for training and for use when auditing the optical diagnosis of diminutive colorectal polyps.