Features Of Polyps Research Articles

Prevalence and characteristics of incidental colorectal polyps in patients undergoing colonoscopy at a South African tertiary institution.

There is a lack of data on the frequency and pattern of colorectal adenomas in sub-Saharan Africa to guide diagnostic and preventive strategies for colorectal cancer (CRC) in the region. To describe polyp characteristics and adenoma frequency in patients at average risk of CRC, who are undergoing colonoscopy for bowel symptoms at a tertiary hospital in South Africa (SA). Colonoscopy records from the prospective endoscopy database at Groote Schuur Hospital, Cape Town, SA, from August 2014 to February 2017, were retrieved. The presence of polyps, and their morphology, size, site and number in relation to ethnicity, symptoms and colonoscopy quality indicators were analysed. The histological type and grade were obtained from laboratory records and analysed. The primary endpoint was the adenoma detection rate (ADR). Age, gender, ethnicity, symptoms, bowel preparation and caecal intubation rates were also compared between patients with adenomas and those without. Of 1 334 colonoscopies, 342 were performed in patients at increased risk of premalignant lesions; these were excluded from the analysis. Polyps were identified in 172 of the remaining 992 patients (17.3%), whose self-declared ethnicity was mixed race (76%), white (12%), black African (11%) or Asian (1%). The quality of bowel preparation and caecal intubation rate were similar between patients with polyps and those without. Patients with polyps were older than those without polyps (mean age 61.5 (standard deviation 12.9) v. 56.3 (17.4) years; p<0.002). On histological examination of these polyps, 119 were adenomas, 26 were hyperplastic and 27 were normal. The majority of the adenomas were tubular (80%), and there were only 6% with high-grade dysplasia. Half (51%) of the adenomas were in the proximal colon, and the overall ADR was 12%. The ADR (prevalence) was highest in white and Asian South Africans (18% each), followed by that in persons of mixed race (13%), but much lower in black Africans (5%). This study provides a benchmark ADR for our catchment population and potentially across Africa. There is evidence of a continuing differential colorectal neoplasia risk according to ethnicity, with fewer adenomas being detected in black South Africans.

Evaluation of a progressive algorithmic approach for the treatment of unresectable colon polyps using colon conservation techniques.

The majority of endoscopically unresectable colon polyps (EUCP) are treated by segmental colectomy. However, up to 90% of EUCP do not harbor malignancy, making colectomy an unnecessary procedure. To minimize unnecessary segmental colectomy, we established a progressive treatment algorithm utilizing colon conservation techniques (CCT). In our progressive CCT algorithm, patients with EUCP first underwent endoscopic submucosal dissection (ESD). If unsuccessful, they progressed to combined endo-laparoscopic surgery (CELS) and ultimately to segmental colectomy, if necessary. We performed a retrospective analysis of all patients treated by our progressive CCT algorithm from August 2015 to April 2019. Demographic information, polyp characteristics, and clinical outcomes were analyzed. We also compared the outcomes of our CCT algorithm group to 156 patients undergoing segmental colectomy for EUCP at related institutions from August 2015 to August 2018. A total of 102 EUCP in 97 patients were treated with our progressive CCT algorithm. Of these, 76 of 102 (75.5%) EUCP were removed without requiring segmental colectomy, with 42 EUCP removed via ESD and 34 via CELS. Interval surveillance colonoscopy confirmed that 72 of 97 (74.2%) patients with EUCP treated by CCT completely avoided segmental colectomy. Polyps > 5cm in size was a significant predictor of CCT failure (OR 3.83, P = 0.03). When compared to an external cohort of patients undergoing segmental colectomy for EUCP, the CCT algorithm was associated with longer operative time, but shorter length of stay, with no difference in postoperative complications. The estimated total healthcare cost of the CCT algorithm was lower than segmental colectomy ($10,956.77 versus $16,692.94), with more dramatic cost savings seen in ESD ($4,492.70) and CELS ($8,507.06). An established progressive CCT algorithm can result in high colon conservation rate and decrease associated health care costs compared to segmental colectomy. It is a reasonable treatment strategy for patients with EUCP.

Clinical characteristics of non-ampullary duodenal polyps in the elderly and the outcomes of endoscopic mucosal resection.

At present, there are no reports on non-ampullary polyps of the duodenum (NAPDs) in the elderly. The aim of this study was to analyze the clinicopathological features of NAPDs in elderly and non-elderly patients to explore the efficacy and safety of endoscopic mucosal resection (EMR) of NAPDs in the elderly.A total of 110 patients underwent EMR of NAPDs between April 2016 and December 2019. The shape, location, size, postoperative complications, and histopathological types of NAPDs were compared between the elderly group (n = 44) and the non-elderly group (n = 66).Sessile type was the most common form of NAPD in both groups. In the elderly group, the average size of NAPDs was 12.6 ± 3.9 mm. In the non-elderly group, NAPDs had an average size of 10.1 ± 5.8 mm. Complete EMR was performed in both groups. The postoperative complications of EMR did not significantly differ between the 2 groups. Postoperative pathological examination showed that tubular villous adenomas were more common in the elderly group than in the non-elderly group (P = .005), while tubular adenomas were more common in the non-elderly group than in the elderly group (P = .007). Of the 110 patients, 99 completed postoperative follow-up (median follow-up duration, 20.93 months). There were no residual or recurrent lesions.EMR is safe and effective for the treatment of NAPDs in elderly patients.

Characteristics of benign and malignant lesions of ampullary polyps and the accuracy of forceps biopsy

OBJECTIVE To distinguish the endoscopic and clinical features of ampullary polyps, to investigate the endoscopic cancer risk factors of ampullary polyps based on the compared differences of benign lesions and adenocarcinoma, and to assess the accuracy of forceps biopsy. METHODS Authors retrospectively analyzed the data extracted from patients treated with endoscopic papillectomy (EP) from January 2009 to May 2019 in the Department of Gastroenterology, Peking University Third Hospital. Endoscopic pictures and pathology reports were reevaluated and analyzed. Differences between benign and cancer groups were conducted. RESULTS In the study, 42 cases were involved, 35 to 83 years old, containing 83.3% older than 50 years old patients. The histological types were as follows, 2 for inflammatory polyps (4.8%), 1 for neuroendocrine tumor (2.4%), 1 for hyperplastic polyp (2.4%), 5 for grade Ⅰ adenoma (11.9%), 10 for grade Ⅱ adenoma (23.8%), 4 for grade Ⅲ adenoma (9.5%) and 19 for adenocarcinoma (45.2%), and 90.5% were adenoma or adenocarcinoma. The average age of benign group (inflammatory polyps and adenomas) was (56.7±9.2), which was significantly younger than that of adenocarcinoma group [(66.0±9.8), P=0.004]. Tumor diameter in adenocarcinoma group[(2.3±0.8) cm] was significantly larger than that in benign group[(1.6±0.6) cm, P=0.002]. Benign lesions only showed Yamada type Ⅰ(57.1%)and type Ⅱ(42.9%). The percentage of Yamada type Ⅰ (36.8%)and type Ⅱ(31.6%) in adenocarcinoma group was lower than that in benign group. Moreover, Yamada type Ⅲ (31.5%) was only found in the adenocarcinoma group. Significant differences were observed between the two groups in Yamada types (P=0.046). Most of the benign lesions had clear boundary(18/21, 85.7%). The percentage of clear boundary in adenocarcinoma group (2/19, 10.5%) was significantly lower than that in the benign group (P < 0.001). No significant differences were investigated in color (P=0.353) and surface (P=0.324) between benign and adenocarcinoma lesions. Pooling age, lesion diameter, Yamada type and clear boundary into Logistic regression analysis, only age (OR=1.186, 95%CI 1.025-1.373, P=0.022) and clear boundary (OR=66.218, 95%CI 3.421-1 281.840, P=0.006) were the independent cancer risk factors. Only 2 (10.5%) in the 19 cancer patients had positive biopsy results before EP. As compared with post-EP, 55.3% (21/38) biopsies were under-estimated, including 17 (17/19, 89.5%) adenocarcinomas and 4 (4/10, 40%) grade Ⅱ adenomas. CONCLUSION adenoma and adenocarcinoma were the major histological type of ampullary po-lyps. Age and unclear boundary were the independent risk factors of ampullary adenocarcinoma. Forceps biopsy was not enough for ampullary polyp differentiation.

Recurrence After Endoscopic Mucosal Resection: Early and Late Incidence, Treatment Outcomes, and Outcomes in Non-Overt (Histologic-Only) Recurrence

Recurrence After Endoscopic Mucosal Resection: Early and Late Incidence, Treatment Outcomes, and Outcomes in Non-Overt (Histologic-Only) Recurrence

Clinical features of fundic gland polyps and their correlation with colorectal tumors

Clinical features of fundic gland polyps and their correlation with colorectal tumors

Colonoscopist Performance and Colorectal Cancer Risk After Adenoma Removal to Stratify Surveillance: Two Nationwide Observational Studies

Colonoscopy surveillance after adenoma removal is an increasing burden in many countries. Surveillance recommendations consider characteristics of removed adenomas, but not colonoscopist performance. We investigated the impact of colonoscopist performance on colorectal cancer risk after adenoma removal. We compared colorectal cancer risk after removal of high-risk adenomas, low-risk adenomas, and after negative colonoscopy for all colonoscopies performed by colonoscopists with low vs high performance quality (adenoma detection rate <20% vs ≥20%) in the Polish screening program between 2000 and 2011, with follow-up until 2017. Findings were validated in the Austrian colonoscopy screening program. A total of 173,288 Polish colonoscopies were included in the study. Of 262 colonoscopists, 160 (61.1%) were low performers, and 102 (38.9%) were high performers; 11.1% of individuals had low-risk and 6.6% had high-risk adenomas removed at screening; 82.2% had no adenomas. During 10 years of follow-up, 443 colorectal cancers were diagnosed. For low-risk adenoma individuals, colorectal cancer incidence was 0.55% (95% confidence interval [CI] 0.40-0.75) with low-performing colonoscopists vs 0.22% (95% CI 0.14-0.34) with high-performing colonoscopists (hazard ratio [HR] 2.35; 95% CI 1.31-4.21; P= .004). For individuals with high-risk adenomas, colorectal cancer incidence was 1.14% (95% CI 0.87-1.48) with low-performing colonoscopists vs 0.43% (95% CI 0.27-0.69) with high-performing colonoscopists (HR 2.69; 95% CI 1.62-4.47; P < .001). After negative colonoscopy, colorectal cancer incidence was 0.30% (95% CI 0.27-0.34) for individuals examined by low-performing colonoscopists, vs 0.15% (95% CI 0.11-0.20) for high-performing (HR 2.10; 95% CI 1.52-2.91; P < .001). The observed trends were reproduced in the Austrian validation cohort. Our results suggest that endoscopist performance may be an important contributor in addition to polyp characteristics in determining colorectal cancer risk after colonoscopy screening.

S1226 Impact of Fellowship Training Level on Quality Metrics in Veterans Undergoing Screening Colonoscopy

INTRODUCTION: Colonoscopy is the recommended modality for colorectal cancer (CRC) screening. Adenoma detection rate (ADR) has emerged as a leading quality metric for screening colonoscopy. The rates of interval CRC and mortality decrease when ADR is improved. The cognitive and fine motor skills required for identification of polyps is a learned skill, which may differ between early and advanced trainees. This could have an impact on the quality of the procedure, even when supervised by faculty. The aim of this study is to compare metrics of screening colonoscopies performed at a teaching hospitals involving early (first year) and advanced (second and third year) gastroenterology fellowship trainees. METHODS: A retrospective review was performed of patients between age 50 and 75 years, with average familial cancer risk, who underwent a first-time screening colonoscopy by a gastroenterology fellowship trainee at Clement J. Zablocki Veterans Affairs Medical Center between January 2018 and June 2019. Patients with inadequate bowel preparation were excluded. Data were analyzed using Chi Square, Fishers' Exact Test, and One-Way ANOVA, as appropriate. A binomial test was used to compare rates of polyp identification against the minimum standard of 25%. All analyses were conducted using SAS 9.4. RESULTS: 280 patients were included in the study. Patient demographics are outlined in Table 1. Procedure-related parameters are outlined in Table 2. When early trainees were involved in a procedure, the time to reach cecum (12.2 vs. 7.1 minutes, P < 0.0001), and the total procedure time (35.8 vs 28.8 minutes, P < 0.0001) were longer. The overall withdrawal time was not different (23.5 vs 21.8 minutes, P = 0.168), however, a second exam of the right colon was less likely to be performed when an early trainee was involved (81.8% vs 96.8%, P < 0.0001). A statistically significant high ADR was achieved by both groups (46.8% vs 50.6%, P = 0.078). There were no emergency room visits, hospital admissions, or deaths attributable to colonoscopy. There were more unrelated 30 day emergency room visits in the early trainee group (8.7% vs. 3.9%, P = 0.0498). CONCLUSION: A high ADR was achieved irrespective of level of trainee involved in the procedure. Trainee level did not adversely affect key quality metrics in screening colonoscopy when performed under supervision. Extra time should be allotted when first year fellowship trainees are involved in the procedure.Table 1.: DemographicsTable 2.: Procedure CharacteristicsTable 3.: Polyp Characteristics

S0191 Comparing Pathologic Features of Different Colonic Segments in Non-Hereditary Young Onset Colorectal Cancer

INTRODUCTION: Young patients with non-hereditary colorectal cancer (CRC) have unfavorable pathologic characteristics. The features and survival outcomes in different colonic segments are to be determined. METHODS: In this retrospective observational study we randomly selected patients (aged 18–50) with a histopathologic diagnosis of CRC at Carilion Clinic, Roanoke, from 2002 to 2017. Patients with inflammatory bowel disease and predisposing genetic syndromes were excluded. Demographics, polyp and tumor features, and mortality were obtained from the electronic medical record. Two pathologists reviewed histopathology to minimize diagnostic variability. The cumulative risk of mortality among patients with different pathologic features was estimated using Kaplan Meier curves. RESULTS: We identified 139 patients (Mean age, 41.6 ± 6.9 years; 53.2% males) with non-hereditary CRC. Thirty percent of tumors were located in the right colon (RC), 35.4% in the left colon (LC), and 34.5% in the rectum (Rec). In patients with resected tumors, a cancer-adjacent polyp was identified in 78.8% (RC), 73.7% (LC), and 47.4% (Rec). Lymphovascular invasion (LVI) was present in 59.0% compared to 38% (LC) and 25% (Rec). Perineural invasion (PNI) was present in 25.0% compared to 10.8% (LC) and 14.35% (Rec). RC tumor budding was (14%) compared to 13.1% (LC) and 2.9% (Rec), and tumor deposits in 30% compared 18.9% (LC) and 17.7% (Rec). Intratumoral lymphocytes were present in 32.1% (RC) compared to 15.8% (LC) and 3.03% (Rec). Intratumoral neutrophils were present in 3.6% in the RC compared to 10.5% (LC) and 3.03% (Rec). Thirty-two percent (RC) had Crohn’s like response compared to 26.3% (LC) and 3.0% (Rec). Microsatellite instability (MSI) accounted for 9.4% of (RC) tumors and 8.1% of (LC) tumors but was not present in rectal tumors. Among patients who had repeat colonoscopy for surveillance, about 90.0% of patients with RC cancer did not receive surveillance colonoscopy within 1 year of cancer diagnosis compared to 42% (LC) and 55.6% (Rec). Patients with Rec cancer had decreased survival compared to patients diagnosed with RC and LC cancers (P = 0.04) (Figure 1). CONCLUSION: Right colon tumors accounted for higher rates of unfavorable pathologic features compared to left colon and rectal tumors. Adherence to USMSTF surveillance recommendations is poor, especially in RC tumors. Patients with rectal cancer had the poorest survival outcomes compared to right and left colon tumors.Figure 1.: Interval time of diagnosis until last visit based on segment.

CLINICAL AND MORPHOLOGICAL PARALLELS IN THE DIAGNOSIS OF ENDOMETRIAL POLYPS IN THE AGE ASPECT

The aim of research: To study the pathomorphological and endoscopic features of endometrial polyps in women of reproductive, premenopausal and postmenopausal age and conduct a comparative analysis.Materials and methods. To carry out the planned study, 116 women with endometrial polyps were included, who were treated at the Women’s Medical Center of Clinical Hospital “Feofania”. Depending on the pathomorphological type of endometrial polyposis, four groups of patients were formed, Group 1 - 34 women with glandular endometrial polyp, group 2 - 32 patients with glandular-fibrous endometrial polyp, group 3 included 34 women with endometrial fibrous polyp, and the fourth group - 16 patients with endometrial adenomatous polyps. Diagnostic search was carried out by ultrasound followed by hysterectectoscopy and histological examination.Results and discussion. Glandular and glandular-fibrous polyps of the endometrium showed predominantly in women of reproductive 15 (39.4%) age and 10 (31.1%) patients of premenopausal age, against the background of simple endometrial hyperplasia without atypia, in 21 (61.7%) women and in 13 (38.2%) cases against the background of unchanged endometrium. Fibrous polyps are characteristic of postmenopausal women in 21 (45.6%) cases, while on the background of atrophic endometrium in 22 (64.7%) patients, in 7 (20.5%) patients on the background of simple endometrial hyperplasia without atypia, in 5 ( 14.7%) cases against the background of unchanged endometrium. Adenomatous polyps of the endometrium were found in 16 (13.7%) patients of them reproductive 5 (13.1%) and 6 (18.7%) cases of premenopausal age, against the background of complex endometrial hyperplasia without atypia in 5 (31.2%) patients, in 4 (25.1%) women on the background of simple endometrial hyperplasia with atypia, as well as in 3 (18.8%) patients on the background of complex adenomatous endometrial hyperplasia with atypia, and in 1 (6.25%) case on the background atrophic endometrium.Conclusions. Glandular and glandular fibrous polyps of the endometrium are characteristic mainly for women of reproductive and premenopausal age, fibrous polyps of the endometrium are mainly manifested in patients of postmenopausal age. Adenomatous polyps of the endometrium are observed in all age groups. A study of the pathomorphological and endoscopic features of endometrial polyps in women of different age categories in the background endometrium and polyp tissue makes it clear that in most cases they have different pathomorphological characteristics (93,3%), it makes sense to use hysteroscopy with targeted sampling with separate marking of histological material with the definition of further tactics for managing patients for results of pathomorphological findings.

Effects of age, sex and pathological type on the risk of multiple polyps: A Chinese teaching hospital study.

The lack of risk profile data on changes in multiple polyps identified by a colonoscopy constrains the creation of evidence-based guidelines. Our study aimed to investigate the relationship between size, location and histology of multiple polyps and patients' characteristics in a large teaching hospital-based Chinese population. We conducted a large, case-control, retrospective analysis on polyps obtained from 8308 patients who presented at the Digestive Endoscopy Center, Changhai Hospital (Shanghai, China) from January 2013 to August 2015. In total 10572 polyps were analyzed, with risk factors extrapolated through chart reviews of patients' electronic medical records. Single polyps were identified in 6843 (82.4%) patients while multiple polyps were found in 1465 (17.6%). A multivariate analysis indicated that men were more likely than women to have multiple polyps (P < 0.001). Compared with the single polyps group, the numbers of patients with multiple polyps increased significantly with age (P < 0.001). Multiple small (6-9 mm) non-advanced adenomas were more likely to be found than were diminutive (<5 mm) non-advanced adenomas (P < 0.001). While most advanced and non-advanced adenomas were diagnosed in patients with single adenomas (55.9% and 65.6%, respectively), advanced adenomas were more likely than non-advanced adenomas to be in multiples (P < 0.001). Our data indicate that particular features of colorectal polyps, such as their large size, advanced histology, together with patients' characteristics, including their sex and age, are risk factors associated with multiple polyps during diagnosis, screening and surveillance.

An automated detection system for colonoscopy images using a dual encoder-decoder model

Conventional computer-aided detection systems (CADs) for colonoscopic images utilize shape, texture, or temporal information to detect polyps, so they have limited sensitivity and specificity. This study proposes a method to extract possible polyp features automatically using convolutional neural networks (CNNs). The objective of this work aims at building up a light-weight dual encoder-decoder model structure for polyp detection in colonoscopy Images. This proposed model, though with a relatively shallow structure, is expected to have the capability of a similar performance to the methods with much deeper structures. The proposed CAD model consists of two sequential encoder-decoder networks that consist of several CNN layers and full connection layers. The front end of the model is a hetero-associator (also known as hetero-encoder) that uses backpropagation learning to generate a set of reliably corrupted labeled images with a certain degree of similarity to a ground truth image, which eliminates the need for a large amount of training data that is usually required for medical images tasks. This dual CNN architecture generates a set of noisy images that are similar to the labeled data to train its counterpart, the auto-associator (also known as auto-encoder), in order to increase the successor’s discriminative power in classification. The auto-encoder is also equipped with CNNs to simultaneously capture the features of the labeled images that contain noise. The proposed method uses features that are learned from open medical datasets and the dataset of Zhejiang University (ZJU), which contains around one thousand images. The performance of the proposed architecture is compared with a state-of-the-art detection model in terms of the metrics of the Jaccard index, the DICE similarity score, and two other geometric measures. The improvements in the performance of the proposed model are attributed to the effective reduction in false positives in the auto-encoder and the generation of noisy candidate images by the hetero-encoder.

Polyp Segmentation with Fully Convolutional Deep Neural Networks-Extended Evaluation Study.

Analysis of colonoscopy images plays a significant role in early detection of colorectal cancer. Automated tissue segmentation can be useful for two of the most relevant clinical target applications—lesion detection and classification, thereby providing important means to make both processes more accurate and robust. To automate video colonoscopy analysis, computer vision and machine learning methods have been utilized and shown to enhance polyp detectability and segmentation objectivity. This paper describes a polyp segmentation algorithm, developed based on fully convolutional network models, that was originally developed for the Endoscopic Vision Gastrointestinal Image Analysis (GIANA) polyp segmentation challenges. The key contribution of the paper is an extended evaluation of the proposed architecture, by comparing it against established image segmentation benchmarks utilizing several metrics with cross-validation on the GIANA training dataset. Different experiments are described, including examination of various network configurations, values of design parameters, data augmentation approaches, and polyp characteristics. The reported results demonstrate the significance of the data augmentation, and careful selection of the method’s design parameters. The proposed method delivers state-of-the-art results with near real-time performance. The described solution was instrumental in securing the top spot for the polyp segmentation sub-challenge at the 2017 GIANA challenge and second place for the standard image resolution segmentation task at the 2018 GIANA challenge.

Endometrial polyps in postmenopausal women: results of a comparative analysis of clinical features after hysteroscopic polypectomy

Aim. To evaluate the clinical features of endometrial polyps (EP) in postmenopausal patients based on a comparative analysis of symptomatic and asymptomatic forms.&#x0D; Мaterials and methods. A retrospective cohort study was conducted with the inclusion of 92 postmenopausal women who underwent hysteroscopic polypectomy in the gynecological Department of the Clinical Hospital of Russian Railways-Medicine Omsk in 20182019. Тhe аverage age of patients was 60.356.56 years. Two groups of patients were identified: group 1 included patients with asymptomatic EP (n=64), group 2 women with EP associated with uterine bleeding (n=28).&#x0D; Results. Postmenopausal EP patients had: asymptomatic (69.6%), uterine bleeding (30.4%), recurrent EP (14.3%), concomitant tamoxifen treatment (5.4%), single (77.2%) and multiple (22.8%) EP. In group 1, patients with late postmenopausal stage (73.4%) with single EP (76.6%) of various localization, glandular-fibrotic type (78.1%, p0.05) prevailed. Group 2 was dominated by patients with early postmenopausal stage (60.7%, p0.05) with single EP (78.6%, p0.05) of various localization, having glandular (50%, p0.01), glandular-fibrotic (46.4%, p0.01) EP and adenomatous EP with malignancy (3.57%, p0.05). Hyperplasia of endometrium was observed in both groups (1.56 and 3.57% in group 1 and 2, respectively), and adenocarcinoma in group 1 (1.56%).&#x0D; Conclusion. In patients with postmenopausal EP, along with a benign course, the disease occurs against the background of atypical hyperplasia and endometrial cancer (in the polyp or endometrium) in 3,3% of cases, including the asymptomatic nature of the disease.

Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas

The recent description of "invasive" forms of intramucosal carcinoma (IMC) has rekindled interest in studying the characteristics, management, and prognosis of IMCs and comparing them with T1 colorectal cancers (CRCs). This population-based study included 282 cases of IMC and 207 cases of T1 CRC diagnosed by colonoscopy after a positive fecal blood test through a screening program. IMC presented mainly in the form of pedunculated polyps (68.4%) located in the distal colon (69.9%)≥20mm in size (60.6%). IMCs were resected endoscopically in 227 (80.5%) patients and surgically resected in 55 (19.5%) patients. Surgical patients had more right-sided, more sessile, and larger lesions. There was no sign of lymphovascular invasion. Compared with T1 CRCs, IMCs demonstrated lower rates of sessile polyps (31.6% vs 49.8%, P< .0001), primary and ultimate surgical treatment (19.5% vs 39.1% and 19.9% vs 78.7%, P< .0001, respectively), lymph node metastasis in surgical patients (0% vs 9.5%, P= .041), cancer recurrence and cancer-related mortality (0% vs 5.6% and 0% vs 2.5%, respectively), and bleeding after endoscopic resection (1.8% vs 8.7%, P= .001). By multivariate analysis of the pooled cohort (IMC+ T1 CRC, n= 489), the factors significantly associated with first-line surgery were shown to be polyp characteristics and the gastroenterologist who performed the colonoscopy. IMCs account for a quarter of all screening-detected CRCs. They have an excellent prognosis regardless of whether endoscopic or surgical treatment is performed. IMCs differ significantly from T1 carcinomas in terms of management and prognosis.

Application of Transcutaneous Laryngeal Ultrasonography in the Diagnosis of Vocal Fold Polyps

The aim of this study was to explore the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps. From December 2016 to June 2019, 87 patients with vocal fold polyps diagnosed pathologically in the Otolaryngology Head and Neck Surgery Department of the Second Affiliated Hospital of Xi'an Jiaotong University were enrolled and examined by electronic laryngoscopy and percutaneous laryngeal ultrasound on the same day before operation. To observe the effect of calcification length as a percentage of thyroid cartilage at the glottic level on vocal fold display, the characteristics of ultrasound images of vocal fold polyps and the value of transcutaneous laryngeal ultrasonography in the diagnosis of vocal fold polyps were assessed. Among 87 patients, the calcification rate of thyroid cartilage at the glottic level was 33.3%. The differences in calcification rate and percentage of calcification length between males and females were statistically significant. The rate of detection of vocal folds decreased gradually with an increase in calcification length percentage. Imaging features of vocal fold polyps were hypo-echoic with a clear boundary and regular shape. The detection rates for circular and non-circular polyps were 92.0% and 70.6%. Ultrasound was more likely to detect circular than non-circular polyps; however, the difference was not significant. Transcutaneous laryngeal ultrasonography can identify the morphology and location of vocal fold polyps and is non-invasive and highly accurate. Therefore, it has the potential to be an effective supplement to laryngoscopy for initial screening and post-operative review of vocal fold polyps.

Detection and clinical characteristics of serrated polyps and conventional adenomas between patients in the outpatient and physical checkup unit receiving colonoscopy.

The sessile serrated adenoma/polyp detection rate (SSA/PDR) among different colonoscopy indications from daily practice has not been fully understood. This study aimed to evaluate the detection and clinical characteristics of serrated polyps and conventional adenomas between outpatient department (OPD) and physical checkup unit (PCU) patients receiving colonoscopy. The data for this retrospective study were collected between 2016 and 2017 at Kaohsiung Veterans General Hospital in Taiwan. A total of 7047 individuals were included, and information on polyp and adenoma detection was extracted from the colonoscopy reports. The adenoma detection rate, the SSA/PDR, and the detection rate of traditional serrated adenoma (TSA) were 32.2%, 0.60%, and 0.50%, respectively. Risk analysis revealed no significant difference (p = 0.095) in SSA/PDR between individuals < 50years and ≥ 50years, and no trend of increased SSA/PDR as age increased was observed (p = 0.320). SSA/P and TSA had higher risks for synchronous advanced neoplasia than conventional adenoma, but with proximal hyperplastic polyps lower (p < 0.001, respectively). No significant difference of SSA/PDR between OPD and PCU patients was observed (p = 1.000); however, the age of SSA/P was significantly older in OPD than in PCU patients (p = 0.048). The detection rates of CA and TSA were associated with age groups; however, SSA/PDR was insignificantly higher among individuals aged < 50years than those with other age groups. In addition, SSA/PDR between OPD and PCU patients was not significantly found in daily practice of colonoscopies.

776 NOVEL METHOD TO ASSESS COLD SNARE POLYPECTOMY QUALITY FOR 1-10 MM COLORECTAL POLYPS – MEASURING THE MINIMUM EXTENT OF A HEALTHY RESECTION MARGIN

Measuring quality of polypectomy in clinical practice remains a challenge. We examined the extent of a normal healthy tissue margin around neoplastic tissue of the resected polyp specimen as a potential quality marker for polypectomy. Prospective single center study in patients who underwent an elective outpatient colonoscopy with non-cautery (cold) polyp resection between July 2017 and September 2019. All non-fragmented polyps were included in the analysis. Patient and polyp characteristics, and resection methods were prospectively documented on predefined case report forms. To control for snare type, all snares were rotated monthly (one snare type each month). The healthy margin was defined as the difference between the resected specimen size and the neoplasia size (serrated or adenomatous; measured by the pathologist) divided by two. We assessed the healthy margin across endoscopists, by type of snare (dedicated cold snare vs standard snare), and by polyp characteristics. 561 patients (mean age 65) with 1724 polyps were included in the analysis. The mean size as estimated by the endoscopist was 4.0 mm (median 4 mm). This estimate was approximately 50% greater than the measured neoplasia size of 2.6 mm (median 2.0 mm). The healthy margin varied across endoscopists from 0.8 to 1.4 mm (p<0.001), with an almost 2-fold variation in the proportions of polyps with a minimum helathy margin of ≥1 mm (29% to 57%, (p<0.001). Attending-gastroenterologists resected polyps with a wider margin than trainees (p<0.001). Dedicated cold snares achieved a larger resection margin than standard snares (1.4 vs 1.0 mm, p<0.001), and removed a greater proportion of polyps with a margin ≥1mm (56% vs 39%, p<0.001). There was no difference in the extent of the healthy margin by polyp size, proximal location, or histology. The study examined the healthy tissue margin surrounding polyp neoplasia as a potentially novel quality marker for polyp resection. The margin varied two-fold across endoscopists, in particular between attendings and trainees, and was larger when dedicated cold snares were used. The findings encourage future validation of this new measure.Figure 1Variation of mean minimum healthy margin across endoscopistsView Large Image Figure ViewerDownload Hi-res image Download (PPT)

Tu1103 A DEEP LEARNING BASED GASTROINTESTINAL ENDOSCOPY PERFORMANCE MEASUREMENT SYSTEM IMPROVED LEISIONS DETECTION

Gastrointestinal endoscopic quality is operator-dependent. Previous studies assessing the effect of audit and feedback (A&F) to decrease variation in endoscopic quality have shown positive effects. A deep learning based endoscopic A&F system named Endo.Adm was constructed and its effect on endoscopic quality improvement was subsequently evaluated in our clinical practice. Endo.Adm system was developed using the methods of deep convolutional neural networks and deep reinforcement learning (DCNN). Endoscopists were recruited from Renmin Hospital of Wuhan University. Enrolled endoscopists were randomly assigned to groups that with or without the quality A&F of Endo.Adm. The form of A&F was a quality report card which was automatically generated by Endo.Adm. The primary end point was to ascertain if there was a difference in adenoma detection rate (ADR) in colonoscopy and gastric precancerous conditions (GPCs) detection rate before and after Endo.Adm A&F. Endo.Adm statistics cecal intubation, withdrawal time, gastroscopic inspection time and stomach photodocumentation with an accuracy of 96.33%, 91.3%, 99.0% and 91.0%, respectively. A total of 17 endoscopists were enrolled and randomised. 1587 colonoscopies and 3573 gastroscopies were analyzed in clinical trial, respectively. ADR was increased after A&F (4.3% - 10.4%, P=0.002, 95% C.I. 0.193-0.696) and endoscopists without A&F remained unchanged at 5.3%. GPCs detection rate increased in A&F group (3.9 - 7.5%, P=0.003, 95% C.I. 0.333-0.796) while no change was observed in control group. Endo.Adm A&F was associated with multifaceted improved Gastrointestinal (GI) endoscopic quality indicators. This intervention is practical to generate and implement and may serve as a standard model for quality improvement in different patient and physician groups.Gastric precancerous conditions detected on gastroscopy (as confirmed by histology) stratified by CQI and EQI endoscopists. Polyp and adenoma characteristics detected on colonoscopy (as confirmed by histology) stratified by CQI and EQI endoscopists.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Serrated polyps of the colon and rectum: Remove or not?

In recent years, the serrated neoplasia pathway where serrated polyps arise as a colorectal cancer has gained considerable attention as a new carcinogenic pathway. Colorectal serrated polyps are histopathologically classified into hyperplastic polyps (HPs), sessile serrated lesions, and traditional serrated adenomas; in the serrated neoplasia pathway, the latter two are considered to be premalignant. In western countries, all colorectal polyps, including serrated polyps, apart from diminutive rectosigmoid HPs are removed. However, in Asian countries, the treatment strategy for colorectal serrated polyps has remained unestablished. Therefore, in this review, we described the clinicopathological features of colorectal serrated polyps and proposed to remove HPs and sessile serrated lesions ≥ 6 mm in size, and traditional serrated adenomas of any size.