Number Of Polyps Research Articles

Changes of gut microbiota and short chain fatty acids in patients with Peutz–Jeghers syndrome

Peutz–Jeghers Syndromeis a rare autosomal dominant genetic disease characterized by gastrointestinal hamartomatous polyps and skin and mucous membrane pigmentation. The pathogenesis of PJS remains unclear; however, it may be associated with mutations in the STK11 gene, and there is currently no effective treatment available. The gut microbiota plays an important role in maintaining intestinal homeostasis in the human body, and an increasing number of studies have reported a relationship between gut microbiota and human health and disease. However, relatively few studies have been conducted on the gut microbiota characteristics of patients with PJS. In this study, we analyzed the characteristics of the gut microbiota of 79 patients with PJS using 16 S sequencing and measured the levels of short-chain fatty acids in the intestines. The results showed dysbiosis in the gut microbiota of patients with PJS, and decreased synthesis of short-chain fatty acids. Bacteroides was positively correlated with maximum polyp length, while Agathobacter was negatively correlated with age of onset. In addition, acetic acid, propionic acid, and butyric acid were positively correlated with the age of onset but negatively correlated with the number of polyps. Furthermore, the butyric acid level was negatively correlated with the frequency of endoscopic surgeries. In contrast, we compared the gut microbiota of STK11-positive and STK11-negative patients with PJS for the first time, but 16 S sequencing analysis revealed no significant differences. Finally, we established a random forest prediction model based on the gut microbiota characteristics of patients to provide a basis for the targeted diagnosis and treatment of PJS in the future.

GPR15 in colon cancer development and anti-tumor immune responses

IntroductionThe chemoattractant receptor, G protein-coupled receptor 15 (GPR15), promotes colon homing of T cells in health and colitis. GPR15 function in colon cancer is largely unexplored, motivating our current studies.MethodsIn human study, immune cells were isolated from tumor tissues and healthy surgical tumor margins (STM), and their proportions as well as expression of GPR15 was analyzed by flow cytometry. In mouse studies, colon cancer was induced in GPR15-deficient (KO) and GPR15-suficient (Het) mice using azoxymethane (AOM) and dextran sulfate sodium (DSS) solution in drinking water. Serial endoscopy was performed in mice to monitor and visualize the distal region of colon. Mice were euthanized 10 weeks after the initial DSS administration, and the colon length and the number of polyps were recorded. Next, we identified the effects of GPR15L on established tumors in the MC38-colorectal cancer (CRC) mouse model. Immune cells were isolated from the mice colons or tumors and assessed by flow cytometry.ResultsOur analysis of human CRC tissue revealed a significant reduction in GPR15+ immune cell frequencies in tumors compared to ‘tumor-free’ surgical margins. Similarly, our data analysis using The Cancer Genome Atlas (TCGA) indicated that lower GPR15 expression is associated with poor survival in human colon cancer. In the AOM/DSS colitis-associated colon cancer model, we observed increased colonic polyps and lower survival in Gpr15+-KO compared to Gpr15-Het mice. Analysis of immune cell infiltrates in the colonic polyps showed significantly decreased CD8+ T cells and increased IL-17+ CD4+ and IL-17+ CD8+ T cells in Gpr15-KO than in Het mice. Consistent with a protective role of GPR15, administration of GPR15L to established tumors in the MC38-CRC model increased CD45+ cell infiltration, enhanced TNFa expression on CD4+ and CD8+ T cells at the tumor site and dramatically reduced tumor burden.DiscussionOur findings highlight an important, unidentified role of the GPR15-GPR15L axis in promoting a tumor-suppressive immune microenvironment and unveils a novel, colon-specific therapeutic target for CRC.

Is Metformin Associated with a Lower Prevalence of Polyps, Adenomas, and Colorectal Carcinoma in Patients with Diabetes Mellitus?

Recent studies suggested a protective role of metformin in the development of colorectal cancer (CRC) and its precursors. We aimed to investigate if metformin was associated with a lower prevalence and number of colorectal polyps in diabetic patients and also adenomas, high-risk adenomas, and CRC. Retrospective study on adult patients with diabetes mellitus followed in our hospital with a total colonoscopy between 2015 and 2019, treated with either metformin for > 5years or other antidiabetic agent (control group). We assessed the number, size, and histopathology examination of proliferative lesions detected on colonoscopy. We included 401 patients aged 69 ± 9years, 57% males, divided into two groups: treated with metformin (n = 260) and without (n = 141). The number of polyps detected was significantly lower in patients under metformin (p = 0.014). There was a nonsignificant trend towards lower polyp detection rates in the metformin compared to the control group both in unadjusted analysis (50% vs 60%, p = 0.058) and multivariable adjusted analysis (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.43-1.09, p = 0.111). In the latter, we identified male gender (OR 2.24, 95%CI 1.44-3.49, p < 0.001), age (OR 1.35 for every 10years, 95%CI 1.07-1.71, p = 0.012), glycated hemoglobin value (OR 1.20 for every 1% increase, 95%CI 1.06-1.37, p = 0.005), and hypertension (OR 1.76, 95%CI 1.01-3.08, p = 0.046) as factors associated with a higher prevalence of polyps. We saw no statistically significant differences regarding adenoma (p = 0.231), high-risk adenoma (p = 0.810), and CRC (p = 0.705) diagnoses between groups. In our study, metformin was associated with less colorectal polyps in diabetic patients compared to other treatment modalities. We observed a nonsignificant trend towards lower polyp detection rates in the metformin group both in unadjusted and adjusted analyses.

TACT: Text attention based CNN‐Transformer network for polyp segmentation

AbstractColorectal cancer (CRC) has been one of the top three disease in the world in terms of incidence for many years. Therefore, how to prevent and treat CRC has become a topic of concern for an increasing number of people, and colonoscopy is the most effective detection method in polyp examination. According to studies, 90% of CRC is caused by adenomatous polyps of the large intestine. In clinical practice, the diversity of polyps' size, number, and shape and the unclear boundary between polyps and colon folds can reduce the operator's accuracy of polyps segmentation and lead to a higher rate of missed diagnosis. To better address the inaccurate segmentation or high miss rate due to the above factors, we propose a text attention‐based CNN‐Transformer network for polyp segmentation (TACT) network to process the images in a way that minimizes operator subjectivity and miss rate. The network is based on the CNN‐Transformer structure, and on this basis, a fully attention progressive sampling module is added to more accurately divide the polyp boundary. Moreover, an auxiliary text classification task was added to focus on polyp size and number features in the form of text attention, which more effectively copes with the segmentation tasks of different sizes and different numbers of polyps. After comparing with multiple state‐of‐the‐art segmentation methods in four challenging datasets, our proposed TACT improves segmentation accuracy for polyps of different sizes in different datasets.

Correlation and influencing factors analysis of colorectal polyps with Helicobacter pylori Infection and p-S6K1 expression

ObjectiveTo investigate the correlation between colorectal polyps (CRP) and Helicobacter pylori (H. pylori) infection, and the correlation between CRP and the expression of phosphorylated ribosomal protein S6 kinase (p-S6K1). Besides, its related influencing factors were determined in the present study.MethodsA total of 191 subjects who underwent colonoscopy in our hospital from January 2020 to February 2022 were selected for this study. Among them, 141 patients were diagnosed with CRP, and the other 50 subjects were no significant colorectal abnormalities. 141 CRP patients were divided into H. pylori-positive group (n = 89) and H. pylori-negative group (n = 52) according to the results of the H. pylori test. The expression of p-S6K1 in CRP tissue was detected. The relationship between the p-S6K1 expression and the clinicopathological characteristics of CRP patients was analyzed. The logistic analysis of factors influencing the occurrence of CRP was performed.ResultsThere were significant differences in pathological type, site of disease, the number and size of polyps between the H. pylori negative group and the H. pylori positive group (P < 0.001, P = 0.037, P = 0.042 and P = 0.039). The percentage of the p-S6K1 positive expression in polyp tissues was higher than that in normal tissue and parapolyp tissues (P < 0.001). The p-S6K1 negative group showed significant difference in the number and pathological type of polyps and the presence or absence of a pedicle as compared with the p-S6K1 positive group (P = 0.006, P < 0.001 and P = 0.012). Logistic multifactor analysis showed that BMI, H. pylori infection, smoking history, ApoB, Lp(a) and the p-S6K1 positive expression were all risk factors for the development of CRP (P = 0.025, P = 0.020, P = 0.010, P = 0.005, P = 0.043 and P < 0.001).ConclusionH. pylori infection was closely related to the pathological type, location, and the number and size of CRP. p-S6K1 was highly expressed in CRP, and was positively related to the number, the pathological type and pedicle of polyps. H. pylori infection and the positive p-S6K1 expression were independent risk factors for CRP. By exploring the association between H. pylori infection as well as p-S6K1 and CRP, it is hoped that it will help to formulate a more rigorous colorectal cancer screening program for H. pylori-positive individuals, and at the same time find a new direction for the prevention of CRP and colorectal cancer, and provide some help for future research.

The risk and predictors of gallbladder cancer in patients with gallbladder polyps: A retrospective cohort study with an insight into confounding by indication.

We aimed to determine the risk and predictors of gallbladder cancer in all individuals with gallbladder polyps (GP) including those who did not have cholecystectomy. The STROCSS guideline was followed to conduct a retrospective cohort study. All individuals with GP between 2010 and 2019 were followed up to determine the risk and predictors of gallbladder cancer. The primary outcomes were gallbladder cancer and gallbladder dysplasia, and the secondary outcomes included polyp growth rate and polyp disappearance rate. Binary logistic regression analysis and receiver operating characteristic curve analysis were conducted to evaluate the outcomes. Analysis of 438 patients showed risk of gallbladder cancer was 0.7% in all polyps (0% in polyps <10mm; 5.9% in polyps ≥10mm). The risk of gallbladder dysplasia or cancer was 1.1% in all polyps (0% in polyps <10mm; 10% in polyps ≥10mm). The polyp size (P=0.0001) was predictor of cancer; however, patient's age (P=0.1085), number of polyps (P=0.9983), symptomatic polyps (P=0.3267), and change in size (P=0.9012) were not. Size of 21mm was cut-off for risk of cancer (area under the curve [AUC]: 0.995, P<0.001) and 11.8mm for risk of dysplasia or cancer (AUC: 0.986, P<0.001). The mean polyp growth rate was 0.3mm/year and polyp disappearance rate was 16%. The GP size remains the only predictor of malignant changes regardless of patient's age, patient's symptoms and number of polyps. The polyp growth rate is unremarkable, and a significant proportion disappears during follow-up. We changed our follow-up protocol with reduced number of scans and early discharge policy.

Lactobacillus plantarum Zhang-LL Inhibits Colitis-Related Tumorigenesis by Regulating Arachidonic Acid Metabolism and CD22-Mediated B-Cell Receptor Regulation.

Colorectal cancer (CRC) is a significant health concern and is the third most commonly diagnosed and second deadliest cancer worldwide. CRC has been steadily increasing in developing countries owing to factors such as aging and epidemics. Despite extensive research, the exact pathogenesis of CRC remains unclear, and its causes are complex and variable. Numerous in vitro, animal, and clinical trials have demonstrated the efficacy of probiotics such as Lactobacillus plantarum in reversing the adverse outcomes of CRC. These findings suggest that probiotics play vital roles in the prevention, adjuvant treatment, and prognosis of CRC. In this study, we constructed a mouse model of CRC using an intraperitoneal injection of azomethane combined with dextran sodium sulfate, while administering 5-fluorouracil as well as high- and low-doses of L. plantarum Zhang-LL live or heat-killed strains. Weight changes and disease activity indices were recorded during feeding, and the number of polyps and colon length were measured after euthanasia. HE staining was used to observe the histopathological changes in the colons of mice, and ELISA was used to detect the expression levels of IL-1β, TNF-α, and IFN-γ in serum. To investigate the specific mechanisms involved in alleviating CRC progression, gut microbial alterations were investigated using 16S rRNA amplicon sequencing and non-targeted metabolomics, and changes in genes related to CRC were assessed using eukaryotic transcriptomics. The results showed that both viable and heat-killed strains of L. plantarum Zhang-LL in high doses significantly inhibited tumorigenesis, colon shortening, adverse inflammatory reactions, intestinal tissue damage, and pro-inflammatory factor expression upregulation. Specifically, in the gut microbiota, the abundance of the dominant flora Acutalibacter muris and Lactobacillus johnsonii was regulated, PGE2 expression was significantly reduced, the arachidonic acid metabolism pathway was inhibited, and CD22-mediated B-cell receptor regulation-related gene expression was upregulated. This study showed that L. plantarum Zhang-LL live or heat-inactivated strains alleviated CRC progression by reducing the abundance of potentially pathogenic bacteria, increasing the abundance of beneficial commensal bacteria, mediating the arachidonic acid metabolism pathway, and improving host immunogenicity.

Association between Helicobacter pylori infection and colorectal polyps.

It was aimed to investigate whether the Helicobacter pylori infection is related to the frequency, localization, size and number of colorectal polyps. The data of 4561 patients who underwent esophagogastroduodenoscopy and colonoscopy were analyzed retrospectively. Patients with and without polyps at colonoscopy were grouped and the frequency of H pylori infection was compared in these patients. The relationship between the groups was evaluated with statistical methods. It was determined that the rate of H pylori infection was higher in patients with colorectal polyps than in patients without polyps (P < .005). Patients with multiple polyps, polyps larger than 1 cm, and tubulovillous and villous adenoma from polyp types had a higher rate of H pylori infection (P = .095; P .004; P .001). When the polyps were evaluated according to their localization, H pylori infection rates were not different between the groups (P = .341). It has been observed that the rate of H pylori infection is higher in large polyps, multiple polyps, tubulovillous and villous adenomas, which are known to have a higher risk of malignancy.

The effect of aspirin and eicosapentaenoic acid on urinary biomarkers of prostaglandin E2 synthesis and platelet activation in participants of the seAFOod polyp prevention trial.

Urinary prostaglandin (PG) E metabolite (PGE-M) and 11-dehydro (d)-thromboxane (TX) B2 are biomarkers of cyclooxygenase-dependent prostanoid synthesis. We investigated (1) the effect of aspirin 300 mg daily and eicosapentaenoic acid (EPA) 2000 mg daily, alone and in combination, on urinary biomarker levels and, (2) whether urinary biomarker levels predicted colorectal polyp risk, during participation in the seAFOod polyp prevention trial. Urinary PGE-M and 11-d-TXB2 were measured by liquid chromatography-tandem mass spectrometry. The relationship between urinary biomarker levels and colorectal polyp outcomes was investigated using negative binomial (polyp number) and logistic (% with one or more polyps) regression models. Despite wide temporal variability in PGE-M and 11-d-TXB2 levels within individuals, both aspirin and, to a lesser extent, EPA decreased levels of both biomarkers (74% [P ≤ .001] and 8% [P ≤ .05] reduction in median 11-d-TXB2 values, respectively). In the placebo group, a high (quartile [Q] 2-4) baseline 11-d-TXB2 level predicted increased polyp number (incidence rate ratio [IRR] [95% CI] 2.26 [1.11,4.58]) and risk (odds ratio [95% CI] 3.56 [1.09,11.63]). A low (Q1) on-treatment 11-d-TXB2 level predicted reduced colorectal polyp number compared to placebo (IRR 0.34 [0.12,0.93] for combination aspirin and EPA treatment) compared to high on-treatment 11-d-TXB2 values (0.61 [0.34,1.11]). Aspirin and EPA both inhibit PGE-M and 11-d-TXB2 synthesis in keeping with shared in vivo cyclooxygenase inhibition. Colorectal polyp risk and treatment response prediction by 11-d-TXB2 is consistent with a role for platelet activation during early colorectal carcinogenesis. The use of urinary 11-d-TXB2 measurement for a precision approach to colorectal cancer risk prediction and chemoprevention requires prospective evaluation.

Clinicopathologic comparison between sporadic and syndromic Peutz-Jeghers polyps

Peutz-Jeghers polyps (PJPs) are hamartomatous polyps that may define patients with Peutz-Jeghers syndrome (PJS), a rare inherited polyposis syndrome with high cancer risk. However, the clinical significance of 1-2 sporadic PJPs (without other PJS stigmata) regarding malignant potential and identification of new PJS probands is still unclear. We identified 112 patients with 524 histologically confirmed PJPs and categorized them based on polyp number intosyndromic (n=38) if ≥3 PJPs or diagnosed PJS, solitary (1 PJP, n=61), and intermediate (2 PJPs, n=13). Clinicopathologic features, including presence of dysplasia in the polyp and development of neoplasia in the patient, were compared on a per-patient and per-polyp basis. Whereas patients with solitary and intermediate PJPs were not different from each other, patients with syndromic PJPs were, in multivariate analysis, younger (P =.001) and more likely to develop neoplasia (P=.02) over a 62.6-months median follow-upthan patients with sporadic PJPs. On an individual polyp basis, syndromic PJPs were more likely, in multivariate analysis, to occur in the small intestine (P<.001), but less likely to harbor metaplasia (P=.03) or dysplasia (P=.001), than sporadic PJPs. Dysplasia and metaplasia were more likely in larger PJPs, by multivariate analysis (P=.007 and P<.001, respectively). These data suggest that strict criteria for PJS (including ≥3 PJPs), as currently used, stratify patients into distinct groups with significant differences in clinicopathologic parameters, particularly regarding risk of neoplasia. However, sporadic PJPs exhibit characteristics such as dysplasia and are thus important to recognize and diagnosebut perhaps as heralding only a forme fruste PJS.

Effectiveness of the Sellick maneuver for painless gastroscopy in patients with esophageal hiatal hernia: A randomized, self‑control trial.

The Sellick maneuver is used for endotracheal intubation to prevent the occurrence of gastroesophageal reflux. The aim of the present study was to observe the effect of the Sellick maneuver on safety, esophageal closure status, gastric mucosal fold extension status, and positive detection rate of lesions in patients with esophageal hiatal hernia under painless gastroscopy. A total of 40 patients with esophageal hiatal hernia who underwent painless gastroscopy were screened for the use of the Sellick maneuver, in which the operator applied pressure to the cervical cricoid cartilage during the examination. The status of esophageal closure at the are pressed, examination time, gastric mucosal fold extension score, positive rate of lesion detection, and reflux of gastric juice or gastric contents, amongst other parameters were assessed. After using the Sellick maneuver, the state of esophageal closure during gastroscopy was significantly better than the no-Sellick maneuver group (P<0.05), and the extension scores of the greater curvature folds of the gastric body, the lateral folds of the lesser curvature of the gastric body, and the mucosal folds of the fundus were significantly higher than that of the no-Sellick maneuver (all P<0.05). The number of gastric polyps and gastric lesions (gastric ulcers and mucosal hyperplasia, amongst others) examined with the Sellick maneuver was significantly higher than the no-Sellick maneuver group (P<0.01). The Sellick maneuver effectively improved the extension of gastric mucosal folds during gastroscopy in patients with esophageal hiatal hernia, increased the positive detection rate of gastric lesions, and shortened the endoscopy time.

Endometrial polyps effect on pregnancy outcomes in infertile women with minimal/mild endometriosis: A retrospective study.

To assess the pregnancy outcomes and associated influencing factors of pregnancy after hysteroscopy combined with laparoscopy treatment in infertile patients with minimal/mild endometriosis. A retrospective study. West China Second University Hospital of Sichuan University. We enrolled 898 infertile women who had their minimal/mild endometriosis lesions removed by laparoscopy, including 271 patients additionally diagnosed with endometrial polyps who also underwent hysteroscopic polypectomy. Based on the existence of endometrial polyps, patients with minimal/mild endometriosis were enrolled and divided into polyps group and non-polyps group. Pregnancy outcomes. A total of 271 women with minimal/mild endometriosis were included in polyps group while 491 women with minimal/mild endometriosis were included in non-polyps group. The pregnancy rate of polyps group was not statistically significant compared with non-polyp group (60.15% vs. 58.25%). The pregnancy rate was higher among patients with polyps ≥1 cm (76.06%, 54/71) than patients with polyps <1 cm (54.50%, 109/200) or patients without polyps (58.25%, 286/491) (p = 0.006). The pregnancy rate was higher for patients with multiple polyps (67.86%, 95/140) than for patients with single polyp (51.91%, 68/131) or without polyps (p = 0.025). Among women with minimal/mild endometriosis, hysteroscopic polypectomy did significantly increase fertility in infertile patients with multiple polyps or size of polyp ≥1 cm compared with those without endometrial polyps, single polyp, and size of polyp <1 cm. The size and number of polyps were independently associated with the reproductive ability of women with minimal/mild endometriosis.

Human immunodeficiency virus patients with low CD4 counts are more likely to have precancerous polyps identified during index colonoscopy.

Antiretroviral treatment (ART) has improved the life expectancy of patients living with human immunodeficiency virus (HIV). As these patients age, they are at increased risk for developing non-acquired immunodeficiency syndrome defining malignancies (NADMs) such as colon cancers. To determine which factors are associated with the development of precancerous polyps on screening colonoscopy in patients with HIV and to investigate whether HIV disease status, measured by viral load and CD4 count, might influence precancerous polyp development. A retrospective review of records at two urban academic medical centers was performed for HIV patients who had a screening colonoscopy between 2005-2015. Patients with a history of colorectal cancer or polyps, poor bowel preparation, or inflammatory bowel disease were excluded. Demographic data such as sex, age, race, and body mass index (BMI) as well as information regarding the HIV disease status such as CD4 count, viral load, and medication regimen were collected. Well-controlled patients were defined as those that had viral load < 50 copies, and poorly-controlled patients were those with viral load ≥ 50. Patients were also stratified based on their CD4 count, comparing those with a low CD4 count to those with a high CD4 count. Using colonoscopy reports in the medical record, the size, histology, and number of polyps were recorded for each patient. Precancerous polyps included adenomas and proximal serrated polyps. Data was analyzed using Fisher's exact tests and logistic regression through SAS 3.8 software. Two hundred and seven patients met our inclusion criteria. The mean age was 56.13 years, and 58% were males. There were no significant differences in terms of age, race or ethnicity, insurance, and smoking status between patients with CD4 counts above or below 500. BMI was lower in patients with CD4 count < 500 as compared to those with count > 500 (P = 0.0276). In patients with CD4 > 500, 53.85% of patients were female, and 70.87% of patients with CD4 < 500 were male (P = 0.0004). Only 1.92% of patients with CD4 ≥ 500 had precancerous polyps vs 10.68% of patients with CD4 < 500 (P = 0.0102). When controlled for sex, BMI, and ART use, patients with CD4 < 500 were 9.01 times more likely to have precancerous polyps [95% confidence interval (CI): 1.69-47.97; P = 0.0100]. Patients taking non-nucleoside reverse transcriptase inhibitors were also found to be 10.23 times more likely to have precancerous polyps (95%CI: 1.08-97.15; P = 0.0428). There was not a significant difference noted in precancerous polyps between those that had viral loads greater or less than 50 copies. Patients with low CD4 counts were more likely to have precancerous polyps on their screening colonoscopy although the etiology for this association is unclear. We also found an increased risk of precancerous polyps in patients taking non-nucleoside reverse transcriptase inhibitors, which is contradictory to prior literature showing ART has decreased the risk of development of NADMs. However, there have not been studies looking at colorectal cancer and ART by drug class, to our knowledge. Further prospective studies are needed to determine the effect of HIV control and therapies on polyp development.

Tumor-Promoting Role of GNA14 in Colon Cancer Development.

Recent studies have shown that mutations in members of the G-protein α family contribute to the onset and progression of cancer. However, the role of GNA14 in CRC remains unknown. In this study, we examined the effect of GNA14 on CRC through genetic approaches in vitro and in vivo. We found that GNA14 knockdown by small interfering RNA (siRNA) inhibited the proliferation of CRC cells SW403 and HT29. Gna14 knockout mice developed normally without obvious abnormalities. However, the number of polyps in the small intestine was significantly reduced in Gna14 knockout mice compared to control mice after mating with ApcMin mice, a representative CRC mouse model. In particular, deletion of the Gna14 inhibited polyp growth, especially in the distal end of the small intestine. Histological examination showed that Gna14 knockout mice suppressed malignant tumor progression due to decreased proliferation and increased apoptosis in polyps compared to controls. In addition, GNA14 knockdown in CRC cells resulted in downregulation of ERK phosphorylation and β-catenin and β-catenin phosphorylation at S675. Similarly, ERK phosphorylation and phospho-β-catenin phosphorylation at S675 were decreased in polyps of Gna14 knockout mice. Collectively, these analyses show that GNA14 may accelerate CRC cell proliferation and malignant tumor progression through ERK and β-catenin pathways.

The Relationship Between Colonoscopy Practice Style, Operator Ergonomics and Procedure Quality.

We aimed to compare three endoscopy operators who performed colonoscopy in three different styles in terms of procedure results, colonoscopy quality, and operator comfort during the procedure. A total of 246 patients, who underwent routine screening colonoscopy for precancerous lesions between May and December 2022 in Istanbul Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey, were prospectively analyzed. The results of three different styles (single operator sitting, single operator standing, and two operators standing) were compared with each other. The following criteria were examined: polyp/adenoma detection rate, number of polyps detected per patient, cecal intubation rate, total procedure time, number of endoscope corrective maneuvers, number of patient position corrections during the procedure, and the endoscopist's subjective pain scale after the procedure. The number of corrections and changes in scope position, rates of changing the patient's position during the procedure, and the postprocedural fatigue degree of the endoscopist were the highest for the single-operator standing style (p<0.001). The total processing time and post-procedure fatigue degree of the endoscopist were the lowest for the single-operator sitting style (p<0.001). The adenoma detection rate was the highest for single-operator standing style (37.8% vs 22.0% and 29.3%). The strongest predictive factors for the total procedure time were the colonoscopy style and patient age. The strongest predictive factors for the change in the total number of detected polyps were colonoscopy style, patient gender, and patient age. Independent of all other factors, the total detected number of polyps was statistically significantly higher for the single-operator standing style compared to other styles (B=-0.217, 95% confidence interval: -0.369 - -0.066 and p=0.005) (B=-0.172, 95% confidence interval: -0.326 - -0.017 and p=0.029). Two conclusions were drawn from this study. For routine screening colonoscopy, the single-operator sitting style seems to be superior to other styles in terms of the shortest procedure time and the least tiring. However, the widely used single-operator standing style should be preferred over other styles in terms of the highest adenoma detection rate although it is most tiring and time-consuming.

Epidemiological and Histological Characteristics of Polyps Detected with Positive Tests During Mass Screening in the Wilaya of Béjaia

Detection of polyps during screening colonoscopy has improved significantly in recent years. This results in an increase in the detection rate of adenomas thanks in particular to technological innovations ( chromoendoscopy with indigo carmine or electronic) and the training of gastroenterologists, which is inversely correlated with the occurrence of colorectal cancer. The main objective of our study is to describe the epidemiological profile and histological characteristics of polyps and adenomas detected during a mass screening operation for colorectal cancer in a healthy population in the wilaya of Bejaia. The total number of polyps found in our target population is 196 in 89 people. A person can have a minimum of 1 polyp and a maximum of 6 polyps, the average number of polyps per person is 2 polyps, 43% of the population participating in mass screening for colorectal cancer have at least one polyp and 28% have two polyps.

G-EYE Colonoscopy Is Superior to Standard Colonoscopy for Increasing Adenoma/Polyp Detection Rate

Abstract Background Colorectal cancer (CRC) is one of the most common cancers worldwide. Most CRCs develop from malignant potential polyps, especially adenomas, SSPs and SSLs. Screening is associated with a reduction in CRC incidence through the detection and removal of precancerous polyps and with reduction in CRC related death through reduction of the incidence and early detection of CRC. Colonoscopy is the most widely used screening tool. Unfortunately during colonoscopy examinations, a substantial number of polyps are still being missed. These missed polyps though to be at least 50% of interval CRCs. Objective comparison between G-EYE colonoscopy and standard colonoscopy (SC) for increasing adenoma/polyp detection rate. Patients and Methods prospective randomized study was conducted on 80 Patients as one group, selection done at Hepatology and Gastroenterology department in Theodor Bilharz Research Institute and Outpatient clinic of Gastroenterology unit at Ain Shams University Hospitals. From: June 2021 to November 2021, after ethical committee approval. Results prospective randomized study demonstrated that the polyp detection rate (PDR) was an increased rate by G-EYE colonoscopy, this difference was statistically significant (P ≤ 0.05) as the total number of patients having polyps detected by G-EYE was 28 (40.60%) and the total number of polyps was 43 polyps while by SC was 15 (21.70%) and the total number of polyps was 19 polyps. There is an advantage for G-EYE over SC in relation to the size of the detected polyps as this study compared the detected polyp size as diminutive (&amp;lt;5 mm), small (6-9 mm) and large polyps (&amp;gt;10 mm) by G-EYE versus SC. For the diminutive polyps, the difference was statistically significant (P ≤ 0.05) favoring the G-EYE, and for small polyps the G-EYE was superior to SC by 3 polyps, while for large polyps there was no difference. G-EYE increased the ADR in comparison with SC [22 (100%) vs 9 (13%) ] respectively as G-EYE colonoscopy detected an additional 15 adenomatous polyps in 13 patients missed from SC colonoscopy. The difference was statistically significant. Fortunately there were very few complications, abdominal pain reported in 3 cases after the end of procedures. Conclusion The study demonstrated that G-EYE is superior to SC in increasing adenoma and polyp detection rate as being more rapid and more precise for detection of diminutive and small adenomatous polyps. However G-EYE could not be done in certain conditions such as diverticulosis, masses, ulcerations or colonic strictures for fear of perforation or incomplete intubation, in this study those patients were excluded from the start as the aim of the study was polyp detection rate difference by balloon assisted colonoscopy (G-EYE) in comparison to the standard colonoscopy (SC).

CD44-targeted nanoparticles for co-delivery of docetaxel and an Akt inhibitor against colorectal cancer

New strategies to develop drug-loaded nanocarriers with improved therapeutic efficacy are needed for cancer treatment. Herein we report a novel drug-delivery nanosystem comprising encapsulation of the chemotherapeutic drug docetaxel (DTX) and recombinant fusion of a small peptide inhibitor of Akt kinase within an elastin-like recombinamer (ELR) vehicle. This combined approach is also precisely targeted to colorectal cancer cells by means of a chemically conjugated DNA aptamer specific for the CD44 tumor marker. This 53 nm dual-approach nanosystem was found to selectively affect cell viability (2.5 % survival) and proliferation of colorectal cancer cells in vitro compared to endothelial cells (50 % survival), and to trigger both apoptosis- and necrosis-mediated cell death. Our findings also show that the nanohybrid particles remain stable under physiological conditions, trigger sustained drug release and possess an adequate pharmacokinetic profile after systemic intravenous administration. In vivo assays showed that these dual-approach nanohybrids significantly reduced the number of tumor polyps along the colorectal tract in a murine colorectal cancer model. Furthermore, systemic administration of advanced nanohybrids induced tissue recovery by improving the morphology of gastrointestinal crypts and the tissue architecture. Taken together, these findings indicate that our strategy of an advanced dual-approach nanosystem allows us to achieve successful controlled release of chemotherapeutics in cancer cells and may have a promising potential for colorectal cancer treatment.

Cost and related factors analysis for patients undergoing colon polyp surgery based on DRG mode.

The aim of the study was to analyze the hospitalization costs of patients with intestinal polyps undergoing colonic polyp surgery and associated influencing factors and to explore the entry point of cost control and the way of fine management. One year before (2021) and one year after (2022) the implementation of the Diagnosis Related Grouping (DRG), the patients receiving APC, CSP and EMR in GK39 (colonoscopy operation) group were included in a second Affiliated Hospital in Nanjing according to the Nanjing grouping scheme. Descriptive analysis method and multiple linear regression method were used for analysis. After the implementation of DRG in 2022, the average hospitalization cost of patients decreased by 19.46% compared with the same period last year. Before and after the implementation of DRG, medical technology costs accounted for the highest proportion of hospitalization costs. Age, hospitalization days, number of polyps, number of clamps and clinical pathway had statistically significant effects on hospitalization cost (p<0.05), among which hospitalization days, number of polyps, and number of clamps had the greatest impact on hospitalization cost, followed by age and clinical pathway. The implementation of DRG has a positive effect on guiding hospitalization cost control. It is suggested to realize accurate cost control by analyzing the cost structure of the disease group. Clinical pathway completion rate has a direct impact on the implementation effect of DRG, including cost control. It is suggested to refine clinical pathway management and achieve scientific cost control through continuous optimization and improvement of clinical pathway management.

Colorectal polyp outcomes after participation in the seAFOod polyp prevention trial: Evidence of rebound elevated colorectal polyp risk after short-term aspirin use.

The seAFOod polyp prevention trial was a randomised, placebo-controlled, 2 × 2 factorial trial of aspirin 300 mg and eicosapentaenoic acid (EPA) 2000 mg daily in individuals who had a screening colonoscopy in the English Bowel Cancer Screening Programme (BCSP). Aspirin treatment was associated with a 20% reduction in colorectal polyp number at BCSP surveillance colonoscopy 12 months later. It is unclear what happens to colorectal polyp risk after short-term aspirin use. To investigate colorectal polyp risk according to the original trial treatment allocation, up to 6 years after trial participation. All seAFOod trial participants were scheduled for further BCSP surveillance and provided informed consent for the collection of colonoscopy outcomes. We linked BCSP colonoscopy data to trial outcomes data. In total, 507 individuals underwent one or more colonoscopies after trial participation. Individuals grouped by treatment allocation were well matched for clinical characteristics, follow-up duration and number of surveillance colonoscopies. The polyp detection rate (PDR; the number of individuals who had ≥1 colorectal polyp detected) after randomization to placebo aspirin was 71.1%. The PDR was 80.1% for individuals who had received aspirin (odds ratio [OR] 1.13 [95% confidence interval 1.02, 1.24]; p = 0.02). There was no difference in colorectal polyp outcomes between individuals who had been allocated to EPA compared with its placebo (OR for PDR 1.00 [0.91, 1.10]; p = 0.92). Individuals who received aspirin in the seAFOod trial demonstrated increased colorectal polyp risk during post-trial surveillance. Rebound elevated neoplastic risk after short-term aspirin use has important implications for aspirin cessation driven by age-related bleeding risk. ISRCTN05926847.