Right-sided Polyps Research Articles

Bleeding Risk With Cold Snare Polypectomy of ≤10 mm Pedunculated Colon Polyps.

Pedunculated polyps (PPs) in the colon are usually resected with hot snare polypectomy to prevent immediate postpolypectomy bleeding (IPPB). This study aimed to evaluate the safety of CSP of <10 mm PPs. Patients undergoing colonoscopy from February 18, 2019, to April 24, 2020, and were found to have at least 1 ≤10 mm PP resected with CSP were included prospectively in a continuous quality improvement project to assess the risk of IPPB and delayed postpolypectomy bleeding. Polyp location, size, and pathology, as well as the method of resection, were recorded. In addition, we assessed the occurrence and severity of IPPB and the need for intervention. We found 239 eligible polyps in 182 patients. The mean (SD) age was 58.8 (8.3) years, and 61% were males. IPPB occurred in 72 of 239 polyps, corresponding to a per-polyp bleeding percentage of 30.1% and in 65 of 182 patients, equating to a per-patient bleeding rate of 35.7%. We successfully treated bleeding by endoscopic hemostasis in 57%; the remaining 31 polyps (43%) did not require endoscopic intervention. There was no association between IPPB with age, gender, or use of aspirin or antithrombotic agents. In the bivariate model, polyp size and pathology were not associated with the risk of IPPB. Right-sided polyps were associated with a reduced risk of IPPB in the bivariate model by 61% (odds ratio=0.39; 95% confidence interval, 0.21-0.74;P=0.0057). In the multivariate model, choking the polyp base decreased the likelihood of IPPB by 97% (odds ratio=0.03; 95% confidence interval, 0.00-0.86;P=0.0459). There were no instances of delayed bleeding, perforation, or postpolypectomy syndrome. CSP can be used for resection of ≤10 mm PPs. It is associated with a lower risk of immediate bleeding than the common perception among gastroenterologists.

Is Endoscopic Submucosal Dissection for Colorectal Lesions Performed in the Endoscopy Suite Safe and Cost Saving?

We aimed to compare the outcomes and the cost differences of endoscopic submucosal dissection (ESD) procedures in the endoscopy suite (ES) versus the operating room (OR). The procedures in the OR were compared with procedures performed in the ES for demographics, lesion characteristics, procedure outcome, and procedure charges. The study included 163 procedures in the ES and 73 in the OR. Both were similar in age, sex, body mass index, and intraprocedural and postoperative 30-day (late) complications. ES cases had significantly greater polyp size, were more commonly right-sided polyps, and had shorter hospital stays, with similar en bloc and margin-negative resection rates. The overall cost ratio of ESD procedures in ES to OR was 0.47 ( P <0.001). Colorectal ESD procedures performed in the ES have similar efficacy and safety as those in the OR. Procedures performed in the ES were associated with a shorter length of stay and significant periprocedural cost savings.

Endoscopic polypectomy for malignant polyps: Should tumor location (right versus left side) guide clinical decisions?

BackgroundCurrent guidelines consider endoscopic resection appropriate treatment for malignant colon polyps with negative margins, low-grade histology, and no lymphovascular invasion. While increasing literature demonstrates a worse prognosis for advanced stage right- versus left-sided colon cancers after curative treatment, there is paucity of data regarding prognostic effect of location in patients undergoing endoscopic resection of T1 polyps. We hypothesized the more aggressive biologic behavior observed in advanced right-sided cancers would be similarly represented in malignant polyps, and this location would be associated with lower overall survival. MethodsThe National Cancer Database was queried for adults with T1NxMx tumors who underwent endoscopic polypectomy (2004–2017). Patients with positive margins or without follow-up information were excluded. ResultsA total of 2,337 patients met inclusion criteria; 22% had right-sided polyps. Endoscopically excised proximal tumors were more common in elderly, and those with public insurance and more comorbidities (all P < .01). Among patients with complete pathologic data, there were no statistical differences between right- and left-sided polyps with 1 cm median size, >92% without lymphovascular invasion, and 100% without tumor deposits. Univariate analysis showed 73% vs 86% 5-year overall survival for right versus left polyps (P < .01). After adjustment for available confounders, right-sided location remained significantly associated with worse overall survival (hazard ratio 1.49, 95% confidence interval 1.21–1.83). ConclusionIn this national cohort of patients with endoscopically excised malignant polyps, we identified right colon location as an independent prognostic factor associated with increased risk of mortality. Our data suggest polyp location should be taken into consideration when making clinical decisions regarding treatment and/or surveillance.

Circulating Sex Hormones and Risk of Colorectal Adenomas and Serrated Lesions in Men.

Sex hormones have been implicated in the etiology of colorectal neoplasia in women for over 40 years, but there has been very little investigation of the role of these hormones in men. Using data from an adenoma chemoprevention trial, we conducted a secondary analysis to examine serum hormone levels [testosterone, androstenedione, DHEA sulfate (DHEAS), and sex hormone binding globulin (SHBG)] and risk of colorectal precursors in 925 men. Multivariable logistic regression models were fit to evaluate adjusted associations between hormone levels and risk of "low-risk" (single tubular adenoma < 1 cm) and "high-risk" lesions (advanced adenoma or sessile serrated adenoma or right-sided serrated polyp or >2 adenomas of any size). Overall, levels of free testosterone, total testosterone, androstenedione, DHEAS, or SHBG were not associated with either "low-risk" or "high-risk" early precursor lesions in the colorectum. These findings do not support the role of sex hormones in early colorectal neoplasia among men. This large prospective study address a missing gap in knowledge by providing information on the role of sex hormones in colorectal neoplasia in males.

The management of colonic polyps in children: a 13-year retrospective study

The aim of this study was to describe the frequency, major symptoms, and characteristics of colonic polyps in a cohort of children. A retrospective chart review of patients aged ≤ 18 years who were diagnosed with colonic polyp(s) from 2006 to 2019 in a tertiary hospital was included. Data collected included demographics, clinical presentation, interval of time between the onset of symptoms and the endoscopic diagnosis of colonic polyps, family history, characteristics of the polyp, and associated lesions. Over the study period, 35 Caucasian children were diagnosed with juvenile colonic polyps. Twenty-three patients (65.7%) were males. Lower gastrointestinal bleeding of a mean duration of 5.3 ± 4.9 months was the presenting symptom in nearly all cases (n = 34, 97%), and it was isolated in 17 patients. Clinical presentation did not significantly vary according to the age or the location or size of the polyp (p = 0.262, p = 1.000, and p = 0.149, respectively). The polyps were mainly located in the left colon (n = 29, 83%). Right colonic polyps were significantly larger than left colonic polyps (p = 0.037).Conclusion: Lower gastrointestinal bleeding represents the most common presentation of colonic polyps in children. Right-sided colonic polyps occur and may be even larger than left-sided ones. A total colonoscopy is therefore mandatory for all cases of suspected colonic polyps. This study represents a real-life contribution, and it can help improve the management strategies of this condition in childhood. What is Known: • Colonic polyps are quite common in children. • The majority of pediatric colonic polyps are solitary, benign, and located in the left colon. What is New: • Right-sided colonic polyps occur and may be even larger than left-sided ones. • A total colonoscopy is mandatory for all cases of suspected colonic polyps.

Risks of post-colonoscopic polypectomy bleeding and thromboembolism with warfarin and direct oral anticoagulants: a population-based analysis

BackgroundThere were limited data on the risk of post-polypectomy bleeding (PPB) in patients on direct oral anticoagulants (DOAC). We aimed to evaluate the PPB and thromboembolic risks among DOAC and...

Is immunohistochemistry always the panacea to morphologic mimics? Two, distinct soft tissue tumors exhibiting alveolar pattern and TFE3 immunoreactivity

Alveolar soft part sarcoma (ASPS) and certain perivascular epithelioid cell neoplasms (PEComas) exhibit overlapping histopathological features, including immunohistochemical expression of TFE3, as well as TFE3 gene rearrangement. PEComas with an epithelioid morphology are known to exhibit variable immunoexpression of muscle markers. At the same time, aberrant immunoreactivity of HMB45 immunostain, which is invariably, used to substantiate a diagnosis of a PEComa, has been reported in various other tumors. Herein, we discuss two rare cases of soft tissue tumors with overlapping morphological and immunohistochemical features. Case1: A 34-year-old male underwent a biopsy for a recurrent, right-sided nasal polyp. Biopsy showed polygonal tumor cells, containing prominent nucleoli, arranged in a "nesting-type"/alveolar growth pattern. Immunohistochemically, tumor cells displayed TFE3 positivity and an aberrant positivity for HMB45. Special stain (PAS-diastase) highlighted intracytoplasmic granules and crystals. Diagnosis of ASPS was offered. Furthermore, the tumor cells displayed TFE3 gene rearrangement. Case 2: A 29-year-old female underwent an aural polypectomy. Microscopic examination revealed a tumor with a "nesting-type"/alveolar arrangement of tumor cells with vacuolated cytoplasm, arranged around thin-walled blood vessels. Immunohistochemically, tumor cells were diffusely positive for HMB45 and TFE3 and focally for SMA. A diagnosis of a PEComa was offered. This report constitutes the first documentation of aberrant HMB45 immunoreactivity in case of ASPS, and one of the first reported cases of a PEComa in the ear. It emphasizes the value of integrating clinicopathological features with immunohistochemical and molecular results in differentiating two rare, but distinct soft tissue tumors with overlapping features. An exact diagnosis of both these tumor entities has therapeutic implications.

Valuing innovative endoscopic techniques: prophylactic clip closure after endoscopic resection of large colon polyps

Clip closure of the mucosal defect after resecting large (≥20mm) nonpedunculated colorectal polyps reduces postprocedure bleeding and is cost saving for payers. Clip costs are not reimbursed by payers, posing a major barrier to adoption of this technique in the community. We aimed to determine appropriate clip costs to support broader use of this procedure in practice. We performed budget impact analysis using our recent decision analytic model, comparing prophylactic clip closure with no clip closure on national cost and outcomes data, to determine the maximum feasible clip price while maintaining cost savings in practice. Sensitivity analyses were performed on important clinical factors. In the original model, the baseline postprocedure bleeding risk was 6.8%, increasing cost of care by $614.11 averaged among all patients undergoing large polyp resection without clip closure. Prophylactic clip closure of only large right-sided polyps reduced postprocedure bleeding risk by 70.7% but resulted in cost saving only if the price of clips was $100 or less. Comparatively, prophylactic clip closure of large left-sided polyps had no clinical benefit and was not cost saving. Clip closure strategies focused only on extra-large polyps (≥40mm), or patients taking antithrombotics regardless of polyp characteristics, were only minimally cost saving. Cost savings and maximum tolerated clip prices depended on medical comorbidity, which directly influences the costs of care to manage postprocedure bleeding. Prophylactic clip closure after endoscopic resection of large colon polyps, particularly those in the right colon segment, is cost saving but requires clip costs less than $100. Translating these findings into practice requires gastroenterology practices to obtain reimbursement from payers for improved clinical outcomes and to align commercial clip prices with this clinical indication.

211 Increased Synchronous Neoplasms Among Patients With Small and Diminutive Proximal Hyperplastic Polyps

INTRODUCTION: Small right-sided sessile serrated polyps (SSPs) are associated with increased risk of synchronous neoplasia. These lesions are difficult to distinguish from non-precancerous hyperplastic polyps (HPs). Hamoudah et al. published a retrospective cohort study showing that diminutive proximal HPs and SSPs are associated with similar increased rates of synchronous advanced neoplasia among screening colonoscopies. Verification of these findings could impact guidelines that currently consider proximal diminutive HPs as surveillance-irrelevant. METHODS: Our data was extracted from UCICQD—a prospective database (est 2012) with polyp location, size, and pathology. Study design was modeled after that of Hamoudah et al, and included screening colonoscopies divided into: Group 1 (G1)—cases with 1–3 proximal HPs ≤10 mm; Group 2 (G2)- cases with no proximal SSPs or HPs; and Group 3 (G3)—cases with 1–2 proximal SSPs ≤10 mm. Synchronous and advanced neoplasms were compared between G1–G3. RESULTS: Compared to G2, G1 had higher per case rates of synchronous adenomas (52% vs 43%, P = 0.001), 2 or more SSPs (0.6% vs 0.1%, P = 0.046) and 2 or more adenomas (12.4% vs 8.3%, P = 0.01). Compared to G2, G3 had higher per-case rates of synchronous adenomas (50% vs 43%, P = 0.041), SSPs &gt; 9 mm (3.6% vs 0.1%, P &lt; 0.0001) and advanced neoplasms (16.2% vs 11.9%, P = 0.034) (Table 1). Odds ratios (OR) for G1 relative to G2 was significant for 2 or more adenomas (1.48 [1.06–2.08], P = 0.021). For G3 relative to G2, OR were significant for SSP &gt;9 mm (31.05 [9.50–101.55], P &lt; 0.0001). Considering G1 and G3 together, OR relative to G1 were significant for finding of any adenoma (1.19 [1.02–1.38], P = 0.027), SSP &gt; 9 mm (12.72 [3.91–41.44], &lt;0.0001) and &gt;2 adenomas (1.37 [1.04–1.81]) (Table 2). CONCLUSION: Our data confirms Hamoudah et al's findings. Proximal diminutive and small serrated polyps are associated with increased rates and OR for synchronous surveillance relevant and advanced neoplasia. The higher rate of advanced neoplasia among small and diminutive proximal serrated neoplasia was largely accounted for by large SSPs. The surveillance-relevance of proximal small and diminutive serrated lesions is also supported by the increased rate and OR of cases with &gt;2 adenomas. However, studies such as this showing “synchrony” may be insufficient to warrant change in surveillance guidelines, which should be based on “metachrony.”

1673 Multitarget Stool DNA Test (Cologuard™): A Double-Edged Sword

INTRODUCTION: Colorectal cancer (CRC) is the third most common cancer diagnosed in both men and women in the United States. Fortunately, early, precancerous lesions, can be caught early with proper screening, however, only approximately 60% of the US population gets screened. The multitarget stool DNA test (Cologuard™) is an alternative to colonoscopy that might help reach more patients. We present two cases of patients with positive Cologuard tests and unexpected outcomes which posed clinical challenges. CASE DESCRIPTION/METHODS: Case 1: A 63-year-old male who declined colonoscopy in the past opted for Cologuard, which was positive. Subsequent colonoscopy revealed several polyps including one measuring 3.5 cm in the proximal transverse colon, which was thought to be cancerous, so it was only biopsied and not removed (Figure 1). Biopsy of this polyp revealed hyperplastic changes necessitating another colonoscopy. However the patient remains lost to follow up. Case 2: A 75-year-old male, with history of stroke, ischemic heart disease, chronic constipation and no family history of CRC presented to gastroenterology clinic after he had a positive Cologuard test. Colonoscopy was performed revealing a normal colon without mass or polyps. DISCUSSION: The multitarget stool DNA (Cologuard™) is highly sensitive for detecting CRC at 92%. It is a convenient alternative for patients who do not want to undergo colonoscopy, however it can sometimes create clinical dilemmas as exhibited by our cases. In our first case Cologuard™ was able to detect a large right-sided polyp, the sensitivity for such polyps is 42%. This patient was very reluctant to undergo colonoscopy in the first place. He agreed to a noninvasive test, but it has proven difficult to get him back for another colonoscopy. This illustrates the potential ethical and medicolegal dilemmas that can arise when patients with positive stool-based tests are lost to follow up. These patients may be prone to defer colonoscopy due their initial reservations about the procedure. In our second case, the positive Cologuard™ with normal colonoscopy raises concern for a neoplasm elsewhere in the GI tract. Some gastroenterologists perform an EGD in this situation, while others do not. The reported false positive rate for Cologuard™ is 45%, however there are no guidelines for what should be done after a false-positive result. This is an area where further research is needed.

Practice patterns and predictors of prophylactic endoscopic clip usage during polypectomy.

Background and study aims Prophylactic endoscopic clips are commonly placed during polypectomy to reduce risk of delayed bleeding, although evidence to support this practice is unclear. Our study aimed to: (1) identify variables associated with prophylactic clip use; (2) explore variability between endoscopists’ clipping practices and (3) study temporal trends in prophylactic clip use. Patients and methods This was a retrospective cohort study in a high-volume unit dedicated to screening-related colonoscopies. Colonoscopies involving polypectomy from 2008 to 2014 were reviewed. The primary outcome was prophylactic clipping status, both at the patient level and per polyp. Hierarchical regression models yielded adjusted odds ratios (AORs) to determine predictors of prophylactic clipping. Results A total of 8,366 colonoscopies involving 19,129 polypectomies were included. Polyp size ≥ 20 mm was associated with higher clip usage (AOR 2.94; 95 % CI: 2.43, 3.54) compared to polyps < 10 mm. Right-sided polyps were more likely to be clipped (AOR 2.78; 95 % CI: 2.34, 3.30) relative to the rectum. Surgeons clipped less than gastroenterologists (OR 0.52; 95 % CI: 0.44, 0.63). From 2008 to 2014, the crude proportion of prophylactically clipped cases increased by 7.4 % (95 % CI: 7.1, 7.6) from 1.9 % to 9.3 %. Significant inter-endoscopist variability in clipping practices was observed, notably, for polyps < 10 mm. Conclusions Prophylactic clip usage was correlated with established risk factors for delayed bleeding. Significantly increased clip usage over time was shown. Given that evidence does not clearly support prophylactic clipping, there is a need to educate practitioners and limit healthcare resource utilization.

Increasing rates of SSA/P detection in a large open-access Australian colonoscopy cohort.

Abstract Background and study aims There are limited longitudinal data regarding detection rates for sessile serrated adenoma/polyps (SSADR) and right-sided hyperplastic polyps (RHPDR) that constitute the proximal serrated lesion detection rate (PSLDR). Recently, a minimum PSLDR of 4.5 % has been suggested. This study was designed to assess SSADR, PSLDR and adenoma detection rate (ADR) for a newly qualified gastroenterologist and compare them to published data and to assess the change in SSADR, PSLDR and ADR over time for potential improvement with experience. Patients and methods All colonoscopies performed by a single colonoscopist (AM), at one Australian ambulatory direct-access endoscopy center over 4 years from 2011 to 2015 were retrospectively analyzed. Histology was reported by a single expert pathologist (SL). ADR, SSADR, RHPDR and PSLDR were recorded. Results A total of 841 colonoscopies were performed on 637 patients. Of them, 454 (54 %) were males. Mean age was 59 years. Of the colonoscopies, 87 % were performed for patients with ASA scores of 1 – 2, 422 (50.2 %) were for screening or surveillance, 374 (44.5 %) for investigation of symptoms and 45 (5.4 %) had therapeutic indications. Conventional adenomas were detected in 346 colonoscopies (ADR = 41.1 %), SSA/P in 124 (SSADR = 14.7 %) and RHP in the absence of SSA/P in 35 (RHPDR = 4.2 %). PSLDR was 18.9 %. ADR was stable over time (range 33 %-50 %). SSADR and PSLDR increased over time [SSADR: 8.6 % (2011), 8.4 % (2012), 14.9 % (2013), 18.5 % (2014), 25.0 % (2015); PSLDR: 10.5 % (2011), 11.3 % (2012), 16.8 % (2013), 27.2 % (2014), 29.4 % (2015)]. There was a statistically significant improvement in SSADR (IRR 1.37) and PSLDR (IRR 1.36) over the study period (P &lt; 0.001), whereas the ADR remained stable (IRR 1.04, P = 0.334). Conclusions SSADR and PSLDR in this unselected direct-access cohort are high and exceed previously reported detection rates in the final 2 years. Detection rates improved with experience, likely representing a learning effect. The minimum expected PSLDR may need to be revised upwards and further studies are required, particularly in areas where screening colonoscopies are offered only for patients with increased colorectal cancer risk (family history or fecal immunochemical test-positive).

Serrated polyposis syndrome: Diagnosis and management

Serrated polyposis syndrome is a clinical diagnosis characterized by a few large right-sided colorectal serrated polyps, multiple small serrated polyps, or a combination of both. Colorectal polyps and cancers develop via the methylator (or serrated) carcinogenic pathway. Patients with SPS have an increased risk of CRC compared to the general population throughout their lifetime and adequate surveillance and intervention are necessary. Cancer develops mainly via serrated polyp intermediates, but adenomas can also be present. The goals of management are to prevent the development of colorectal cancer and death from colorectal cancers. Colonoscopy beginning at age 40 at the latest, with polypectomy is the mainstay of clinical management. Surgery is utilized to treat colorectal cancer or decrease its risk. First-degree family members of patients with SPS are also at increased risk of colorectal cancer compared to the general population and increased colonoscopic screening is indicated.

Right-sided Colonic Juvenile Polyp [Polyps] in Paediatric Primary Sclerosing Cholangitis Patients

Right-sided Colonic Juvenile Polyp [Polyps] in Paediatric Primary Sclerosing Cholangitis Patients

Sa1051 FREQUENCY OF RIGHT-SIDED PRECANCEROUS POLYPS REMAINS HIGH DESPITE ABSENCE OF POLYPS IN THE LEFT COLON

Flexible sigmoidoscopy has become an important tool for colorectal cancer screening but unfortunately lacks visualization of more proximal colonic lesions. Colorectal lesions found during flexible sigmoidoscopy may warrant further proximal colonic lesion investigation. There however is limited research on the frequency of right-sided precancerous polyps in the absence of polyps in the left colon. Assess the likelihood of finding a polyp, adenoma or sessile serrated adenoma/polyp (SSA/P) in the right colon when no polyps are seen within the left colon. Colonoscopy quality data was collected prospectively at our single tertiary referral center from June 2012 to Nov 2017 using Qualoscopy (Docbot, Inc.). We included all colonoscopies for patients of all ages. We compared detection rates of polyps (PDR), adenomas (ADR) and sessile serrated adenomas/polyps (SSADR/SSPDR) with the left colon (rectum to splenic flexure) and right colon (transverse colon to cecum). 2777 colonoscopies met our inclusion criteria. 49% of patients were male and 51% were female. Mean age was 58.1 years, average Boston prep scores was 7.9 out of 10 and average cecal intubation rate was 98%. Table 1 shows the detection rates and mean number of polyps, adenomas, SSAs and SSPs within the right colon. The ‘Independent of Left Colon Findings’ row shows right colon detection rates that are independent of lesions within the left colon. The ‘No Polyps’ row shows these same values when no polyp was found within the left colon. The ‘Adenoma’ row shows these same values when at least 1 adenoma was found in the left colon. The ‘Sessile Serrated Polyp’ row shows these same values when at least 1 SSA or 1 hyperplastic polyp was found in the left colon. The PDR, ADR and SSADR in the right colon when no polyp was found within the left colon were, 0.33%, 0.22% and 0.058%, respectively. Table 1 also shows the rates of PDR, ADR and SSADR/P are higher when an adenoma or SSP was found within the left colon. Our data demonstrate a higher detection rate of polyps, adenomas and SSA/Ps in the right colon if an adenoma or SSP is found within the left colon. More importantly and interestingly, our data also reveals the absence of polyps in the left colon does not reliably predict the rate of precancerous polyps in the right colon. High PDR, ADR and SSADR within the right colon despite an absence of polyps in the left colon suggest that limited colonoscopies such as flexible sigmoidoscopies may miss many significant precancerous lesions more proximally.Tabled 1Detection Rates within the Right ColonRIGHT COLONLEFT COLONColonoscopiesPDRADRSSADRSSPDRMean Polyps PPMean Adenomas PPMean SSAs PPMean SSPs PPIndependent of Left Colon Findings27770.440.290.08N/A2.201.941.51N/ANo Polyps17010.330.220.0580.630.380.075Adenoma5470.640.490.121.621.080.20Sessile Serrated Polyp5360.620.39N/A0.291.570.76N/A0.55PDR-polyp detection rate, ADR-adenoma detection rate, SSADR -sessile serrated adenoma detection rate, SSPDR – sessile serrated polyp detection rate (SSADR + hyperplastic polyp detection rate), PP - per procedure, SSA -sessile serrated adenoma, SSP – sessile serrated polyp Open table in a new tab PDR-polyp detection rate, ADR-adenoma detection rate, SSADR -sessile serrated adenoma detection rate, SSPDR – sessile serrated polyp detection rate (SSADR + hyperplastic polyp detection rate), PP - per procedure, SSA -sessile serrated adenoma, SSP – sessile serrated polyp

Genetic Biopsy for Prediction of Surveillance Intervals after Endoscopic Resection of Colonic Polyps: Results of the GENESIS Study.

Current surveillance strategies for colorectal cancer following polypectomy are determined by endoscopic and histopathological factors. Such a distinction has been challenged. The present study was designed to identify molecular parameters in colonic polyps potentially defining new sub-groups at risk. One hundred patients were enrolled in this multicentre study. Polyps biopsies underwent formalin-free processing (PAXgene, PreAnalytiX) and targeted next generation sequencing (38 genes (QIAGEN), NextSeq 500 platform (Illumina)). Genetic and histopathological analyses were done blinded to other data. In 100 patients, 224 polyps were removed. Significant associations of genetic alterations with endoscopic or histological polyp characteristics were observed for BRAF, KRAS, TCF7L2, FBXW7 and CTNNB1 mutations. Multivariate analysis revealed that polyps ≥ 10 mm have a significant higher relative risk for harbouring oncogene mutations (relative risk 3.467 (1.742-6.933)). Adenomas and right-sided polyps are independent risk factors for CTNNB1 mutations (relative risk 18.559 (2.371-145.245) and 12.987 (1.637-100.00)). Assessment of the mutational landscape of polyps can be integrated in the workflow of current colonoscopy practice. There are distinct genetic patterns related to polyp size and location. These results suffice to optimise individual risk calculation and may help to better define surveillance intervals.

Management of the colorectal polyp referred for resection: A case-matched comparison of advanced endoscopic surgery and laparoscopic colectomy

BackgroundColonoscopy is the gold standard for colorectal screening and surveillance. Advanced endoscopic polypectomy techniques such as endoscopic submucosal dissection (ESD) have been introduced to remove large colorectal polyps. Our aim was to compare the outcomes of patients who underwent ESD with those of who underwent laparoscopic colectomy for benign colorectal polyps. MethodsPatients with a preoperative diagnosis of benign colorectal polyp who underwent ESD or colectomy between 2011 and 2016 were case matched for age, sex, body mass index, American Society of Anesthesiologists status, polyp size, and location. Outcomes and cost data were analyzed. Polyps proximal to the splenic flexure were grouped as right-sided polyps, and polyps distal to the splenic flexure were grouped as left-sided polyps. ResultsWe identified 144 patients in the laparoscopic resection group and 111 patients in the ESD group; 48 patients met the matching criteria. Of the 48 patients in the ESD group, 5 required operative resection. Mean duration of stay in laparoscopic resection group and the ESD group was 5.2 ± 2.4 days vs 1.5 ± 1.4 (P < .001). Mean operative time was no different (136 ± 45 vs 133 ± 72.7 minutes, respectively). Six patients had follow-up colonoscopy within a year in the laparoscopic resection group versus 22 patients in the ESD group. The laparoscopic group had 21% complication rate versus 15% for the ESD group (P > .05). ESD had a 43% cost-reduction advantage over laparoscopic colectomy, with a 44% and 39% cost advantage for right- and left-sided lesions, respectively. ConclusionESD is more cost effective than conventional segmental resection. With an experienced endoscopist, ESD can be offered as a colon-preserving procedure.

Su1734 - Isolated Small Right-Sided Hyperplastic Polyps Confer Higher Rates of Synchronous Advanced Neoplasia Compared to an Average Risk Screening Population

Su1734 - Isolated Small Right-Sided Hyperplastic Polyps Confer Higher Rates of Synchronous Advanced Neoplasia Compared to an Average Risk Screening Population

Feasibility of Large-Scale Identification of Sessile Serrated Polyp Patients Using Electronic Records: A Utah Study.

The serrated pathway accounts for 15-25% of sporadic colorectal cancer (CRC). In our study, we sought to accurately characterize sessile serrated polyps (SSP) in a population by electronically interrogating colonoscopy patients' endoscopy and pathology reports using a rules-based text search of pre-defined SSP-related terms. To this aim, we compared a sample of putative SSP and hyperplastic polyps (HP) using our algorithm to a determination of SSP or HP by pathologist and molecular examination to determine the feasibility of large-scale identification of SSP in electronic medical records. In 23,990 endoscopy reports from colonoscopies with pathology performed at a University of Utah Healthcare facility in 2000-2012, we identified serrated lesions and categorized each as putative SSP or HP using a text search algorithm. We obtained 93 tissue samples for histologic and molecular analysis. Serrated polyps were categorized as putative SSP (N=920) and putative HP (N=7159) by text search algorithm. Histologic examination of 93 samples identified 37 SSP, 11 probable SSP, and 45 HP. Of 26 putative SSP, 25 were SSP/probable SSP (96%) by histology. Of 67 putative HP, 44 were HP (66%) by histology. Reducing size criterion from ≥1 to ≥5mm in the search algorithm caused improved sensitivity (77.1%) without decline in specificity (97.8%). A simple rules-based search to identify SSP provides "proof of principle" that SSP can be identified in a large electronic record set. Pilot data indicate defining large, right-sided polyps as ≥5mm provides adequate sensitivity to detect SSP from electronic records while maintaining high specificity.

Outcome of Microlaryngeal Surgery for Vocal Fold Polyp on Quality of Voice

ABSTRACT Aim To study the outcome of microlaryngeal surgery for vocal fold polyp on quality of voice with voice handicap index-10 (VHI-10). Objective Microlaryngeal surgery for vocal fold polyp will improve the quality of voice. Materials and methods This is a nonrandomized prospective study with a quasi-experimental design. A total of 36 patients presenting with vocal cord polyp and who underwent a microlaryngeal surgery for the same from March 2016 to August 2016 were included in the study. All the patients were given a self-reporting questionnaire consisting of 10 questions — VHI-10 — and asked to score it. The same questionnaire was given 6 weeks postmicrolaryngeal surgery to these patients and both scores were compared. Results The mean age of the study population was 44.67 ± 0.34 with the maximum number of patients in the age group 31 to 50. Out of the 36 patients, 27 were males and 9 females. A total of 22 (61%) patients had right-sided polyp and 14 (39%) had left-sided polyp. The majority of the patients were voice professionals, with the maximum number being that of teachers. The mean preoperative and postoperative VHI-10 was 30.36 ± 6.42 and 1.11 ± 1.76 respectively. The reduction in preoperative and postoperative scores gave a p-value of &lt;0.05 at a confidence interval of 95%. How to cite this article Nath HSS, Menon JR, Issac ME, Binukrishnan R, Sebastian A. Outcome of Microlaryngeal Surgery for Vocal Fold Polyp on Quality of Voice. Int J Phonosurg Laryngol 2017;7(1):13-15.