Risk Factors For Adenoma Research Articles

Synergistic Effect of Hyperglycemia and Helicobacterpylori Infection Status on Colorectal Adenoma Risk.

Both Helicobacter pylori and type 2 diabetes mellitus are possible risk factors for colon adenoma. The purpose of this study was to assess the interaction between H. pylori and hyperglycemia status on the risk of colon adenoma. This was a cross-sectional, retrospective study conducted at the MacKay Memorial Hospital, Taiwan. The study included 3943 subjects aged >40 years undergoing bidirectional gastrointestinal endoscopy on the same day between July 2006 and June 2015. All subjects had a gastric biopsy specimen tested for H. pylori. Colon adenoma with and without H. pylori infection at different hemoglobin A1c (HbA1c) levels. The prevalence of colorectal adenomas in patients who were H. pylori-positive and H. pylori-negative was 37.3% and 27.29%, respectively. Multivariate logistic regression analysis identified male sex, age, body mass index, H. pylori infection, and HbA1c ≥6.5% as independent risk factors for adenoma; use of hypoglycemic agents decreased this risk. The prevalence of adenoma was increased with elevated HbA1c levels regardless of H. pylori status. The odds ratio (OR) for adenoma was 1.44 (95% confidence interval [CI], 1.20 to 1.73) if H. pylori was present or 1.68 (95% CI, 1.05 to 2.70) in patients who were H. pylori-negative but had HbA1c ≥7.0%. If both conditions were present, the OR was 4.79 (95% CI, 2.92 to 7.84). A 1% increase in HbA1c was associated with an increased prevalence of adenoma by 42.4% in H. pylori-positive subjects. The combination of H. pylori infection and elevated HbA1c is associated with an increased risk of colon adenoma.

Abstract A24: Lifetime use of antibiotics and risk of colorectal adenoma

Abstract Background: Antibiotics shift the gut microbiota to temporally quasi-stable or alternative stable states, marked by a loss of diversity, alternations in the abundance of specific taxa, shifts in metabolic capacity, and by reduced resistance to colonization against invading pathogens. Recent evidence suggests that antibiotic use may be associated with an increased risk of colorectal cancer. However, these prior studies may be confounded by symptoms associated with colorectal cancer or differential exposure to medical care. To address these potential concerns, we examined the association of chronic antibiotic exposure and recent antibiotic use with risk of colorectal adenomas, which are largely asymptomatic and the precursor of majority of colorectal cancers. Methods: We prospectively evaluated the association between chronic lifetime antibiotic use at age 20-39 and age 40-59 (assessed in 2004), and recent antibiotic use (assessed in 2008) and risk of subsequent colorectal adenoma among women aged ≥60 in the Nurses' Health Study who underwent at least one lower endoscopy through 2010. Antibiotic use was categorized according to the total time using antibiotics (excluding skin creams, mouthwash or Isoniazid) during a specific time period (age 20-39, or age 40-59, or past 4 years). We also investigated the association between antibiotic exposure during each time period and risk of high-risk (adenoma ≥1cm, or with villous histology, or ≥3 adenomas) vs. low-risk adenoma, as well as risk of adenoma according to anatomic location. We used multivariate logistic regression adjusting for known and putative risk factors for adenoma to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among 17,002 women aged ≥60 who reported their antibiotic exposure and then subsequently underwent at least one lower endoscopy, we documented 1,213 cases of adenoma over 6 years of follow-up. An increasing duration of antibiotic use at age 20-39 (Ptrend=0.002) and 40-59 (Ptrend=0.001) was significantly associated with an increased risk of colorectal adenoma. Compared to non-users, women who used antibiotics for ≥2 months between age 20-39 had a multivariable OR for adenoma of 1.37 (95% CI: 1.04-1.81). Women who used ≥2 months of antibiotics between age 40-59 had a multivariable OR of 1.71 (95% CI: 1.25-2.33). The associations were similar for high-risk compared to low-risk adenomas, but appeared somewhat stronger for adenomas of the proximal compared with distal colon. In contrast, recent antibiotic use within the past 4 years was not associated with risk of adenoma (Ptrend=0.44). Conclusion: In this prospective study, exposure to antibiotics earlier in life (age 20-39 and 40-59) was significantly associated with an increased risk for colorectal adenoma. This increased risk was evident even after adjustment for known colorectal cancer risk factors. In contrast, more recent antibiotic use (within 4 years) was not associated with risk. To the best of our knowledge, this study is the first to link midlife antibiotic use, in a dose-dependent fashion, to colorectal adenoma. These data provide additional support for the association of the gut microbiome with colorectal neoplasia. Citation Format: Yin Cao, Kana Wu, Raaj Mehta, David Drew, Mingyang Song, Paul Lochhead, Jacques Izard, Charles Fuchs, Wendy Garrett, Curtis Huttenhower, Shuji Ogino, Edward Giovannucci, Andrew Chan. Lifetime use of antibiotics and risk of colorectal adenoma. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr A24.

High C-reactive protein level is associated with high-risk adenoma.

Background/AimsThere is substantial evidence supporting a role of inflammation in the pathogenesis of colorectal cancer; however, little is known about the association between serum C-reactive protein (CRP) and the risk of colorectal adenoma. This study was conducted to investigate the association between serum CRP and colorectal adenoma risk.MethodsA retrospective cross-sectional study was performed on first-time screening colonoscopies in asymptomatic subjects who also had their serum CRP level measured during a routine health check-up between September 2006 and September 2009 in Korea. Serum CRP level was compared between high-risk and low-risk adenoma groups and independent predictors of high-risk adenoma were analyzed using multivariate regression analysis.ResultsAmong the 3,309 eligible patients, the high-risk adenoma group had higher serum CRP levels than the low-risk adenoma group (P=0.000). In addition, patients with a high-risk adenoma were more frequently included in the high CRP group than in the low CRP group (8.6% vs. 4.0%, P<0.001). The prevalence of high-risk adenoma was 3.5 times higher in the highest quartile of CRP level (P=0.000) compared with that in the lowest quartile. In logistic regression analysis, a higher quartile CRP level was found to be an independent risk factor for high-risk adenoma (odds ratio, 1.8; 95% confidence interval, 1.3–2.5; P=0.000).ConclusionsHigh CRP level is associated with high-risk adenoma in both men and women. Our data may support the association between chronic inflammation and colorectal neoplasia, which warrants further investigation.

Determining the optimal surveillance interval after a colonoscopic polypectomy for the Korean population?

Background/AimsWestern surveillance strategies cannot be directly adapted to the Korean population. The aim of this study was to estimate the risk of metachronous neoplasia and the optimal surveillance interval in the Korean population.MethodsClinical and pathological data from index colonoscopy performed between June 2006 and July 2008 and who had surveillance colonoscopies up to May 2015 were compared between low- and high-risk adenoma (LRA and HRA) groups. The 3- and 5-year cumulative risk of metachronous colorectal neoplasia in both groups were compared.ResultsAmong 895 eligible patients, surveillance colonoscopy was performed in 399 (44.6%). Most (83.3%) patients with LRA had a surveillance colonoscopy within 5 years and 70.2% of patients with HRA had a surveillance colonoscopy within 3 years. The cumulative risk of metachronous advanced adenoma was 3.2% within 5 years in the LRA group and only 1.7% within 3 years in the HRA group. The risk of metachronous neoplasia was similar between the surveillance interval of <5 and ≥5 years in the LRA group; however, it was slightly higher at surveillance interval of ≥3 than <3 years in the HRA group (9.4% vs. 2.4%). In multivariate analysis, age and the ≥3-year surveillance interval were significant independent risk factors for metachronous advanced adenoma (P=0.024 and P=0.030, respectively).ConclusionsPatients had a surveillance colonoscopy before the recommended guidelines despite a low risk of metachronous neoplasia. However, the risk of metachronous advanced adenoma was increased in elderly patients and those with a ≥3-year surveillance interval.

Helicobacter pylori infection is an independent risk factor for colonic adenomatous neoplasms.

Helicobacter pylori infection is considered to have a positive association with colorectal neoplasms. In this study, we evaluated the association between H. pylori infection and colorectal adenomas, based on the characteristics of these adenomas in Korea, where the prevalence of H. pylori infection is high and the incidence of colorectal cancer continues to increase. The study cohort consisted of 4,466 subjects who underwent colonoscopy and esophagogastroduodenoscopy during screening (1,245 colorectal adenomas vs. 3,221 polyp-free controls). We compared the rate of H. pylori infection between patients with adenoma and polyp-free control cases, using multivariable logistic regression analysis. The overall rate of positive H. pylori infection was higher in adenoma cases than in polyp-free control cases (55.0 vs. 48.5%, p<0.001). The odds ratio (OR) of positive H. pylori infection in patients with adenoma compared to polyp-free controls was 1.28 (95% CI 1.11-1.47). The positive association of H. pylori infection with colorectal adenomas was more prominent in advanced adenomas (OR 1.84, 95% CI 1.25-2.70) and multiple adenomas (OR 1.72, 95% CI 1.26-2.35). Based on the location of these adenomas, the OR was significant only in patients with colonic adenomas (OR 1.31, 95% CI 1.13-1.52) and not in those with rectal adenoma (OR 0.85, 95% CI 0.58-1.24). Helicobacter pylori infection is an independent risk factor for colonic adenomas, especially in cases of advanced or multiple adenomas, but not for rectal adenomas.

Modifiable lifestyle factors associated with risk of sessile serrated polyps, conventional adenomas and hyperplastic polyps

ObjectiveTo identify modifiable factors associated with sessile serrated polyps (SSPs) and compare the association of these factors with conventional adenomas (ADs) and hyperplastic polyps (HPs).DesignWe used data from the Tennessee...

Case-control study of candidate gene methylation and adenomatous polyp formation.

Colorectal cancer (CRC) is one of the most common and preventable forms of cancer but remains the second leading cause of cancer-related death. Colorectal adenomas are precursor lesions that develop in 70-90% of CRC cases. Identification of peripheral biomarkers for adenomas would help to enhance screening efforts. This exploratory study examined the methylation status of 20 candidate markers in peripheral blood leukocytes and their association with adenoma formation. Patients recruited from a local endoscopy clinic provided informed consent and completed an interview to ascertain demographic, lifestyle, and adenoma risk factors. Cases were individuals with a histopathologically confirmed adenoma, and controls included patients with a normal colonoscopy or those with histopathological findings not requiring heightened surveillance (normal biopsy, hyperplastic polyp). Methylation-specific polymerase chain reaction was used to characterize candidate gene promoter methylation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using unconditional multivariable logistic regression to test the hypothesis that candidate gene methylation differed between cases and controls, after adjustment for confounders. Complete data were available for 107 participants; 36% had adenomas (men 40%, women 31%). Hypomethylation of the MINT1 locus (OR 5.3, 95% CI 1.0-28.2) and the PER1 (OR 2.9, 95% CI 1.1-7.7) and PER3 (OR 11.6, 95% CI 1.6-78.5) clock gene promoters was more common among adenoma cases. While specificity was moderate to high for the three markers (71-97%), sensitivity was relatively low (18-45%). Follow-up of these epigenetic markers is suggested to further evaluate their utility for adenoma screening or surveillance.

Risk factors cannot explain the higher prevalence rates of precancerous colorectal lesions in men.

Background:Prevalence of (pre)cancerous colorectal lesions are higher in men than in women, although transition rates from advanced lesions to cancer is similar in both sexes. Our aim was to investigate whether the sex-specific difference in incidence of premalignant colorectal lesions might be explained by the impact of risk factors.Methods:A cross-sectional study analysing health check-up examinations and screening colonoscopies performed within a national quality assurance program.Results:A total of 25 409 patients were included in this study, 50.8% were women. Median age for both sexes was 60 years (interquartile range (IQR) 54–67). A multivariable model showed that risk factors mediated only 0.6 of the 10.4% gender gap in adenoma and 0.47 of the 3.2% gender gap in advanced adenoma detection rate. Smoking was the only independent risk factor with a varying sex-specific effect (men OR 1.46, CI 1.29, 1.64, women OR 1.76, CI 1.53, 2.06) and advanced adenomas (men OR 1.06, CI 0.80–1.42; women OR 2.08, CI 1.52–2.83). Independent risk factors for adenomas were BMI (OR 1.35 per IQR, CI 1.25–1.47) and triglyceride level (OR 1.03 per IQR, CI 1.00–1.06); for advanced adenomas physical activity (none vs regular: OR 1.54, CI 1.18–2.00, occasional vs regular: OR 1.17, CI 1.00–1.38), cholesterol level (OR 1.13 per IQR, CI 1.02–1.25), blood glucose level (OR 1.05 per IQR, CI 1.01–1.09) and alcohol score (OR 1.09 per IQR, CI 1.01–1.18).Conclusions:Risk factors cannot explain higher prevalence rates in men. Results of this study strongly underline the need for sex-specific screening recommendations.

Adenoma Detection Rate Among Smokers in an Urban Minority Population: A Retrospective Study

Introduction: Cigarette smoking is a leading cause of preventable deaths in the United States (US). An estimated 42.1 million US adults smoke cigarettes. Smoking has been associated with cancers in organs that are not directly exposed to inhaled smoke. African Americans have an increased incidence and younger age of presentation of colorectal cancer. Colorectal adenomas are known precursors for colorectal cancer. The aim of this study is to investigate cigarette smoking as an independent risk factor for colonic adenomas in an urban minority population. Methods: We retrospectively reviewed screening colonoscopies in an urban minority population done over the last five years. Our study population was divided into two groups. Group A consisted of current or former smokers and group B consisted of lifetime non-smokers. The adenoma detection rate (ADR) and advanced adenoma detection (aADR) rate were calculated and compared between the two groups. Results: A total of 230 patients who underwent screening colonoscopies were included in the study. 62.6% (144/230) of the study population was African American, 29.1% (67/230) was Hispanic, and 8.2% (19/230) were of other racial/ethnic groups. 81.3% (187/230) were female. 37.4% (86/230) of study subjects were smokers and were included in group A. Of these, 55.8% (48/86) were current smokers. 62.6% (144/230) were lifetime non-smokers and were included in group B. Average age was 57 years (group A) and 59 years (group B). Average body mass index was similar in both groups: 30.7 in group A and 30.9 in group B. The ADR was 23% in group A compared to 15% in Group B. No significant difference in ADR was seen in former (22%) vs current smokers (23%). The aADR was 9% in group A and 5% in group B. Conclusion: The initial results of this ongoing study suggests an increase in the ADR and aADR among cigarette smokers in minority population. No difference in ADR was noted in current smokers and former cigarette smokers. This study highlights the importance of smoking cessation counseling and considering smoking history in decision making for screening CRC.

Demographic Risk Factors for Adenoma and Rates of Detection with Screening Colonoscopy During Liver Transplant Evaluation

Demographic Risk Factors for Adenoma and Rates of Detection with Screening Colonoscopy During Liver Transplant Evaluation

Discordantly High Colorectal Adenoma Prevalence in South Asians

Introduction: Colon cancer is the 2nd leading cause of cancer related death in the US. Colonoscopy with polypectomy prevents this. The National Cancer Institute advocates individualized screening strategies to reduce risk and cost. South Asians (Indians, Pakistanis, Bangladeshis, Sri Lankans, Nepalese, etc), the 2nd largest Asian subgroup in USA, are the fastest growing ethnic minority(1). Their CRC incidence is very low (12.3/100,000 compared to 31.6 in Caucasians)(2). However, their colon adenoma prevalence is understudied. Methods: Using ICD-9 code V76.51, 50,206 screening colonoscopy patients between 1/1/06 & 10/31/15 were identified. South Asian category (n=528) was creating using an Asian Indian name database (3). Demographics, BMI, diabetes, race data were extracted. Patient records in our pathology database were reviewed to identify types of polyps detected.Chi square tests examined effect of race on prevalence of adenoma types. Multivariate logistic regression analysis controlled for effect of age, gender, BMI & diabetes. Results: Race distribution was Caucasian 76%, Other (Hispanic, Native American, Pacific Islander) 8.7%, Asian 7 %, Black 7%, South Asian 1%. Majority were female 55%. Means age was 59 yrs & mean BMI was 28.6. South Asian were predominantly male (52%), and had the highest diabetes rate (31%). Overall 27% had tubular adenomas, 7.8 % tubulovillous, 2% villous and 2.2% serrated adenomas, with 9% hyperplastic polyps. Overall males had significantly higher prevalence of all polyps, except sessile serrated. South Asian tubular adenoma prevalence was lower (22%),p < 0.05; but there was no difference with other polyp types. Race was an independent predictor of adenoma presence. Male gender, increasing age & BMI, diabetes were associated with higher prevalence of all polyps except serrated adenomas. Conclusion: South Asians had unexpectedly higher colon adenoma prevalence (22%), despite low rates of colon cancer. Therefore screening strategies for them should not deviate from recommended guidelines at this time, pending further studies of the discordance between their adenoma prevalence and CRC rates. Traditional risk factors for adenomas was not found to affect serrated adenoma prevalence. This needs further study to explain interval cancers, right-sided cancers, etc.

Effect of insulin therapy and obesity on colon adenoma and advanced adenoma among type II diabetes mellitus population

Insulin is a debatable risk factor for colon adenoma (Ad) among type II diabetes mellitus (DM II) patients. Obesity is an important confounding variable. The study involved chart review of DM II patients undergoing screening colonoscopy. Study population was divided into obese [body mass index (BMI)≥30] and nonobese (BMI&amp;lt;30) groups which were further divided into insulin and non-insulin subgroup. Colonoscopy and pathology reports were used to calculate Ad detection rate (ADR) and AAd detection rate (AADR). A total of 538 subjects satisfied the inclusion and exclusion criteria. The study population composed of 52.8% obese and 47.2% non-obese subjects. Obese group had 28.9% insulin and 71.1% non-insulin subjects. Non-obese group composed of 29.9% insulin and 70.1% non-insulin subjects. ADR for non-obese insulin and non-insulin subgroup was 31.6% and 37.1% respectively. AADR for non-obese insulin and non-insulin subgroup was 13.2% and 11.2% respectively. ADR for obese insulin and non-insulin subgroup was 41.5% and 34.2% respectively. AADR for obese insulin and non-insulin subgroup was 15.9% and 16.3% respectively. Insulin exposure lacked statistically significant association with ADR or AADR among obese and non-obese DM II subjects.

Su1929 Sarcopenia Is an Independent Risk Factor for Advanced Colorectal Adenoma

Su1929 Sarcopenia Is an Independent Risk Factor for Advanced Colorectal Adenoma

Risk Factors of Advanced Adenoma in Small and Diminutive Colorectal Polyp.

The aims of this study were to review the clinicopathological characteristics of diminutive (≤ 5 mm) and small polyps (> 5 mm but < 10 mm) and to evaluate the risk factors of advanced adenoma for polyps of diameter < 10 mm in the colon. The medical records of 4,711 patients who underwent first colonoscopy at outpatient clinics or health promotion center were reviewed retrospectively. We analyzed the presence and risk factors of advanced adenoma, which was defined as a villous or tubulovillous polyp, high-grade dysplasia or intramucosal carcinoma histologically. Total 5,058 polyps were detected in the 4,711 patients, and 93.0% (4,704/5,058) polyps were < 10 mm in size. Among them, advanced adenoma was noted in 0.6% (28/4,704) with a villous component in 19, high-grade dysplasia in 3, and adenocarcinoma in 6. Advanced and non-advanced adenomas differed significantly in age group, gender, and polyp size. Multivariate analysis showed that an advanced age (> 65 years), a male gender, and a polyp size of > 5 mm were risk factors of advanced adenoma. The incidence of advanced adenoma in polyps of < 10 mm was 0.6%. Polyp size, male gender, and age of > 65 years are independent risk factors of advanced adenoma.

Prevalence and Risk Factors of Gastric Adenoma and Gastric Cancer in Colorectal Cancer Patients.

Background/Aims. To evaluate the incidence of gastric adenoma and gastric cancer in colorectal cancer patients, as well as the clinicopathological features that affect their incidence. Methods. Among patients who underwent surgery after being diagnosed with colorectal cancer between January 2004 and December 2013 at Chungnam National University Hospital, 142 patients who underwent follow-up upper gastrointestinal endoscopy were assigned to the patient group. The control group included 426 subjects randomly selected. The patient group was subdivided into two: one that developed gastric adenoma or cancer and one that did not. Clinicopathological characteristics were compared between these groups. Results. In total, 35 (24.6%) colorectal cancer patients developed a gastric adenoma or gastric cancer, which was higher than the number in the control group (20 [4.7%] patients; p < 0.001). Age, alcohol history, and differentiation of colorectal cancer were associated with higher risks of gastric adenoma or gastric cancer, with odds ratios of 1.062, 6.506, and 5.901, respectively. Conclusions. In colorectal cancer patients, screening with upper gastrointestinal endoscopy is important, even if no lesions are noted in the upper gastrointestinal tract at colorectal cancer diagnosis. Endoscopic screening is particularly important with increasing age, history of alcohol consumption, and poor cancer differentiation.

High levels of carcinoembryonic antigen and smoking might be markers of colorectal adenoma in Korean males aged 40-49 years

Background: Prevalence of adenoma in males aged 40-49 years in Korea was higher than expected. The aim of this study was to investigate the prevalence and risk factors of colorectal adenoma in males aged 40-49 years. Methods: Total 1,902 asymptomatic subjects with a mean age of 47.9±6.7 years, who underwent a screening colonoscopy in a health promotion center of Myongji Hospital from 2010 to 2013 were enrolled in this study. We conducted a case-control study to determine the risk factors for adenoma. The subjects were classified into two groups (adenoma vs. controls). To validate the diagnostic value of carcinoembryonic antigen (CEA) for adenoma, area under the receiver operating characteristic curve (AUROC) was calculated. Results: At least one colorectal adenoma was identified in 385 subjects (20.2%). Among these 385 subjects, 372 subjects were found to have a non-advanced adenoma, 13 subjects had an invasive adenoma. One subject had cancer. Male sex, age, smoking, metabolic syndrome, and elevated CEA level were significantly associated with a colorectal adenoma in univariate analysis. However, metabolic syndrome was not significant in multivariate analysis. In the male group, the AUROC of CEA for colorectal adenoma was 0.600 (0.543 to 0.656) in non-smokers under 50 years of age, and 0.615 (0.540 to 0.690) in smokers under 50 years of age. Conclusion: Male sex, smoking, and high levels of CEA seem to be associated with colorectal adenoma. High levels of CEA and smoking may be diagnostic markers for any colorectal adenoma in Korean males aged 40-49 years.

Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence.

To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm. Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients (40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo (mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis. Median size of the lesions was 30 mm (20-70 mm), 69.0% were localized in the right-sided (cecum, ascending and transverse) colon. Most of the lesions (85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique (78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216 (23.6%) lesions including 4 low risk carcinomas (pT1a, L0, V0, R0 - G1/G2). Histologically proven recurrence was observed in 33/216 patients (15.3%). Patient age > 65 years, polyp size > 30 mm, non-pedunculated morphology, localization in the right-sided colon, piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis, only localization in the right-sided colon (HR = 6.842/95%CI: 1.540-30.394; P = 0.011), tubular-villous histology (HR = 3.713/95%CI: 1.617-8.528; P = 0.002) and polyp size > 30 mm (HR = 2.563/95%CI: 1.179-5.570; P = 0.017) were significantly associated risk factors for adenoma recurrence. Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm, with tubular-villous histology.

A novel quality scoring system for the evaluation of individual colonoscopy: A multicenter retrospective study.

It is essential to develop a novel evaluation system for the quality of individual colonoscopy and provide guidelines on whether and when to follow up the patient after the initial colonoscopy. This study aimed to establish and validate a scoring system for the quality of individual colonoscopy in terms of the adenoma miss rate (AMR). Patients undergoing two consecutive colonoscopies within 90 days between 2009 and 2011 from different levels of hospitals in China were enrolled into this study. Potential risk factors for adenoma miss at the individual colonoscopy in a cohort of patients were evaluated in univariate and multivariate analyses. Corresponding scores for the procedure-related factors were generated based on their weights, and a scoring system was established and then validated by correlating the system with AMR. A total of 2093 patients were enrolled. Procedure-related factors at the individual colonoscopy (including bowel preparation and imaging methods), doctor experience, retroflexion, and withdrawal time were identified to be independent risk factors, and each of these factors was scored from 0 to 3. Then, a novel scoring system for the quality of individual colonoscopy (ranging from 0 to 9) was established, which was closely correlated with the AMRs in the establishment (adjusted R(2) = 0.845) and validation databases (adjusted R(2) = 0.733). The developed and validated evaluation system, consisting of procedure-related independent factors, successfully assesses the quality of individual colonoscopy in terms of AMRs.

Analysis of population screening results for colorectal cancer and the risk factors of colorectal adenoma in prediabetes in Hefei communities

Objective To explore the prevalence of colorectal cancer and the risk factors associated with colorectal adenoma in prediabetes in community population. Methods Preliminary screening for colorectal cancers was carried out to prediabetes subjects aged over 40 years in four communities in Hefei City, by combining questionnaire and fecal occult blood test. Colonscopy were performed among high risk people, and the clinical characteristics of colorectal adenoma and related risk factors were also analyzed. Results A total of 1 912 people were investigated, and 547 cases of them were referred to high-risk group. Colonscopy were performed to 501 cases, and colorectal mucosa lesions were found in 281 cases, the detection rate was 56.1%(281/501). Of which colorectal cancer were found in 21 cases, the detection rate was 4.19%(21/501), nearly two-thirds belong to intermediate to late stages. In addition, colorectal adenomas were found in 248 cases, the detection rate was 49.5%(248/501), including multiple adenoma(43.1%), adenomatous polyps(58.1%), and 57.3% with the size of adenoma over 1 cm. The multiple logistic regression analyses revealed that male sex, waist-to-hip ratio, 2 h plasma glucose levels, and family history of diabetes were independent factors associated with increase in the risk of colorectal adenoma(P<0.05). Conclusion Early colorectal cancer screening and appropriate intervention measures should be taken in prediabetes. (Chin J Endocrinol Metab, 2015, 31: 851-855) Key words: Prediabetes; Colorectal cancer; Colonscopy; Risk factors

Demonstration of high coincidence of pituitary adenoma in patients with ruptured Rathke's cleft cyst: Results of a prospective study

ObjectiveRepeated chronic inflammation, such as under circumstances of ruptured Rathke's cleft cyst (RCC), is known as the fundamental basis of various pathological changes including neoplastic change, therefore to examine accurate incidence of pituitary adenomas is important for the preventive medicine. Materials and methodsAs a prospective study, patients were initially screened by the symptoms such as periodic headache and dizziness together with the abnormal findings such as seller floor bone defect on 3D-CT. Those screened patients who showed abnormal basal pituitary hormone values were additionally examined by several loading test and 3T magnetic resonance imaging (MRI) by three-dimensional reconstructions of Flair cube images. The presence of pituitary adenomas was evaluated by composite 3T MRI and 11C methionine MET positron-emission tomography imaging. Immunohistochemical studies were employed for surgical biopsy specimens to demonstrate hormone production. Results308 cases of RCC were diagnosed by both radiologic and intraoperative findings. Pathological examination confirmed 111 pituitary adenomas in 106 patients with ruptured RCC, therefore the rate of coincidence was revealed 34%. In 78 patients with abnormalities of pituitary hormone secretion, MET uptake was observed in the pituitary gland and verified pituitary adenoma pathologically. In addition, 28 adenomas were verified without MET-PET study on pathological examination only, for a total of 106 cases. ConclusionsHigh coincidence (34%) of ruptured RCC and pituitary adenomas was demonstrated, which is a proof that ruptured RCC is contributed to a risk factor of pituitary adenoma.