Significant Polyp Research Articles

FP1.3 - SPEC MDT in Aneurin Bevan University Health Board

Abstract Aims The SPEC (significant polyp and early cancer) multi-disciplinary team (MDT) meeting was started in ABUHB in 2022 to discuss complex colonic and rectal polyp cases, such as polyps >20mm, likely to be sessile, or difficult to remove endoscopically. The aim was to evaluate the effectiveness and clinical role of the SPEC MDT. Methods Data for patients discussed in SPEC MDT since its conception in January 2022 until September 2023 was retrospectively collected from the SPEC MDT database, a prospectively collected database. This included patient demographics, reason for referral, polyp characteristics and MDT outcomes. Results In 21 months, there have been 38 SPEC MDTs, with 355 cases discussed (average of 9 cases per MDT). There was at least one laparoscopic colorectal surgeon, gastroenterologist and a histopathologist in every MDT in accordance with BSG guidelines. Main referral reasons included endoscopy findings (72%) and re-discussion post-procedure (22%). Twenty-three patients had adenocarcinomas and three had NETs. MDT outcomes were EMR (23%), endoscopic surveillance (21%), clinic to discuss (no) surgery (19%), TAMIS (16%), urgent endoscopy (13%) or other (8%). Conclusion As the busiest Health Board in Wales for Colorectal Cancers, the formation of SPEC MDT has been an important step in improving the detection and treatment of advanced polyps and early cancers. Although too early to measure the impact on early cancer detection rates and improved decision making for these patients, formalising the MDT process in line with BSG guidelines has been an important step in improving the service offered to patients.

Substratifying the risk of covert malignancy in significant rectal polyps: Outcomes from a specialist multidisciplinary team (MDT).

A treatment strategy for patients with a significant polyp or early colon cancer (SPECC) of the rectum presents a challenge due to the significant rate of covert malignancy and lack of standardized assessment. For this reason, NICE recommends multidisciplinary meetings to improve outcomes. The primary aim of the present study was to report the performance of our specialist early rectal cancer (SERC) multidisciplinary team (MDT) in correctly substratifying the risk of cancer and to discuss the limitations of staging investigations in those patients with "poor outcomes". This was a retrospective review of patients referred to our SERC MDT from 2014 to 2019. Lesions were assigned by the MDT to three pre-resection categories (low, intermediate, high) according to the risk of covert malignancy. Resection method and final histology were compared to the pre-resection categories. Of 350 SPECC lesions, 174 were assessed as low-risk, 108 intermediate-risk and 68 high-risk. The cancer incidence was 4.8%, 8.3% and 53%, respectively (15.5% overall). Eight lesions were categorized as low-risk but following piecemeal resection were found to be malignant. Five lesions, three of which were categorized as high-risk, were ultimately benign following conventional surgery. One pT1sm1 cancer, removed by anterior resection, may have been treated by local excision. A total of 83% of malignant polyps were triaged to an en bloc resection technique and surgical resection avoided for nearly all benign lesions. However, 12 patients from this cohort were deemed to have a poor outcome because of miscategorization. Further comparative research is needed to establish the optimum strategy for rectal SPECC lesion assessment. There is currently no consensus for staging significant polyps of the rectum. This paper reports the effectiveness of a specialist early rectal cancer MDT to correctly risk-stratify significant rectal polyps. It underscores the importance of accurate categorization for treatment decision-making, while acknowledging the limitations of current staging modalities.

Efficacy of Brolucizumab in Polyp Regression of Treatment-Naïve Polypoidal Choroidal Vasculopathy and Its Effect on One-Year Treatment Outcome.

To evaluate the efficacy of intravitreal brolucizumab in polyp regression of treatment-naïve polypoidal choroidal vasculopathy (PCV) patients and its effect on one-year treatment outcome. Medical records of 31 treatment-naïve PCV patients, who received three monthly intravitreal brolucizumab injections followed by as-needed injections for at least a year, were retrospectively reviewed. Visual and anatomical outcomes were evaluated at 3-month, 6-month, and 12-month. Complete polyp regression rate and percentage change of vascular lesion and polyp area were evaluated after three monthly injections of brolucizumab. The effect of complete polyp regression and the impact of vascular lesion and polyp reduction rate on one-year treatment outcome were also evaluated. Additionally, the incidence of brolucizumab-related intraocular inflammation (IOI) and its clinical course were examined. In terms of visual outcome, best-corrected visual acuity(BCVA) significantly improved after 12 month follow-up (p<0.001). In terms of anatomical outcome, central macular thickness(CMT) and central choroidal thickness(CCT) significantly decreased after 12 month follow-up (p<0.001). Complete polyp regression was observed in 74.2% (23/31) after three monthly injections. Group with complete polyp regression had a higher rate of achieving dry macula at 3-month(p=0.026) and fewer number of injections(p<0.001) compared to the group without complete polyp regression. Higher polyp reduction rate was significantly associated with higher CMT change from baseline at 3-month (p=0.048) while higher vascular lesion reduction rate was significantly associated with higher CMT change from baseline at 12-month(p=0.031) and fewer number of injections(p=0.012). Brolucizumab related IOI occurred in one eye (1/31, 3.2%). Intravitreal brolucizumab injection effectively improved visual and anatomical outcomes and achieved significant polyp regression in treatment-naïve PCV patients. Complete polyp regression and the reduction rate of vascular lesion size and polyp size after loading injection significantly influence the treatment outcome of PCV patients. However, careful monitoring and preoperative warning is warranted due to occurrence of brolucizumab-related IOI.

Nasal polyposis from cystic fibrosis in children - the experience of a single center.

Cystic fibrosis (CF) is the most common monogenic disease, characterized by clinically notable polymorphism. Respiratory disease is the main factor that influences the disease outcome and prognosis of the patient with CF, bacterial infections being responsible for severe exacerbations and rhinosinusitis a difficult complication, besides lung disease. The aim of the paper was to present a case series of CF-associated nasal polyposis and our management experience, providing new data for nasal and sinus complications. Patients attending the National Cystic Fibrosis Center, Timişoara, Romania, were evaluated for nasal polyposis. Besides clinical examination, endoscopy, and computed tomography (CT) was performed for comprehensive evaluation. Patients with persistent symptoms or with complicated sinusitis underwent surgical approach. Fourteen (18.18%) children were diagnosed with nasal polyposis and had surgery, with positive outcomes. One patient received Omalizumab for an associated, uncontrolled asthma with a subsequent substantial effect with the significant polyp reduction and lack of recurrence. Even if extremely difficult to manage, complicated nasal polyposis CF related might have an improved outcome and better life quality.

Functional characterization of the gonococcal polyphosphate pseudo-capsule.

Neisseria gonorrhoeae is an exclusively human pathogen able to evade the host immune system through multiple mechanisms. Gonococci accumulate a large portion of phosphate moieties as polyphosphate (polyP) on the exterior of the cell. Although its polyanionic nature has suggested that it may form a protective shield on the cell surface, its role remains controversial. Taking advantage of a recombinant His-tagged polyP-binding protein, the presence of a polyP pseudo-capsule in gonococcus was demonstrated. Interestingly, the polyP pseudo-capsule was found to be present in specific strains only. To investigate its putative role in host immune evasion mechanisms, such as resistance to serum bactericidal activity, antimicrobial peptides and phagocytosis, the enzymes involved in polyP metabolism were genetically deleted, generating mutants with altered polyP external content. The mutants with lower polyP content on their surface compared to the wild-type strains, became sensitive to complement-mediated killing in presence of normal human serum. Conversely, naturally serum sensitive strains that did not display a significant polyP pseudo-capsule became resistant to complement in the presence of exogenous polyP. The presence of polyP pseudo-capsule was also critical in the protection from antibacterial activity of cationic antimicrobial peptide, such as cathelicidin LL-37. Results showed that the minimum bactericidal concentration was lower in strains lacking polyP than in those harboring the pseudo-capsule. Data referring to phagocytic killing resistance, assessed by using neutrophil-like cells, showed a significant decrease in viability of mutants lacking polyP on their cell surface in comparison to the wild-type strain. The addition of exogenous polyP overturned the killing phenotype of sensitive strains suggesting that gonococcus could exploit environmental polyP to survive to complement-mediated, cathelicidin and intracellular killing. Taken together, data presented here indicate an essential role of the polyP pseudo-capsule in the gonococcal pathogenesis, opening new perspective on gonococcal biology and more effective treatments.

Clinical significance of incidental 18 FDG PET uptake in the gastrointestinal tract: a retrospective cohort study.

Incidental gastrointestinal tract (GIT) uptake is found in up to 6.3% of patients undergoing positron emission tomography (PET). This may be physiologic or pathologic and requires endoscopic assessment. To determine the diagnostic yield of endoscopy in this setting and characterise PET avidity as a predictor of clinically significant findings. We retrospectively reviewed all consecutive patients undergoing upper endoscopy or colonoscopy for incidental 18 FDG PET positivity in the GIT. A total of 255 patients (62% male, median age 67 years) underwent colonoscopy or sigmoidoscopy for 276 separate areas of PET avidity in the colon. Malignancy was found in 44 cases (16%), and a significant polyp was found in an additional 103 cases (37%). Neoplastic change was found more often in the case of intense compared with non-intense PET avidity (odds ratio (OR) 3.40, 95% confidence interval (CI) 1.95-5.93, P < 0.001), and in focal compared with diffuse uptake (OR 5.97, 95% CI 2.9-12.2, P < 0.001). Upper GIT endoscopy was performed in 75 patients (46 male, median age 63 years) for 77 isolated areas with PET avidity. Malignancy was found in 16 cases (21%), and all were new primary lesions. Numerically, malignant findings were more common in intense (29.7%) than non-intense (12.5%) PET avidity (OR 2.96, 95%, CI 0.92-9.57, P = 0.069). Both focal and intense colonic 18 FDG uptake correlate strongly with a high-risk polyp or malignant lesion. Up to 21% of all gastroscopies performed for evaluation of incidental PET uptake diagnosed a new primary malignancy. These referrals need appropriate triaging and timely endoscopic assessment.

Low Colon Capsule Endoscopy (CCE) False Negative Rate for Polyps Excluding Reader Error

CCE is a diagnostic tool lacking clinical data on false negative rates. We aimed to assess this rate and the reader/technical error breakdown. False negative CCEs were identified after comparing to a colonoscopy database. Missed pathology characteristics and study indications/quality were collated. Cases were re-read by experts and newly identified lesions/pathologies were verified by an expert panel and categorised as reader/technical errors. Of 532 CCEs, 203 had an adequately reported comparative colonoscopy, 45 (22.2%) had missed polyps, and 26/45 (57.8%) reached the colonic section with missed pathology. Of the cases, 22 (84.6%) had adequate bowel preparation. Indications included 13 (50%) polyp surveillance, 12 (46%) GI symptoms, 1 (4%) polyp screening. CCE missed 18 (69.2%) diminutive polyps and 8 (30.8%) polyps ≥ 6 mm, 18/26 (69.2%) of these were adenomas. Excluding incomplete CCE correlates, colonoscopy total and significant polyp yield were 97/184 (52.7%) and 50/97 (51.5%), respectively. CCE total polyp and significant polyp false negative rate was 26.8% (26/97) and 16% (8/50), respectively. Following re-reading, reader and technical error was 20/26 (76.9%) and 6/26 (23.1%). Total and significant missed polyp rates were 20.6% (20/97) and 14% (7/50) for reader error, 6.2% (6/97) and 2% (1/50) for technical error. False negative CCE rate is not insubstantial and should be factored into clinical decision making.

Je možné individualizovat vysazení antikoagulační terapie před preventivní koloskopií?

Summary: Background: Hot-snare polypectomy is a standard method for removal of polyps larger than 10 mm. It is recommended to discontinue anticoagulant therapy before this procedure to reduce a bleeding risk. In contrast, diagnostic colonoscopy and cold-snare polypectomy up to 10 mm are considered safe during uninterrupted anticoagulation therapy (with only omission of the direct oral anticoagulant therapy on the day of the procedure). The increasing number of anticoagulated individuals undergoing a colorectal cancer screening program leads to efforts to individualize the interruption of anticoagulation therapy. Aim: Estimation of probability that adenomatous polyp over 10 mm is detected during preventive colonoscopy in the Czech Republic in particular population groups according to gender and age. Methods: We retrospectively analyzed data from prospective database (Registry of Preventive Colonoscopies) covering screening colonoscopies and colonoscopies indicated for immunochemical faecal occult blood test positivity (FIT-positive). A distinction was made between adenoma polyps ≤10 mm and &gt;10 mm. The patient was categorized according to the largest polyp diameter in case of detection of multiple polyps. Results: Between 2016 and 2020, 16,942 and 52,052 adenomatous polyps were found during 55,546 screenings and 119,229 FIT-positive colonoscopies, representing adenoma detection rate (ADR) of 31% and 44%, respectively. The estimate of probability of significant polyp detection (over 10 mm) and the need of hot-snare polypectomy ranged widely (2.3–21.6%) depending on age, sex and indication. It can be estimated to 7% in females and 5–10% in males undergoing screening colonoscopy. For colonoscopies indicated for positive stools for occult bleeding, this probability is approximately two to three times higher in FIT-positive colonoscopies: it exceeds 10% in woman over 60 years of age and is 15% and more in men of all ages (over 20% in men over 60 years of age). Conclusions: The decision to discontinue anticoagulation therapy prior to preventive colonoscopy can be individualized with respect to the indication (screening vs. FIT-positive), age and gender of examined person – we prefer to discontinue the anticoagulation therapy in FIT-positive people over 60 years and/or of male gender. The individual thromboembolic risk during interruption of anticoagulation therapy must be considered depending on the specific indication (e. g. CHA2DS2 VASc score in atrial fibrillation). Key words: colonoscopy – anticoagulant therapy – direct-acting oral anticoagulants – cancer screening – personalized medicine

Allergic Fungal Rhinosinusitis: The Role and Expectations of Biologics

Allergic fungal rhinosinusitis (AFRS) is a noninvasive subtype of chronic rhinosinusitis with nasal polyps (CRSwNP) that usually develops in immunocompetent atopic individuals and is more common in geographic regions characterized by warm temperatures and high humidity, conducive to higher environmental fungal presence. Allergic fungal rhinosinusitis usually presents with unique computed tomography findings and significant polyp burden, yet patients often report minimal sinus symptoms. Patients with AFRS often have extremely elevated serum total and fungal-specific IgE levels. Treatment almost always requires surgery, in which adjuvant medical therapy is critical to success. However, until recently the choice of adjuvant therapy has consisted primarily of either oral and/or topical steroids. Although oral corticosteroids decrease recurrence after surgery, data for the effectiveness of other adjunctive pharmacologic agents, including topical and oral antifungal agents and immunotherapy, have remained unclear and hence are not recommended in recent guidelines including the International Consensus of Allergy and Rhinology. Three biologics, omalizumab, dupilumab, and mepolizumab, have recently been approved for treating CRSwNP in general, but clinical trials to date with these biologics did not involve AFRS patients. Recently published case reports and smaller prospective studies have shown good efficacy of these biologics on the AFRS subgroup of patients. This article provides an overview of the understanding of the pathophysiology of AFRS, implications of this understanding on the possible role of biologics, and clinical reports on the use of biologics in treating AFRS. Because biologics are indicated for treating CRSwNP, follow up real-world evidence studies are needed for AFRS.

Endoscopic management of familial adenomatous polyposis targeting colorectal lesions greater than 5mm in size: a single-center retrospective study.

Preserving the colon while preventing colorectal cancer is challenging in patients with familial adenomatous polyposis. Although prophylactic colectomy is the current standard of care, some patients with familial adenomatous polyposis may wish to postpone colectomy as long as polyposis can be managed by endoscopic resection. This study examined our endoscopic management and prognostic results for patients with familial adenomatous polyposis who refused to undergo colectomy. We retrospectively analyzed the data of 12 patients with familial adenomatous polyposis treated at our hospital between January 1995 and December 2020. All patients opted to postpone prophylactic colectomy although they had significant polyp burdens and underwent endoscopic management, in which colorectal polyps sized > 5mm were thoroughly resected during baseline colonoscopies and subsequently, newly arising colorectal polyps sized > 5mm were periodically resected during surveillance colonoscopies. Patients (median age, 33years) were followed up for a median of 5.2years. The median number of colonoscopies and resected lesions per patient was 2 and 14 at baseline as well as, 9 and 32 during surveillance, respectively. The interval between colonoscopies was 1.0 and 7.0months for baseline and surveillance, respectively. The colons of all 12 patients were preserved, and no invasive colorectal cancer developed. In 10 patients, 35 cases of high-grade dysplasia were observed and managed by endoscopic resection. Repeated endoscopic resection of colorectal polyps sized > 5mm with appropriate surveillance may be an alternative form of endoscopic management for patients with familial adenomatous polyposis wishing to postpone colectomy.

Management of Significant Polyp and Early Colorectal Cancer Is Optimized by Implementation of a Dedicated Multidisciplinary Team Meeting: Lessons Learned From the United Kingdom National Program.

The concept of significant polyps and early colorectal cancer encompasses complex polyps not amenable to routine snare polypectomy or where malignancy cannot be excluded. The assessment and management of these lesions is contentious and increasingly important due to the significant risk of over- or undertreatment. Following the recommendations of the Significant Polyps and Early Colorectal Cancer National Program, we implemented a dedicated multidisciplinary team meeting and analyzed the influence on patient outcomes. This was a retrospective study using a prospectively collected database of patients discussed at the dedicated multidisciplinary team meeting. This study was conducted in a single tertiary-care center. Consecutive patients with significant polyps and early colorectal cancer were identified either through the Bowel Cancer Screening Program or colonoscopy for symptomatic patients. Proportions of patients who had organ preservation, and secondary treatment and recurrence rate served as outcome measures. Overall, 135 patients discussed at the dedicated multidisciplinary team meeting were included, with a median age of 71 years. Median size of the lesions was 25 mm, and 39% were in the rectum. Patients were discussed either after the lesion was removed during the initial colonoscopy (n = 38), of whom 16 (42%) had unexpected cancer, or had no initial treatment with subsequent case review (n = 97). Of these 97 patients, 46 underwent endoscopic excision (26% cancer), 20 trans-anal excision (10% cancer), 23 primary surgical resection (35% cancer), and 8 had no treatment. In 104 (82%) patients, organ preservation was achieved. Secondary surgery was required in 7 of 104 (6.7%) patients after local excision due to radical treatment of high-risk T1 lesions, local recurrence, or patients' decisions. The cumulative hazard estimates for recurrence after a median follow-up of 18.5 months was less than 10% for both benign and malignant lesions. This study was limited by its relatively small sample size and single-center setting. A dedicated multidisciplinary team meeting improved the management of significant polyps and early colorectal cancer, safely refining organ preservation for patients, with low recurrence rates. See Video Abstract at http://links.lww.com/DCR/B826. ANTECEDENTES:El concepto de pólipos complejos y cáncer colorrectal temprano abarca engloba pólipos avanzados que no es posible la reseccion endoscopica rutinaria, o aquellos en los que no se puede excluir malignidad. La evaluación y el manejo de estas lesiones es controversial y cada vez más importante debido al riesgo significativo de ser tratadas o no.OBJETIVO:Siguiendo las recomendaciones del Programa Nacional de Pólipos Complejos y Cáncer Colorrectal Temprano, implementamos reuniónes del equipo multidisciplinario especializado y analizamos el impacto en los resultados de los pacientes.DISEÑO:Estudio retrospectivo sobre una base de datos recopilada prospectivamente de los pacientes discutidos en la reunión del equipo multidisciplinario especializado.AJUSTE:Este estudio se realizó en un centro de atención terciaria.PACIENTES:Pacientes consecutivos con pólipos complejos y cáncer colorrectal temprano identificado a través del Programa de detección de cáncer intestinal o colonoscopia para pacientes sintomáticos.PRINCIPALES MEDIDAS DE RESULTADO:Proporción de pacientes que tuvieron preservación de órganos, tratamiento secundario y tasa de recurrencia.RESULTADOS:En total, se incluyeron 135 pacientes discutidos en la reunión del equipo multidisciplinario especializado dedicada, con una media de edad de 71 años. El tamaño medio de las lesiones fue de 25 mm y el 39% estaban en el recto. Se discutio de los pacientes después de que se resecara la lesión durante la colonoscopia inicial [n = 38, de los cuales 16 (42%) tenían un cáncer imprevisto] o no recibieron tratamiento de inicio, con revisión posterior del caso (n = 97). De estos, 46/97 fueron sometidos a resección endoscópica (26% cáncer), 20/97 resección transanal (10% cáncer), 23/97 resección quirúrgica primaria (35% cáncer) y 8/97 no recibieron tratamiento. En 104 (82%) pacientes, se logró la preservación de órgano. Cirugía secundaria fue requeria en 7/104 (6,7%) pacientes después de la resección local debido a tratamiento radical de lesiones T1 de alto riesgo, recidiva local o decisión del paciente. Las estimaciones de riesgo acumulativo de recurrencia después de una media de seguimiento de 18,5 meses fue inferior al 10% tanto para las lesiones benignas como para las malignas.LIMITACIONES:Tamaño de muestra relativamente pequeño y entorno de un solo centro.CONCLUSIONES:La Reunion del equipo multidisciplinario especializado mejoró el manejo de los pólipos complejos y cáncer colorrectal temprano, refinando de manera segura la preservación de órganos para los pacientes, con bajas tasas de recurrencia. Consulte Video Resumen en http://links.lww.com/DCR/B826. (Traducción- Dr. Francisco M. Abarca-Rendon).

1029 Evaluation of Significant Polyp and Early Colorectal Cancer (SPECC) MDT In A District General Hospital

Abstract Aim There is an increase in the number of complex SPECC cases presented at colorectal MDT meetings with a wide variation in the treatments offered to patients, many of whom undergo high-risk and life-changing surgical resection. This study aimed to evaluate the detection, diagnosis and treatment of early colorectal cancer since the introduction of a SPECC MDT. Method This was a retrospective audit of 108 patients, from the SPECC MDT database from January 2014 to December 2019. Primary outcome assessed the recognition of lesions using endoscopy and radiological evaluation to assess depth of invasion and lymph node involvement. Secondary outcomes included definite treatment, pathological reporting and recurrence. Results Overall, mean age of 72, 79% had one or more significant co-morbidity. Clinical presentation; 61 asymptomatic, 46 symptomatic and 31 referred from the national bowel cancer-screening programme. All patients (n = 108) had endoscopic assessment the lesions were, 53% sessile and 47% pedunculated; 78% of the lesions were found in the rectum. We observed surgical management in 31 cases, endoscopic in 28, chemo-radiotherapy in 12 and 3 cases were palliative. However, 17 (n = 108) underwent failed endoscopic resection and required surgical intervention. Recurrence was observed in 17.6% of cases and mortality in 4%. Conclusions Pathological reports provide a definitive answer to questions of malignancy but SPECC can be challenging in all areas. A specialist MDT allows for appropriate assessment and treatment of lesions and leads to better patient outcomes.

A Polyp Worth Removing: A Paradigm for Measuring Colonoscopy Quality and Performance of Novel Technologies for Polyp Detection.

Leaving no significant polyp behind while avoiding risks due to unnecessary resections is a commonsense strategy to safely and effectively prevent colorectal cancer (CRC) with colonoscopy. It also alludes to polyps worth removing and, therefore, worth finding. The majority of "worthy" precancerous polyps are adenomas, which for over 2 decades, have received the most attention in performance research and metrics. Consequently, the detection rate of adenomas is currently the only validated, outcome-based measure of colonoscopy demonstrated to correlate with reduced risk of postcolonoscopy CRC. However, a third or more of postcolonoscopy CRCs originate from sessile serrated polyps (SSPs), which are notoriously difficult to find, diagnose and completely resect. Among serrated polyps, the agreement among pathologists differentiating SSPs from non-neoplastic hyperplastic polyps is moderate at best. This lack of ground truth precludes SSPs from consideration in primary metrics of colonoscopy quality or performance of novel polyp detection technologies. By instead leveraging the distinct endoscopic and clinical features of serrated polyps, including those considered important due to proximal location and larger size, clinically significant serrated polyps represent serrated polyps worth removing, enriched with subtle precancerous SSPs. With the explosion of technologies to assist polyp detection, now is the time to broaden benchmarks to include clinically significant serrated polypss alongside adenomas, a measure that is relevant both for assessing the performance of endoscopists, and for assessing new polyp detection technologies.

Re-initiation of CT colonography services during the COVID-19 pandemic: Preliminary evaluation of safety.

Objective:The COVID-19 pandemic has led to cancellation and deferral of many cancer investigations, including CT colonography (CTC). In May 2020, BSGAR and SCoR issued guidelines outlining steps for conduct of CTC in the early recovery phase. We evaluated the implementation of these in four English hospital trusts.Methods:Ethical permission was not required for this multicentre service evaluation. We identified patients undergoing CTC over a 2-month period from May to July 2020 at four Trusts. We recorded demographics, scan indications, colonic findings, and incidental lung base changes compatible with COVID-19. A subset of patients were contacted via telephone to document new symptoms 2 weeks following their scan. Staff were contacted to determine if any acquired COVID-19 during the period.Results:224 patients (118 male, 52.7%) were scanned during the period. In 55 patients (24.6%), CTC showed a ≥6 mm polyp. 33 of 224 (14.7%) scans showed incidental lung base changes felt unrelated to COVID-19, and only one patient had changes indeterminate for COVID-19; no classic COVID-19 pulmonary changes were found. Of 169 patients with telephone follow-up, none reported any new symptoms of COVID-19 (cough, fever, anosmia, ageusia) within 14 days of CTC. None of the 86 staff contacted developed COVID-19.Conclusion:We found no cases of patients or staff acquiring COVID-19 infection following CTC; and no evidence of significant asymptomatic COVID-19 patients attending for CTC appointments based on lung base changes.Advances in knowledge:Our findings suggest that current practice is unlikely to contribute significantly to spread of SARS-nCOV2. Cancer and significant polyp detection rates were high, underlining the importance of maintaining service provision.

Effect of Screen Distance on Colonic Polyp Detection and Colonic Polyp Size Estimation: A Pilot Study

Background Colorectal cancer is the 3rd most common cancer in the world, with about 1.2 million new cases reported annually. It is one of the three most common causes of cancer related mortality in Europe and North America. Thus, prevention and detection are critical aspects in managing colorectal cancer. Colonoscopy remains the gold standard for screening of colorectal cancer, as it is valuable not only for detection but also prevention with polyp identification. Adenoma detection rate remains a pivotal part of a good endoscopic exam. While various factors have been known to influence it, data regarding ideal screen distance for adenoma detection remains unclear. The aim of this study was to assess the rate of polyp detection and estimate the size of diminutive (&lt;1 cm) polyps with varying screen distance from the proceduralist. Materials and Methods This was a quality improvement project carried at OSF Saint Francis Medical center where post graduate trainees and attending physicians were enrolled. A 26-inch-high resolution screen was used and placed at eye level for the endoscopist. We selected 50 high resolution slides of polyps (&lt;1 cm) intermixed with slides of normal colonic mucosa. These slides were downloaded from Orpheus Medical, a global clinical media platform and video informatics company. These were shown to each endoscopist standing either 3, 6, or 9 feet away (0.91, 1.8, or 2.7 meters) from the screen on three separate days, arranged in 3 different configurations. Both the rate of polyp detection and the sizes of polyps measured at various distances were recorded. The endoscopists were able to move +/- 10 cm (0.5 feet) from their index position to enhance their visualization and for better accommodation. The data was collected for multiple outcomes and statistical analysis was performed using odds ratio and t-test. Results Seven subjects who were either 3rd year Gastroenterology fellows or attendings were included in the study. We included 50 slides, with 33 consisting of polyps (&lt;1 cm) and others containing normal colonic mucosa. Our results showed that the number of polyps detected decreased as the distance from the screen increased. Overall polyp detection rate (PDR) was 92.18% at 3 feet (0.91 m), 87% at 6 feet (1.8m) and 77% at 9 feet (2.7m). An endoscopist positioned at 3 ft had a statistically significant higher polyp detection rate than one positioned at 9 ft with odds ratio (OR) of 3.43 (95% CI: 1.45 – 8.11, p= 0.004). The mean polyp size reported by all subjects was 2.68 mm at 3 feet, 2.57 mm at 6 feet and 2.25 mm at 9 feet. Comparison of mean polyp sizes at different distances from screen did not reveal statistically significant differences. Secondary outcomes included accuracy of polyp detection, miss rate and mean overestimation rate. The participating subjects were surveyed verbally at the end of the study to assess their comfort at various distances. They reported the highest level of comfort at 3 feet (0.91m), followed by 6 feet (1.8m). Conclusions This quality improvement study sheds light on the importance of screen distance for polyp detection, especially in case of smaller polyps &lt;1cm. Our results show that ideal screen distance for polyp detection should be close to 3 feet (0.91m) and ideally no more than 6 feet (1.8m). Similarly, our results also point out that polyp size may be overestimated if the examiner is too close to the screen and underestimated if the examiner is too far from the screen. We advocate standardization of screen distance from the endoscopist, so that the polyp size estimation is uniform across the board.

Polyposis Syndromes

Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in men and women. Although about one third of cancers arise in patients with a family history of CRC, only 5% arise in the setting of mendelian-inherited disorders. Patients without a family history but with a significant polyp burden (&gt; 20 polyps) should be considered to have polyposis syndrome. The field of polyposis syndromes continues to advance, based on new genetic discoveries that define the genetic etiologies of polyposis syndromes. When considered in relation to an individual’s phenotype, these discoveries help guide screening and treatment based on the cancer risk created by specific mutations. Patients with polyposis syndromes carry an increased risk of CRC and some other extracolonic cancers. Future research will provide additional insight into the cause of polyposis syndromes without a currently detectable gene defect and will improve early identification and cancer prevention in affected individuals. Identification of additional molecular characteristics may lead to a more personalized approach to treatment for these individuals. This review contains 7 figures, 11 tables and 52 references. Key words: attenuated familial polyposis, colorectal cancer risk, familial adenomatous polyposis, hamartomatous polyposis syndrome, juvenile polyposis syndrome, MUTYH-associated polyposis, Peutz-Jeghers syndrome, polyposis syndromes, screening guidelines, serrated polyposis syndrome

Polyposis Syndromes

Colorectal cancer (CRC) is the third most common type of cancer and the second leading cause of cancer death in men and women. Although about one third of cancers arise in patients with a family history of CRC, only 5% arise in the setting of mendelian-inherited disorders. Patients without a family history but with a significant polyp burden (&gt; 20 polyps) should be considered to have polyposis syndrome. The field of polyposis syndromes continues to advance, based on new genetic discoveries that define the genetic etiologies of polyposis syndromes. When considered in relation to an individual’s phenotype, these discoveries help guide screening and treatment based on the cancer risk created by specific mutations. Patients with polyposis syndromes carry an increased risk of CRC and some other extracolonic cancers. Future research will provide additional insight into the cause of polyposis syndromes without a currently detectable gene defect and will improve early identification and cancer prevention in affected individuals. Identification of additional molecular characteristics may lead to a more personalized approach to treatment for these individuals. This review contains 7 figures, 11 tables and 52 references. Key words: attenuated familial polyposis, colorectal cancer risk, familial adenomatous polyposis, hamartomatous polyposis syndrome, juvenile polyposis syndrome, MUTYH-associated polyposis, Peutz-Jeghers syndrome, polyposis syndromes, screening guidelines, serrated polyposis syndrome

Significant polyp and early colorectal cancer - SPECC: The role of the Colorectal Cancer Clinical Nurse Specialist (CNS): promoting patient-centred care.

The colorectal Clinical Nurse Specialist (CNS) makes an important contribution to the care of individuals diagnosed with a significant polyp and early colorectal cancer (SPECC). This paper offers an expert opinion on the role of the CNS in SPECC, informed by relevant literature. A CNS can support the patient through the diagnostic and treatment pathway acting as the patient's advocate as a core member of the multidisciplinary team. They will offer support and information to help patients understand their diagnosis, make choices about their available treatment options and help them to feel prepared for any treatment undertaken. By providing care that is respectful of, and responsive to, individual patient preferences, needs and values, the CNS can play an important role in promoting patient-centred care.

Significant polyp and early colorectal cancer - decision-making and treatment planning in regional networks and multidisciplinary teams.

Significant polyp and early colorectal cancer - decision-making and treatment planning in regional networks and multidisciplinary teams.

Assessment of a rectal SPECC lesion by endoluminal ultrasound.

Assessment of a rectal SPECC lesion by endoluminal ultrasound.