Treatment Of Colorectal Polyps Research Articles

Colon polyp detection based on multi-scale and multi-level feature fusion and lightweight convolutional neural network

Early diagnosis and treatment of colorectal polyps are crucial for preventing colorectal cancer. This paper proposes a lightweight convolutional neural network for the automatic detection and auxiliary diagnosis of colorectal polyps. Initially, a 53-layer convolutional backbone network is used, incorporating a spatial pyramid pooling module to achieve feature extraction with different receptive field sizes. Subsequently, a feature pyramid network is employed to perform cross-scale fusion of feature maps from the backbone network. A spatial attention module is utilized to enhance the perception of polyp image boundaries and details. Further, a positional pattern attention module is used to automatically mine and integrate key features across different levels of feature maps, achieving rapid, efficient, and accurate automatic detection of colorectal polyps. The proposed model is evaluated on a clinical dataset, achieving an accuracy of 0.9982, recall of 0.9988, F1 score of 0.9984, and mean average precision (mAP) of 0.9953 at an intersection over union (IOU) threshold of 0.5, with a frame rate of 74 frames per second and a parameter count of 9.08 M. Compared to existing mainstream methods, the proposed method is lightweight, has low operating configuration requirements, high detection speed, and high accuracy, making it a feasible technical method and important tool for the early detection and diagnosis of colorectal cancer.

Standardized diagnosis and treatment of colorectal polyps

This article explores the standardized management of colorectal polyps, including classification, treatment, follow-up, and preventive control. Corresponding treatment strategies, including endoscopic resection and surgical intervention, are employed for different types of polyps. Currently, there is debate over whether to choose endoscopic resection or surgical intervention for malignant polyps at pT1 stage. Drawing on the latest literature and guidelines, the article elaborates on polyp classification, treatment modalities, follow-up, and preventive measures. Standardized management of colorectal polyps is important for reducing the incidence of colorectal cancer and improving the cure rate of early-stage colorectal cancer.

Progress in the treatment of colorectal polyps from the perspective of the "spleen"

Progress in the treatment of colorectal polyps from the perspective of the "spleen"

Hp-Positive Chinese Patients Should Undergo Colonoscopy Earlier and More Frequently: The Result of a Cross-Sectional Study Based on 13,037 Cases of Gastrointestinal Endoscopy.

BackgroundIn China, the prevalence and mortality of colorectal cancer (CRC) have always been high, and more than 95% of CRC cases have evolved from colorectal polyps (CPs), especially adenoma. Early detection and treatment of CPs through colonoscopy is essential to reduce the incidence of CRC. Helicobacter pylori (Hp) is regarded as a risk factor for gastritis and gastric cancer and may also be a risk factor for CPs and CRC. However, few studies based on vast clinical cases exist in China to clarify whether Hp is a risk factor for CPs and CRC, and whether Hp-positive patients need to undergo colonoscopy checks earlier. This article attempts to make up for that deficiency.MethodThis cross-sectional study was conducted based on 13,037 patients without a treatment history of Hp who underwent their first gastroscopy and colonoscopy simultaneously at The First Affiliated Hospital of Zhejiang Chinese Medical University from January 2018 to December 2019. Pearson χ2 test and logistic regression were used to determine whether Hp is a risk factor for CPs and CRC. Multifactor analysis of variance was used to define the impact of Hp on CPs prevalence with different ages, sexes.ResultsFor Chinese individuals, Hp is a risk factor for CPs and CRC. The odds ratio (OR) value are 1.228 (95% CI, 1.130 to 1.336) and 1.862 (95% CI 1.240-2.796), respectively. Hp-positive patients have a higher probability of multiple or large intestinal polyps. However, Hp infection does not increase the incidence of adenomas, nor does it affect the pathological type of adenomas. The OR of Hp on the risk of CPs was 1.432 (95%CI 1.275-1.608) for males but increased to 1.937 (95%CI 1.334-2.815) for those aged 35 to 40. For females, the results were similar.ConclusionsFor the Chinese, Hp is a risk factor for CPs and CRC (OR>1); the infection of Hp increased CPs risk in Chinese of all ages, especially aged 35-40, suggesting that Hp-positive patients should undergo colonoscopy frequently.

Underwater vs conventional endoscopic mucosal resection in treatment of colorectal polyps: A meta-analysis.

BACKGROUNDUnderwater endoscopic mucosal resection (UEMR) of colorectal lesions is emerging as an alternative method to conventional endoscopic mucosal resection (EMR); however, it is still controversial whether there is a difference in the effectiveness between UEMR and EMR.AIMTo evaluate the effectiveness and safety of UEMR in the treatment of colorectal polyps.METHODSClinical studies comparing the effectiveness or safety of UEMR in the treatment of colorectal polyps were searched in medical databases, including PubMed, Embase, Cochrane Library, CNKI, and Wanfang Data, monographs, theses, and papers presented at conferences. Statistical analyses were performed using Revman 5.3 software.RESULTSSeven non-randomized controlled trials and one randomized controlled trial met the inclusion criteria. In total, 1382 patients (1511 polyps) were included in the study, including 722 who received UEMR and 789 who received EMR. In the UEMR and EMR groups, the en bloc resection rates were 85.87% and 73.89%, respectively, with a relative risk (RR) value of 1.14 (95% confidence interval [CI]: 1.01-1.30; P < 0.05). In the sub-group analysis, the en bloc resection rate showed no statistically significant difference between the EMR and UEMR groups for polyps less than 20 mm in diameter. However, a statistically significant difference was found between the EMR and UEMR groups for polyps equal to or greater than 20 mm in diameter. The post-endoscopic resection recurrence rates at 3-6 mo of the UEMR and EMR groups were 3.26% and 15.17%, respectively, with an RR value of 0.27 (95%CI: 0.09-0.83; P < 0.05). The post-endoscopic resection recurrence rates of UEMR and EMR at 12 mo were 6.25% and 14.40%, respectively, with an RR value of 0.43 (95%CI: 0.20-0.92; P < 0.05). Additionally, the incidence of adverse events was 8.17% and 6.21%, respectively, with an RR value of 1.07 (95%CI: 0.50-2.30; P > 0.05).CONCLUSIONUEMR is an effective technique for colorectal polyps and appears to have some advantages over EMR, particularly with regard to some treatment outcomes.

The efficacy and safety of sulindac for colorectal polyps: A protocol for systematic review and meta-analysis.

Background:Sulindac has been used for treating colorectal polyps widely. However, the efficacy and safety of sulindac for colorectal polyps are unclear. This study aims to evaluate the efficacy and safety of sulindac for colorectal polyps.Methods:Randomized controlled trials of sulindac in the treatment of colorectal polyps will be searched in PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang, the Chongqing VIP Chinese Science, and Technology Periodical Database, and China biomedical literature database (CBM) from inception to August, 2020. And Baidu Scholar, Google Scholar, International Clinical Trials Registry Platform, and Chinese Clinical Trials Registry will be searched to obtain more relevant studies comprehensively. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3.Results:This study will summarize the present evidence by exploring the efficacy and safety of sulindac in the treatment of colorectal polyps.Conclusion:The findings of the study will provide helpful evidence for the efficacy and safety of sulindac in the treatment of colorectal polyps, facilitating clinical practice and further scientific studies.Ethics and dissemination:The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.OSF Registration number:DOI 10.17605/OSF.IO/N5GDH

Mo1673 HYDRAULIC INFUSION OF EPINEPHRINE-CONTAINING SALINE IS EFFECTIVE IN PREVENTING POSTOPERATIVE BLEEDING DURING ANTICOAGULANTS COLD SNARE POLYPECTOMY

Cold snare polypectomy has recently been reported to be useful in the treatment of colorectal polyps and has become widely used worldwide. For HSP using a radiofrequency generator, CSP is recognized to have a lower risk of post-polyp bleeding and fewer bleeding complications, one of the post-polyp syndrome, because it does not perform heat coagulation, although bleeding occurs immediately after polyp removal. However, recent advances in anticoagulants have led to the administration of antithrombotic agents such as NOAC and aspirin in a large number of cases for the purpose of preventing cardiovascular diseases, and antithrombotic agents have been increasingly administered in colorectal polypectomy. Therefore, it is necessary to pay attention to the prevention of bleeding after CSP. Generally, the injection of physiological saline using the water jet mechanism is used to prevent bleeding after CSP, and we examined whether the addition of a small amount of epinephrine to the saline can prevent postoperative bleeding. From January 2018 to March 2019, 200 patients who underwent CSP with an antithrombotic agent in our hospital were randomly assigned to receive either saline infusion after CSP (NS group) or epinephrine infusion (ES group) and prospectively enrolled to determine the presence of postoperative bleeding events. As the concentration of epinephrine, 0.1%-2 ml/1A dissolved in 200 ml physiological saline was used as a 100-fold dilution. NS group was injected with saline after CSP, and ES group was injected with epinephrine added saline after CSP. All procedures for CSP and equipment such as snares were the same. Post-CSP fluid infusion was terminated in both groups when the ablated surface bulged, and hemostasis was achieved using Olympus OFP -2 as a Water Jet device. Postoperative bleeding events were defined as the occurrence of anal bleeding from the day following polypectomy. In the CSP, all cases were examined, and only those diagnosed as adenoma by the diagnosis of JNET TYPE 2A by the magnifying observation of NBI or BLI were examined. Postoperative bleeding occurred in 2/100 of patients in the NS group. In the ES group, 0/100 patients had postoperative bleeding. There were no differences in polyp size, location, or histology between the two groups. There was no difference in antithrombotic therapy between the two counties. Hydraulic infusion of epinephrine in anticoagulated cold snare polypectomy is effective in preventing postoperative bleeding.

大肠息肉的危险因素与治疗研究进展

大肠息肉的危险因素与治疗研究进展

Efficacy of three different endoscopic methods in treatment of colorectal polyps

Efficacy of three different endoscopic methods in treatment of colorectal polyps

Screening colonoscopy: what is the most reliable modality for the detection and characterization of colorectal lesions?

Colonoscopy is considered the best modality for the detection and treatment of colorectal polyps. However, some polyps still may not be detected. Although conventional white-light endoscopy is the gold standard for the detection of colorectal polyps, up to a fifth of lesions may be missed on screening colonoscopy, especially non-polypoid colorectal neoplasms. Recently, many studies have reported on various endoscopic modalities that improve the detection and characterization of colorectal lesions. Newly developed modalities might be helpful to recognize colorectal lesions; however, careful observation is required to identify flat/depressed lesions as well as hidden polyps during screening and surveillance colonoscopy.

Treatment of colorectal polyps by nylon ligation combined with endoscopic high-frequency electric snare

Objective To evaluate the clinical efficacy and safety of nylon ligation combined with endoscopic high-frequency electric snare for the treatment of colorectal polyps.Methods The clinical data of 345 patients with colorectal polyps who received the treatment of nylon ligation combined with endoscopic high-frequency electric snare at the Zhongshan Hospital of Fudan University from January 2006 to January 2011 were retrospectively analyzed.Complications including bleeding and perforation were observed.Postoperative wound healing and local residual recurrence were assessed during follow-up.Results A total of 362 colorectal polyps were successfully removed.The mean diameter of the colorectal polyps was 2.7 cm (range,1.5-4.0 cm). Operative bleeding occurred in 1 patient,and perforation in 1 patient.The results of histological examination showed that 93.6％(339/362) colorectal polyps were adenoma,17 were hyperplastic polyps,5 were inflammatory polyps,and caneeration of colorectal polyps in 1 patient was detected.Endoscopic follow-up was completed in 334 patients at the first month after operation,and 9 patients with residual benign colorectal polyps received endoscopic resection.No residue or recurrence was found in the other patients.Endoscopic follow-up was completed in 308 patients at the second months after operation,and no residue or recurrence was found.The overall effective rate was 97.1％ (299/308).Conclusion Endoscopic nylon ligation combined with endoscopic high-frequency electric snare is effective and safe for the treatment of colorectal polyps. Key words: Colorectal polyps; Nylon thread; Endoscopic high-frequency electric snare

Advances in endoscopic visualization of colorectal polyps

Conventional white-light endoscopy is currently the gold standard for the detection and treatment of colorectal polyps. However, up to a fifth of polyps may be missed on initial examination, especially flat and small mucosal lesions. This study reviews the literature reporting on the use of new advances in endoscopic visualization. Literature searches were performed on PubMed using the terms 'chromoendoscopy', 'narrow-band imaging' (NBI), 'autofluorescence imaging' (AFI), 'Fujinon Intelligent Colour Enhancement' (FICE), 'i-Scan colonoscopy', 'zoom colonoscopy' and 'confocal laser endomicroscopy' (CLE). We focused on systematic reviews, national guidelines and randomized controlled trials written in English. Studies were assessed for methodological quality using QUADAS. Prospective studies assessing new technology were also reviewed. Further publications were identified from reference lists. Chromoendoscopy increases the detection of neoplastic polyps compared with conventional colonoscopy. NBI avoids the use of additional dyes and enhances the vascular network of capillaries surrounding the crypts, increasing the adenoma detection rate and the ability to distinguish between neoplastic and non-neoplastic lesions. FICE, AFI and i-Scan are new developments that improve tissue contrast. Zoom endoscopy may be combined with different modalities to help further characterize colonic lesions. CLE provides live in vivo high-resolution optical sections of tissue and may be particularly useful in the surveillance of patients with long-standing ulcerative colitis, reducing the number of random biopsies. Although there is mounting evidence that these new technologies are superior to conventional endoscopy, current guidelines are limited. Further large-scale randomized controlled trials comparing these modalities in different patient subpopulations are warranted.

Endoscopic mucosal resection for treatment of colorectal polyps occurring in the senium and presenium: a report of 561 cases

Endoscopic mucosal resection for treatment of colorectal polyps occurring in the senium and presenium: a report of 561 cases

Locating polyps by endoscopy with or without videolaparoscopy, radioguided occult colonic lesion identification or magnetic endoscopic imaging: the way forward to complete polyp removal

Endoscopic polypectomy is the gold standard for the treatment of colorectal polyps. In the case of non-palpable lesions or to complete polyp removal, the lesions are located intra-operatively. With the advent of laparoscopy, identifying their position is even more important because there is no opportunity for intestinal palpation. Several methods of preoperative endoscopic marking have been proposed using different types of tattooing and recently using clips followed by ultrasonography detection. Innovative methods are analysed; magnetic endoscopic imaging is a reliable and accurate method for determining the anatomical position of the tip of the endoscope during colonoscopy. Radioguided colonic lesion identification needs a gamma detection probe. Endoscopic removal can be converted to endo-laparoscopic rendezvous, failing which, laparoscopic resection is a reliable and safe choice, offering all the advantages of minimally invasive surgical techniques.

Endoscopic treatment of colorectal polyps and early cancer.

To analyze the efficacy and outcome of colonoscopic resection for colorectal neoplastic lesions, we retrospectively reviewed 338 colorectal lesions from 232 patients regarding the clinical profiles, colonoscopic findings, histological findings, complications, and outcome. Morphologically, these lesions were classified into three categories: pedunculated (n = 140), sessile (n = 176); and flat (n = 22). Histological findings of lesions included adenoma (n = 248), carcinoma in situ (n = 17), submucosal carcinoma (n = 2), hyperplastic polyp (n = 57), and inflammatory polyp (n = 14). Neoplastic lesions are generally larger than nonneoplastic lesions (chi2 test, P < 0.05). The incidence of carcinoma was 5.6% of 338 resected lesions. The rate of cancer or high-grade dysplasia in flat polyps was greater than in pedunculated and sessile polyps (13.6 vs 4.54 vs 5.71%; P < 0.05). There were no perforations or deaths after colonoscopic treatment, and only mild bleeding occured in two patients. To date, 19 patients with early colorectal cancer were treated successfully by endoscopy with no recurrence or metastasis. To reduce the incidence and mortality of colorectal cancer, colonoscopic resection is a simple and safe procedure for removing neoplastic lesions. Detailed histological examinations are essential to decide the indications of surgery.

Laparoscopic approach for colorectal polyps unresectable under laparoscopy

When colonoscopic polypectomy has an unacceptable risk of perforation due to the size or location of the polyp, it is usual to proceed to colectomy through a laparotomy. The laparoscopic approach provides an alternative method of managing these polyps unsuitable for colonoscopic polypectomy. The aim of the present study was to evaluate the laparoscopic approach for treatment of colorectal polyps. Patients and method : From September 1996 to May 1999,20 patients (7 women, 13 men) underwent laparoscopic surgery for polyps of the colon or rectum. The mean age was 63 years (ranged from 34 to 77). In 15 patients, colonoscopic resection appeared to be unsafe (sessil polyps: 6 ; pedunculated polyps> 2 em : 3 ; number of polyps> 3 : 5 ; pedunculated polyp associated with diverticular disease: I). In 5 patients, secondary colectomy was necessary because of discovery of carcinoma on colonoscopic resection specimen (muscularis mucosae invasion : 4 ; involved margin of resection: I). Polyps were tattooed during pre-operative colonoscopy in one case. Colonoscopy during laparoscopy was performed in 5 patients in order to landmark the polyp. The laparoscopically surgical procedure performed were: 9 sigmoidectomies, 4 sigmoido-rectal resections, 2 left colectomies, 2 right colectomies. I caecal wedge resection and 2 polypectomies through a colotomy. Three to five ports were used. Specimen were removed through a 5 em laparotomy with protection of the wedges. Resected polyps were removed through a port in a bag. Results : There was one conversion due to a mesocolic artery bleeding. There was no mortality. Three complications occured : I wound abcess, I small bowel occlusion, I reversible paralysis of the fibularis communis nerve. No reoperation was necessary. There was no anastomotic leak, no blood transfusion. The median duration of postoperative morphinic analgesia was 2 days (1-5 days). Oral feedings began on the third post-operative days (2-5 days). The median length of hospital stay was 9 days (4-16 days). On pathologic examination, there were 6 in situ carcinomas and 3 Dukes A carcinomas. In one case, a secondary right colectomy was performed because of an involved margin of a wedge caecal resection. All nodes were free of disease. There were no cancer recurrence and no port site recurrence. Conclusion : Laparoscopic approach for colorectal polyps allowed safe and complete resection of colonoscopically unresectable polyps without mortality and with a low morbidity in our study.

Large Bowel Adenomas

The last 20 years have witnessed dramatic technological advances in the diagnosis and treatment of colorectal polyps. These developments, in addition to an increased understanding of large bowel carcinogenesis, have shifted the risk/benefit balance toward a more aggressive approach to colorectal polyps. Mounting evidence for the adenoma-carcinoma sequence supports the position that all colorectal polyps should be removed, recovered, and evaluated. Moreover, in most cases polypectomy can be achieved endoscopically. To justify surgery today, adenomas must be too large to be removed endoscopically, located in the distal rectum, or malignant with submucosal invasion or questionable margins.

4. Histological Study on Adenoma-Early Cancer Relationship of the Large Bowel

Adenoma-early cancer relatiotship was studied from the histological investigation of a large number of adenomas and carcinomas arising in adenomas of the large bowel. It was strongly suggested that the majority of colonic cancers evolved from preexisting adenomas. The concept was supported by the evidence that most focal cancers (carcinoma confined to the mucosa) were found in otherwise benign adenomas. It was also suggested that as cancers spread through the bowel wall so they expand on the mucosal surface and tend to destroy surviving benign adenomatous tissue. The process of malignant transformation in an adenoma may be variable in individual adenomas.Out of 100 adenomas removed through colonosope there were 18 early cancers, among which 16 cancers had definite histological evidence of adenoma origin. The value of colonoscopic polypectomy was emphasized in the treatment of colorectal polyps and in the study of adenomacancer sequence.