Different risk factors for advanced colorectal neoplasm in young adults

AIM: To compare the risk of developing advanced colorectal neoplasm(ACRN) according to age in Koreans.METHODS: A total of 70428 Koreans from an occupational cohort who underwent a colonoscopy between 2003 and 2012 at Kangbuk Samsung Hospital were retrospectively selected. We evaluated and compared odds ratios(OR) for ACRN between the young-adults(YA 50 years) and in the older-adults(OA ≥ 50 years). ACRN was defined as an adenoma ≥ 10 mm in diameter, adenoma with any component of villous histology, high-grade dysplasia, or invasive cancer.RESULTS: In the YA group, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 1.26, 95%CI: 1.02-1.55), current smoking(OR = 1.37, 95%CI: 1.15-1.63), family history of colorectal cancer(OR = 1.46, 95%CI: 1.01-2.10), diabetes mellitus related factors(OR = 1.27, 95%CI: 1.06-1.54), obesity(OR = 1.23, 95%CI: 1.03-1.47), CEA(OR = 1.04, 95%CI: 1.01-1.09) and low-density lipoprotein-cholesterol(OR = 1.01, 95%CI: 1.01-1.02) were related with an increased risk of ACRN. However, age(OR = 1.08, 95%CI: 1.06-1.09), male sex(OR = 2.12, 95%CI: 1.68-2.68), current smoking(OR = 1.38, 95%CI: 1.12-1.71), obesity(OR = 1.34, 95%CI: 1.09-1.65) and CEA(OR = 1.05, 95%CI: 1.01-1.09) also increased the risk of ACRN in the OA group.CONCLUSION: The risks of ACRN differed based on age group. Different colonoscopic screening strategies are appropriate for particular subjects with risk factors for ACRN, even in subjects younger than 50 years.     

Prevalence and risk of colorectal adenoma in asymptomatic Koreans aged 40–49 years undergoing screening colonoscopy

Background and Aim: Colorectal cancer screening is recommended for average‐risk persons beginning at age 50. However, information about the incidence and risk factors of precursor adenoma in preceding decades is limited. The aim of this study was to determine the prevalence and risk factors of colorectal adenoma in persons aged 40–49 years and to compare the data with those aged 30–39 years and 50–59 years. Methods: A cross‐sectional study of 5254 asymptomatic subjects who underwent screening colonoscopy was conducted. Data were stratified by age into three groups: 608 aged 30–39 years, 1930 aged 40–49 years, and 2716 aged 50–59 years. Results: Prevalence of overall adenomas was 10.4% in the 30–39 years age group, 22.2% in the 40–49 years age group, and 32.8% in the 50–59 years age group. Advanced adenoma was found in 0.7% of the 30–39 years age group, 2.7% of the 40–49 years age group, and 4.1% of the 50–59 years age group. In the 40–49 years age group, male sex and current smoking habits showed associations with low‐risk adenoma after multiple adjustments. Moreover, male sex (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.02–3.23), current smoking (OR = 1.58, 95%CI: 1.06–3.50), and family history of colorectal cancer (OR = 2.54, 95%CI: 1.16–5.56) were independent predictors of advanced adenoma in this age group. Conclusions: Prevalence of adenoma in subjects aged 40–49 years was higher than in previous studies. Male sex and current smoking habits along with a family history of colorectal cancer were associated with advanced adenoma in this age group.     

Prevalence and risk of colorectal polyps among the Korean population under 50 years

Colorectal cancer is a common cancer; generally, adults aged ≥ 50 years are screened using stool occult blood tests and colonoscopy. However, colorectal adenoma and cancer have been found in patients under the aged of 50, and studies on characteristics and risk factors in young patients are lacking. We evaluated the prevalence and risk factors of colorectal adenoma and cancer in young adults aged under 50 years.We retrospectively analyzed 570 individuals aged under 50 years who underwent colonoscopy at the Haeundae Paik Hospital, Korea, from January to June 2018. Logistic regression model was used to identify the risk factors for colorectal adenoma and colorectal cancer.The prevalence of colorectal adenoma in group of 19–29 years was 3.2% (1 of 31), 30–39 years was 13.8% (30 of 217) and in the group of 40–49 years was 21.1% (68 of 322) (P = .009). In multivariable analysis, age over 45 years (adjusted odds ratio [OR], 1.941; 95% confidence interval [CI], 1.187–3.172; P = .008) and male sex (adjusted OR, 1.711; 95% CI, 1.044–2.806; P = .033) were independent risk factors for colorectal neoplasia including cancer.The prevalence of colorectal adenoma increases as the age increased in young adults under 50 years of age, especially after the age of 45 years, the risk of colorectal neoplasia increases; hence, early screening should be considered before the age of 50 years.     

IFOBT与肿瘤标志物、炎症指标联合检测对结直肠进展期腺瘤发生的预测价值

背景目前临床缺乏对结直肠癌前病变有效的无创筛查手段,识别高危人群和多指标联合检测已成为癌及癌前病变筛查的趋势.多种炎症指标已广泛用于各种肿瘤的诊断及预后,而对癌前病变诊断价值的研究较少.目的探讨粪便免疫潜血实验(immunochemical fecal occult blood testing,IFOBT),肿瘤标志物(CEA、CA199),炎症指标包括中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)、血小板/淋巴细胞比值(platelet/lymphocyte ratio,PLR)及一般临床特征对结直肠进展期腺瘤息肉发生的预测价值.方法回顾性分析我院2014-2018年行电子结肠镜检查并经病理学证实的295例结直肠进展期腺瘤病例作为观察组,选择同期448例非进展期腺瘤病例作为对照组,收集患者的一般临床资料包括基本特征(性别、年龄)、生活习惯(吸烟史、饮酒史)、既往史(高血压史、冠心病史、糖尿病史),手术史(胆囊或阑尾切除史);实验室检查(NLR、PLR、CEA、CA199、IFOBT);进行单因素差异分析,将有意义的结果纳入二元logistic回归分析,绘制ROC曲线,评估相关指标对结直肠进展期腺瘤发生的预测价值.结果Logistic回归分析显示:年龄(OR=1.047,95%CI:1.028-1.066,P=0.000)、吸烟(OR=1.880,95%CI:1.250-2.826,P=0.002)、糖尿病(OR=2.073,95CI%:1.216-3.535,P=0.007)、既往胆囊切除(OR=9.206,95CI%:2.904-29.181,P=0.000)、IFOBT(OR=7.681,95%CI:4.585-12.869,P=0.000)、CA199(OR=1.039,95%CI:1.018-1.059,P=0.000)、NLR(OR=1.706,95%CI:1.388-2.097,P=0.000)与进展期腺瘤的发生独立相关.对于预测进展期腺瘤的发生,IFOBT的灵敏度为34.6%,特异度为94.2%,AUC为0.644,95%CI:0.602-0.686,CA199的最佳截断点为7.87 U/mL,灵敏度为53.9%,特异度为66.1%,AUC为0.639,95%CI:0.598-0.679,NLR的最佳截断点为2.04,灵敏度为50.2%.特异度为71.8%,AUC为0.645,95%CI:0.605-0.685,当三者联合检测时其灵敏度为52.9%,特异度为82.8%,AUC 95%CI为0.752(0.716-0.788),进展期腺瘤亚组分析中,IFOBT(-)和IFOBT(+)亚组之间的腺瘤位置(P=0.048)、腺瘤直径(P=0.000)、分化级别(P=0.000)差异有统计学意义,低NLR(<2.04)和高NLR(≥2.04)亚组之间的性别(P=0.004)、腺瘤直径(P=0.028)、分化级别(P=0.000)差异有统计学意义.结论高龄、吸烟、糖尿病、既往胆囊切除人群更易发生结直肠进展期腺瘤,临床需对此类人群提高重视,IFOBT、NLR、CA199对进展期腺瘤的发生具有诊断意义,三者联合检测时其诊断效能最佳.     

Chromoendoscopy of gastric adenoma using an acetic acid indigocarmine mixture

AIM:To investigate the usefulness of chromoendoscopy,using an acetic acid indigocarmine mixture(AIM),for gastric adenoma diagnosed by forceps biopsy.METHODS:A total of 54 lesions in 45 patients diagnosed as gastric adenoma by forceps biopsy were prospectively enrolled in this study and treated by endoscopic submucosal dissection(ESD)between January 2011 and January 2012.AIM-chromoendoscopy(AIMCE)was performed followed by ESD.AIM solution was sprinkled and images were recorded every 30 s for 3min.Clinical characteristics such as tumor size(<2cm,≥2 cm),surface color in white light endoscopy(WLE)(whitish,normochromic or reddish),macroscopic appearance(flat or elevated,depressed),and reddish change in AIM-CE were selected as valuables.RESULTS:En bloc resection was achieved in all 54 cases,with curative resection of fifty two lesions(96.3%).Twenty three lesions(42.6%)were diagnosed as welldifferentiated adenocarcinoma and the remaining 31lesions(57.4%)were gastric adenoma.All adenocarcinoma lesions were well-differentiated tubular adenocarcinomas and were restricted within the mucosal layer.The sensitivity of reddish color change in AIM-CE is significantly higher than that in WLE(vs tumor size≥2 cm,P=0.016,vs normochromic or reddish surface color,P=0.046,vs depressed macroscopic type,P=0.0030).On the other hand,no significant differences were found in the specificity and accuracy.In univariate analysis,normochromic or reddish surface color in WLE(OR=3.7,95%CI:1.2-12,P=0.022)and reddish change in AIM-CE(OR=14,95%CI:3.8-70,P<0.001)were significantly related to diagnosis of early gastric cancer(EGC).In multivariate analysis,only reddish change in AIM-CE(OR=11,95%CI:2.3-66,P=0.0022)was a significant factor associated with diagnosis of EGC.CONCLUSION:AIM-CE may have potential for screening EGC in patients initially diagnosed as gastric adenoma by forceps biopsy.     

Incidence of colorectal neoplasms among male pilots

AIM: To assess the prevalence of colorectal neoplasms (adenomas, advanced adenomas and colorectal cancers) among Israeli military and commercial airline pilots.METHODS: Initial screening colonoscopy was performed on average-risk (no symptoms and no family history) airline pilots at the Integrated Cancer Prevention Center (ICPC) in the Tel-Aviv Medical Center. Visualized polyps were excised and sent for pathological examination. Advanced adenoma was defined as a lesion >10 mm in diameter, with high-grade dysplasia or villous histology. The results were compared with those of an age- and gender-matched random sample of healthy adults undergoing routine screening at the ICPC.RESULTS: There were 270 pilots (mean age 55.2 ± 7.4 years) and 1150 controls (mean age 55.7 ± 7.8 years). The prevalence of colorectal neoplasms was 15.9% among the pilots and 20.6% among the controls (P = 0.097, χ² test). There were significantly more hyperplastic polyps among pilots (15.5% vs 9.4%, P = 0.004) and a trend towards fewer adenomas (14.8% vs 20.3% P = 0.06). The prevalence of advanced lesions among pilots and control groups was 5.9% and 4.7%, respectively (P = 0.49), and the prevalence of cancer was 0.7% and 0.69%, respectively (P = 0.93).CONCLUSION: There tends to be a lower colorectal adenoma, advanced adenoma and cancer prevalence but a higher hyperplastic polyp prevalence among pilots than the general population.     

Difference in the prevalence of advanced colon adenoma between patients with gastric neoplasm and healthy people: A STROBE-compliant study

We compared the prevalence of adenoma and cancerous colon polyps in patients undergoing endoscopic removal or gastric surgery for gastric adenoma or gastric cancer and in healthy individuals.The medical records of 707 patients with gastric neoplasm and 798 age- and sex-matched healthy subjects were retrospectively analyzed between January 2010 and July 2018. The clinicopathological characteristics, prevalence of colorectal neoplasm diagnosed by colonoscopy, and risk factors for colorectal polyps were also investigated.When comparing the two groups, the prevalence of overall colorectal polyps and its distribution was not different between the two groups (54.0% vs.49.5%, P = .079), whereas, the number of colon polyps (1.20 ± 1.71 vs 0.99 ± 1.54, P = .015) and the maximal size (3.53 ± 6.14 vs 2.08 ± 2.88, P < .001) were significantly larger in the gastric neoplasm group. The prevalence of advanced colon adenoma was significantly higher in the gastric neoplasm group (10.7% vs 3.8%, P < .001). Risk factors such as elevated glucose levels and the presence of gastric neoplasm were related to the prevalence of all colon polyps. The presence of gastric neoplasm is an important risk factor for advanced colon polyps.Patients with gastric neoplasms had a significantly higher prevalence of advanced colon adenoma. Advanced colon adenoma is associated with the chain from benign adenomas through malignant altered adenomas to advanced colon cancer. Thus, patients with gastric neoplasm are regarded as a high-risk group for colorectal cancer and are recommended for screening colonoscopy at the time of diagnosis.     

Incidental focal colorectal 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography

AIM: To assess the clinical significance of incidental focal colorectal 18 F-fluorodeoxyglucose ( 18 F-FDG) uptake on 18 F-FDG-positron emission tomography/computed tomography (PET/CT). METHODS: The records of all the cases which had undergone colonoscopy after PET/CT within a two weeks interval were reviewed. Adenomas were considered advanced when they were villous, ≥ 10 mm in size, or had high-grade dysplasia. Colorectal cancers and advanced adenomas are collectively referred to as advanced colorectal neoplasms. Receiver-operating characteristic curve analysis was used to determine thesignificant predictive maximum standardized uptake value (SUVmax) cutoff value for advanced colorectal neoplasms and cancer. RESULTS: Ninety-five colorectal lesions matched the site of incidental focal colorectal 18 F-FDG uptake on PET/CT and 146 did not. Colonoscopy showed advanced colorectal neoplasms corresponding to the site of 18 F-FDG uptake in 49 of the 95 (51.5%) lesions with incidental uptake. Of the lesions without incidental uptake, only 6 of 146 (4.1%) had advanced colorectal neoplasms on colonoscopy, indicating a statistically significant difference between the two groups (P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of incidental focal 18 F-FDG uptake in identifying advanced colorectal neoplasms were 89.1%, 75.3%, 51.6%, 95.9%, and 78.4%, respectively. In detecting only CRC, these values were 89.2%, 69.6%, 34.7%, 97.3%, and 72.6%, respectively. The significant SUVmax cutoff value for advanced colorectal neoplasms (area under the curve 0.755, P < 0.001) was 4.35, with a sensitivity, specificity, PPV, NPV, and accuracy of 75.5%, 65.2%, 69.8%, 71.4% and 70.5%, respectively. For CRC, 5.05 was the significant SUVmax cutoff value (area under the curve 0.817, P < 0.001), with a sensitivity, specificity, PPV, NPV, and accuracy of 84.8%, 71.0%, 80.9%, 89.8%, and 75.8%, respectively. CONCLUSION: The presence of incidental focal colorectal 1     

Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma for adults: A systematic review and meta-analysis (PRISMA-compliant article)

Background:Helicobacter pylori infection and hyperglycemia are associated with an increased risk of colorectal neoplasm, and may have a synergistic effect in combination. However, these 2 factors that affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H pylori infection rate with colorectal adenoma risk for adults.Methods:We conducted systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence <6% (Group 1); between 6% and 8% (Group 2); between 8% and 10% (Group 3), and more than 10% (Group 4). The random-effects model had used to calculate pooled prevalence estimates with 95% confidence interval (CI).Results:Twenty-seven studies were finally eligible for meta-analysis. The random-effects model of the meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86–1.78). As the diabetes rate exceed 6%, the H pylori infection became the more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61–2.91); Group 3: OR 1.40 (95% CI 1.24–1.57); and Group 4: OR 1.52 (95% CI 1.46–1.57)).Conclusions:The results of this meta-analysis showed elevated diabetes prevalence combined H pylori infection increasing the risks of colorectal adenoma in the adult population.     

Is proliferative colonic disease presentation changing?

AIM: To compare the site, age and gender of cases of colorectal cancer (CRC) and polyps in a single referral center in Rome, Italy, during two periods.METHODS: CRC data were collected from surgery/pathology registers, and polyp data from colonoscopy reports. Patients who met the criteria for familial adenomatous polyposis, hereditary non-polyposis colorectal cancer syndrome or inflammatory bowel disease were excluded from the study. Overlap of patients between the two groups (cancers and polyps) was carefully avoided. The χ² statistical test and a regression analysis were performed.RESULTS: Data from a total of 768 patients (352 and 416 patients, respectively, in periods A and B) who underwent surgery for cancer were collected. During the same time periods, a total of 1693 polyps were analyzed from 978 patients with complete colonoscopies (428 polyps from 273 patients during period A and 1265 polyps from 705 patients during period B). A proximal shift in cancer occurred during the latter years for both sexes, but particularly in males. Proximal cancer increased > 3-fold in period B compared to period A in males [odds ratio (OR) 3.31, 95%CI: 2.00-5.47; P < 0.0001). A similar proximal shift was observed for polyps, particularly in males (OR 1.87, 95%CI: 1.23-2.87; P < 0.0038), but also in females (OR 1.62, 95%CI: 0.96-2.73; P < 0.07).CONCLUSION: The prevalence of proximal proliferative colonic lesions seems to have increased over the last decade, particularly in males.     

Rectosigmoid findings are not associated with proximal colon cancer： Analysis of 6 196 consecutive cases undergoing total colonoscopy

AIM: To review the risk of proximal colon cancer in patients undergoing colonoscopy. METHODS: We estimated the risk of advanced proximal adenomas and cancers in 6 196 consecutive patients that underwent colonoscopy (mean age 60 years, 65% males, without prior history of colorectal examination). Neoplasms were classified as diminutive adenoma (5 mm or less), small adenoma (6-9 mm), advanced adenoma (10 mm or more, with villous component or high-grade dysplasia) and cancer (invasive adenocarcinoma). The sites of neoplasms were defined as rectosigmoid (rectum and sigmoid colon) and proximal colon (from cecum to descending colon). RESULTS: The trend of the prevalence of advanced proximal adenoma was to increase with severe rectosigmoid findings, while the prevalence of proximal colon cancer did not increase with severe rectosigmoid findings. Among the 157 patients with proximal colon cancer, 74% had no neoplasm in the rectosigmoid colon. Multivariate logistic-regression analysis revealed that age was the main predictor of proximal colon cancer and existence of rectosigmoid adenoma was not a predictor of proximal colon cancer. CONCLUSION: Sigmoidoscopy is inadequate for colorectal cancer screening, especially in older populations.     

Accuracy of early detection of colorectal tumours by stool methylation markers: A meta-analysis

AIM: To evaluate the accuracy of methylation of genes in stool samples for diagnosing colorectal tumours.METHODS: Electronic databases including PubMed, Web of Science, Chinese Journals Full-Text Database and Wanfang Journals Full-Text Database were searched to find relevant original articles about methylated genes to be used in diagnosing colorectal tumours. A quality assessment of diagnostic accuracy studies tool (QADAS) was used to evaluate the quality of the included articles, and the Meta-disc 1.4 and SPSS 13.0 software programs were used for data analysis.RESULTS: Thirty-seven articles met the inclusion criteria, and 4484 patients were included. The sensitivity and specificity for the detection of colorectal cancer (CRC) were 73% (95%CI: 71%-75%) and 92% (95%CI: 90%-93%), respectively. For adenoma, the sensitivity and specificity were 51% (95%CI: 47%-54%) and 92% (95%CI: 90%-93%), respectively. Pooled diagnostic performance of SFRP2 methylation for CRC provided the following results: the sensitivity was 79% (95%CI: 75%-82%), the specificity was 93% (95%CI: 90%-96%), the diagnostic OR was 47.57 (95%CI: 20.08-112.72), the area under the curve was 0.9565. Additionally, the results of accuracy of SFRP2 methylation for detecting colorectal adenomas were as follows: sensitivity was 43% (95%CI: 38%-49%), specificity was 94% (95%CI: 91%-97%), the diagnostic OR was 11.06 (95%CI: 5.77-21.18), and the area under the curve was 0.9563.CONCLUSION: Stool-based DNA testing may be useful for noninvasively diagnosing colorectal tumours and SFRP2 methylation is a promising marker that has great potential in early CRC diagnosis.     

Osteoporosis Is Associated with an Increased Risk of Colorectal Adenoma and High-Risk Adenoma: A Retrospective,Multicenter, Cross-Sectional,Case-Control Study

Background/AimsThe protective effects of vitamin D and calcium on colorectal neoplasms are known. Bone mineral density (BMD) may be a reliable biomarker that reflects the long-term anticancer effect of vitamin D and calcium. This study aimed to evaluate the association between BMD and colorectal adenomas including high-risk adenoma.MethodsA multicenter, cross-sectional, case-control study was conducted among participants with average risk of colorectal cancer who underwent BMD and screening colonoscopy between 2015 and 2019. The main outcome was the detection of colorectal neoplasms. The variable under consideration was low BMD (osteopenia/osteoporosis). The logistic regression model included baseline demographics, components of metabolic syndrome, fatty liver disease status, and aspirin and multivitamin use.ResultsA total of 2,109 subjects were enrolled. The mean age was 52.1±10.8 years and 42.6% were male. The adenoma detection rate was 43%. Colorectal adenoma and high-risk adenoma were both more prevalent in subjects with low BMD than those with normal BMD (48.2% vs 38.8% and 12.1% vs 9.1%). In the univariate analysis, old age, male sex, smoking, metabolic components, fatty liver, and osteoporosis were significantly associated with the risk of adenoma and high-risk adenoma. In the multivariate analysis, osteoporosis was independently associated with risk of colorectal adenoma (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.11 to 2.46; p=0.014) and high-risk adenoma (OR, 1.94; 95% CI, 1.14 to 3.29; p=0.014).ConclusionsOsteoporosis is an independent risk factor of colorectal adenoma and high-risk adenoma.     

Esophageal Squamous Cell Carcinoma Patients Have an Increased Risk of Coexisting Colorectal Neoplasms

Background/Aims

Esophageal squamous cell carcinoma (ESCC) and colorectal neoplasms (CRNs) share risk factors. We aimed to investigate whether the CRN risk is increased in ESCC patients.

Methods

ESCC patients who underwent a colonoscopy within 1 year of diagnosis were retrospectively analyzed. Patients were matched 1:3 by age, gender, and body mass index to asymptomatic controls. CRN was defined as the histological confirmation of adenoma or adenocarcinoma. Advanced CRN was defined as any of the following: ≥3 adenomas, high-grade dysplasia, villous features, tumor ≥1 cm, or adenocarcinoma. The risk factors for both CRN and advanced CRN were evaluated by univariate and multivariate analyses.

Results

Sixty ESCC patients were compared with 180 controls. The ESCC group had significantly higher numbers of CRNs (odds ratio [OR], 2.311; 95% confidence interval [CI], 1.265 to 4.220; p=0.006) and advanced CRNs (OR, 2.317; 95% CI, 1.185 to 4.530; p=0.013). Significant risk factors for both CRN and advanced CRN by multivariate analysis included ESCC (OR, 2.157, 95% CI, 1.106 to 4.070, p=0.024; and OR, 2.157, 95% CI, 1.045 to 4.454, p=0.038, respectively) and older age (OR, 1.068, 95% CI, 1.032 to 1.106, p<0.001; and OR, 1.065, 95% CI, 1.024 to 1.109, p=0.002, respectively).

Conclusions

The rates of CRN and advanced CRN are significantly increased in ESCC. Colonos-copy should be considered at ESCC diagnosis.     

Factors associated with incomplete colonoscopy at a Japanese academic hospital

AIM:To evaluate significant risk factors for incomplete colonoscopy at a Japanese academic hospital.METHODS:A total of 11812 consecutive Japanese people were identified who underwent a colonoscopy at an academic hospital.A multiple logistic regression model was used to evaluate retrospectively the significant risk factors for incomplete colonoscopy.RESULTS:The cecal intubation rate was 95.0%.By univariate analysis,age,female sex,poor bowel cleansing,and a history of abdominal or pelvic surgery were significant risk factors for incomplete colonoscopy(P<0.001).Moreover,age-and sex-adjusted analysis showed that significant risk factors for incomplete colonoscopy were female sex(OR=1.38,95%CI:1.17-1.64,P=0.0002),age≥60 years old(OR=1.44,95%CI:1.22-1.71,P<0.0001),a history of prior abdominal or pelvic surgery(OR=1.55,95%CI:1.28-1.86,P<0.0001),poor bowel cleansing(OR=4.64,95%CI:3.69-5.84,P<0.0001),and inflammatory bowel disease(IBD)(OR=1.48,95%CI:1.13-1.95,P=0.0048).In Japanese men,by age-adjusted analysis,IBD(OR=1.69,95%CI:1.18-2.43,P=0.005)was an independent risk factor for incomplete colonoscopy.CONCLUSION:Several characteristics in the Japanese population were identified that could predict technical difficulty with colonoscopy.     

Immunohistochemical Expression of Matrix Metalloproteinase-7 in Human Colorectal Adenomas Using Specified Automated Cellular Image Analysis System: A Clinicopathological Study

Background/Aim:

To evaluate the immunohistochemical expression of matrix metalloproteinase-7 (MMP-7) in colorectal adenomas, and to correlate this expression with different clinicopathological parameters.

Patients and Methods:

The study was retrospectively designed. Thirty three paraffin blocks from patients with colorectal adenoma and 20 samples of non-tumerous colonic tissue taken as control group were included in the study. MMP-7 expression was assessed by immunohistochemistry method. The scoring of immunohistochemical staining was conducted utilizing a specified automated cellular image analysis system (Digimizer).

Results:

The frequency of positive immunohistochemical expression of MMP-7 was significantly higher in adenoma than control group (45.45% versus 10%) (P value < 0.001). Strong MMP-7 staining was mainly seen in adenoma cases (30.30%) in comparison with control (0%) the difference is significant (P < 0.001). The three digital parameters of MMP-7 immunohistochemical expression (Area (A), Number of objects (N), and intensity (I)) were significantly higher in adenoma than control. Mean (A and I) of MMP-7 showed a significant correlation with large sized adenoma (≥ 1cm) (P < 0.05), also a significant positive correlation of the three digital parameters (A, N, and I) of MMP-7 expression with villous configuration and severe dysplasia in colorectal adenoma had been identified (P < 0.05).

Conclusion:

MMP-7 plays an important role in the growth and malignant conversion of colorectal adenomas as it is more likely to be expressed in advanced colorectal adenomatous polyps with large size, severe dysplasia and villous histology. The use of automated cellular image analysis system (Digmizer) to quantify immunohistochemical staining yields more consistent assay results, converts semi-quantitative assay to a truly quantitative assay, and improves assay objectivity and reproducibility.     

肥胖、2型糖尿病与大肠腺瘤腺癌的相关性研究

目的 初步探讨体质量指数（BMI）、2型糖尿病与大肠腺瘤腺癌的相关性.方法 2008年7月至2009年7月间,选择年龄为20～86岁的大肠镜检查患者971例,测量身高、体重,并记录有无糖尿病及病程.根据肠镜检查及活检病理结果纳入研究组（即腺瘤腺癌组,总计471例）和正常对照组（500例）.利用多因素Logistic回归进行相关性分析.结果 调整了可能的混杂因素后,肥胖组患大肠腺瘤腺癌的危险度是正常组的2.55倍,其中肥胖组男性患大肠腺瘤腺癌的危险度是正常组的3.32倍,而女性中不同BMI指数大肠腺瘤腺癌的患病率差异无统计学意义.超重组差异无统计学意义.2型糖尿病的患者引起大肠腺瘤腺癌的危险度是无糖尿病患者的约2.10倍,其中,病程〈6年引起大肠腺瘤腺癌的危险度是病程≥6年的约3.00倍,且风险与性别无关.糖尿病合并肥胖患者患大肠腺瘤腺癌的危险度是糖尿病无合并肥胖患者的3.05倍.结论 肥胖与大肠腺瘤腺癌的发生显著相关,肥胖男性患病风险明显大于女性.2型糖尿病患者患大肠腺瘤腺癌的风险较高,且糖尿病合并肥胖的患者患大肠腺瘤腺癌的风险显著高于糖尿病无肥胖的患者.     

Efficacy and tolerability of high and low-volume bowel preparation compared: A real-life single-blinded large-population study

BACKGROUNDLow-volume preparations for colonoscopy have shown similar efficacy compared to high-volume ones in randomized controlled trials (RCT). However, most RCTs do not provide data about clinical outcomes including lesions detection rate. Moreover, real-life comparisons are lacking. AIMTo compare efficacy (both in terms of adequate bowel preparation and detection of colorectal lesions) and tolerability of a high-volume (HV: 4 L polyethylene glycol, PEG) and a low-volume (LV: 2 L PEG plus bisacodyl) bowel preparation in a real-life setting.METHODSConsecutive outpatients referred for colonoscopy were prospectively enrolled between 1 December 2014 and 31 December 2016. Patients could choose either LV or HV preparation, with a day-before schedule for morning colonoscopies and a split-dose for afternoon procedures. Adequate bowel preparation according to Boston Bowel Preparation Scale (BBPS), clinical outcomes including polyp detection rate (PDR), adenoma detection rate (ADR), advanced adenoma detection rate (AADR), sessile/serrated lesion detection rate (SDR) and cancer detection rate and self-reported tolerability of HV and LV were blindly assessed.RESULTSTotal 2040 patients were enrolled and 1815 (mean age 60.6 years, 50.2% men) finally included. LV was chosen by 52% of patients (50.8% of men, 54.9% of women). Split-dose schedule was more common with HV (44.7% vs 38.2%, P = 0.005). High-definition scopes were used in 33.4% of patients, without difference in the two groups (P = 0.605). HV and LV preparations showed similar adequate bowel preparation rates (89.2% vs 86.6%, P = 0.098), also considering the two different schedules (HV split-dose 93.8% vs LV split-dose 93.6%, P = 1; HV day-before 85.5% vs LV day-before 82.3%, P = 0.182). Mean global BBPS score was higher for HV preparations (7.1 ± 1.7 vs 6.8 ± 1.6, P < 0.001). After adjustment for sex, age and indications for colonoscopy, HV preparation resulted higher in PDR [Odds ratio (OR) 1.32, 95%CI: 1.07-1.63, P = 0.011] and ADR (OR 1.29, 95%CI 1.02–1.63, P = 0.038) and comparable to LV in AADR (OR 1.51, 95%CI 0.97-2.35, P = 0.069), SDR and cancer detection rate. The use of standard-definition colonoscopes was associated to lower PDR (adjusted OR 1.59, 95%CI: 1.22-2.08, P < 0.001), ADR (adjusted OR 1.71, 95%CI: 1.26–2.30, P < 0.001) and AADR (adjusted OR 1.97, 95%CI: 1.09-3.56, P = 0.025) in patients receiving LV preparation. Mean Visual Analogue Scale tolerability scored equally (7, P = 0.627) but a ≥ 75% dose intake was more frequent with LV (94.6% vs 92.1%, P = 0.003). CONCLUSIONIn a real-life setting, PEG-based low-volume preparation with bisacodyl showed similar efficacy and tolerability compared to standard HV preparation. However, with higher PDR and ADR, HV should still be considered as the reference standard for clinical trials and the preferred option in screening colonoscopy, especially when colonoscopy is performed with standard resolution imaging.     

Helicobacter pylori infection concomitant with metabolic syndrome further increase risk of colorectal adenomas

AIM: To investigate the association of colorectal adenomas with both Helicobacter pylori (H. pylori) infection and metabolic syndrome. METHODS: Using a cross-sectional hospital-based study, we analyzed physical examination data from 9311 healthy subjects with overnight physical examinations performed between January 2004 and December 2006. Examined data included gender, age, life style, anthropometric measurements, blood pressure, biochemical and hematological studies, H. pylori infection detected by esophagogastroduodenoscopy and biopsy urease tests, and colorectal adenomas detected with a complete total colonoscopy. RESULTS: The prevalence values for H. pylori infection, metabolic syndrome, and colorectal adenoma were39.2%, 18.7%, and 20.7%, respectively. Colorectal adenoma risk factors included male gender [odd ratio (OR): 2.005, 95% conf idence interval (CI): 1.740-2.310, P < 0.001], advanced age (OR: 1.046, 95% CI: 1.040-1.052, P < 0.001), smoking (OR: 1.377, 95% CI: 1.146-1.654, P = 0.001), increased body fat (OR: 1.016, 95% CI: 1.007-1.026, P = 0.001), higher white blood cell count (OR: 1.038, 95% CI: 1.005-1.073, P = 0.025), H. pylori infection (OR: 1.366, 95% CI: 1.230-1.517, P < 0.001), and metabolic syndrome (OR: 1.408, 95% CI: 1.231-1.610, P < 0.001). In addition, concomitant H. pylori infection with metabolic syndrome further increased the probability of colorectal adenomas. CONCLUSION: Our study revealed H. pylori infection with concomitant metabolic syndrome might further increase the risk of colorectal adenomas.     

Sessile serrated adenomas in the proximal colon are likely to be flat,large and occur in smokers

AIM:To examine the epidemiology and the morphology of the proximal sessile serrated adenomas(SSAs).METHODS:We conducted a retrospective study to identify patients with SSAs using a university-based hospital pathology database query from January 2007to April 2011.Data collected included:age,gender,ethnicity,body mass index,diabetes,smoking,family history of colorectal cancer,aspirin,and statin use.We collected data on morphology of SSAs including site(proximal or distal),size,and endoscopic appearance(flat or protuberant).We also compared proximal SSAs to proximal tubular adenomas detected during same time period.RESULTS:One hundred and twenty patients with SSAs were identified:61%were distal and 39%were proximal SSAs.Proximal SSAs were more likely to be flat than distal(100%vs 78%respectively;P=0.0001).Proximal SSAs were more likely to occur in smokers(OR=2.63;95%CI:1.17-5.90;P=0.02)and in patients with family history of colorectal cancer(OR=4.72;95%CI:1.43-15.55;P=0.01)compared to distal.Proximal SSAs were statistically more likely to be≥6 mm in size(OR=2.94;P=0.008),and also more likely to be large(≥1 cm)(OR=4.55;P=0.0005)compared to the distal lesions.Smokers were more likely to have proximal(P=0.02),flat(P=0.01)and large(P=0.007)SSAs compared to non-smokers.Compared to proximal tubular adenomas,proximal SSAs were more likely to be large and occur in smokers.CONCLUSION:Proximal SSAs which accounted for two-fifths of all SSAs were more likely to present as flat lesions,larger SSAs,and were more likely to occur in smokers and in patients with family history of colorectal cancer.Our data has implications for colorectal cancer screening.