Sporadic Duodenal Adenoma and Association with Colorectal Neoplasia: A Case–Control Study

Background

Sporadic duodenal adenomas are uncommon. Prior studies show that patients with sporadic duodenal adenoma have increased risk of colorectal neoplasia and should undergo colorectal screening. However, the nature of the risk, location, and type of colorectal neoplasia are not well studied.

Aim

We aimed to identify the risk of colorectal neoplasia in patients who have duodenal adenomas.

Methods

A retrospective case–control study was conducted to identify sporadic duodenal adenoma patients using the databases at one academic center. Colonoscopic findings including histology and location of colorectal cancer neoplasia in sporadic duodenal adenoma patients were compared with a control group of patients without duodenal adenomas who underwent both gastroduodenoscopy and colonoscopy.

Results

Hundred and two patients with sporadic duodenal adenomas or adenocarcinomas were identified. Colonoscopy was performed in 47 patients (46 %), and colorectal neoplasia was present in 22 (46 %). There was a significantly higher rate of colorectal neoplasia in patients with sporadic duodenal adenoma (43 %) compared to the control group (24 %) odds ratio 4.8, 95 % confidence interval (1.7–7.4), but not for advanced colorectal adenoma (9 vs. 26 %, p = 0.17). Case patients had significantly more right-sided lesions than matched controls (p = 0.02).

Limitations

Single-center, retrospective study.

Conclusions

Individuals with sporadic duodenal adenomas have a significantly higher risk of colorectal neoplasia and proximal location of neoplasia. Therefore, these patients should undergo colonoscopy with particular attention to the right colon.     

ß-catenin, Cox-2 and p53 immunostaining in colorectal adenomas to predict recurrence after endoscopic polypectomy

Background

Endoscopic polypectomy significantly reduces the incidence of colorectal cancer, but recurrence rates are high, especially for adenomas with advanced histology. The present guidelines recommend re-colonoscopy 3 to 5 years later. Due to limited resources, more precise predictions of adenoma recurrence are required.

Design

Lesions from 109 patients with colorectal adenomas recruited into a randomized, placebo-controlled chemoprevention trial with mesalazine were included. Formalin-fixed paraffin-embedded tissue sections were stained for ß-catenin, cyclooxygenase-2 (Cox-2), and p53 and scored. Adenoma recurrence rates were recorded after 3 years and associated with clinical and immunohistochemical parameters by contingency table analysis.

Results

After 3 years, adenomas recurred in 51.4 % of patients. Out of 109 adenomas, 95 met at least one criterion of advanced adenoma (size >1 cm, villous histology, high-grade intraepithelial neoplasia). There was no influence of age, sex, size or villous histology on adenoma reappearance, whilst the number of adenomas at baseline was positively associated with recurrence (p?=?0.003). In contrast, ß-catenin nuclear localisation, Cox-2 expression and p53 nuclear expression were significantly associated with adenoma recurrence after 3 years (ß-catenin: p?=?0.002; Cox-2: p?=?0.001; p53: p?=?0.001). Combining these three markers led to a negative predictive value of 88.5 % and a sensitivity of 94.6 %. (OR?=?13.54)

Conclusions

Scoring each single parameter and, more strongly, the combination of all three parameters of the expression of ß-catenin, Cox-2 and p53 in colorectal adenoma tissue may be a useful negative predictor for adenoma recurrence in patients with advanced colorectal adenomas.     

Impact of a Family History of Colorectal Cancer on the Prevalence of Advanced Neoplasia at Colonoscopy in 4,967 Asymptomatic Patients

Background and Aims

A family history of colorectal cancer is considered an independent risk factor for advanced neoplasia at colonoscopy. The expected outcome for screening colonoscopy in patients with a family history is not well established in all populations.

Methods

We designed a large, prospective study of an unselected population in San Diego, California to assess the impact of a family history of colorectal cancer on the prevalence of advanced neoplasia on screening colonoscopy.

Results

We evaluated 6,905 consecutive patients referred for colonoscopy between January 2005 and December 2006. Of the 4,967 who met the inclusion criteria, the mean age was 58.8 and consisted of 58.6% women. Overall 930 (18.7%) had neoplasia and 249 (5%) had advanced neoplasia, eight (0.16%) of which were cancer. The 4,967 patients were divided into 643 with and 4,324 without a family history of colorectal cancer. Of the 643 patients with a family history, 38 (5.9%) had advanced neoplasia, one of which was cancer. Of the 4,324 patients without a family history, 211 (4.9%) had advanced neoplasia including seven cancers. The relative risk for finding advanced neoplasia in patients with a single affected first degree relative was 1.21 (95% CI, 0.87?C1.69; P?=?0.31).

Conclusions

A family history of one first-degree relative with colorectal cancer did not predict a significantly higher prevalence of advanced neoplasia at screening colonoscopy in this Southwestern cohort.     

Detection rate and proximal shift tendency of adenomas and serrated polyps: a retrospective study of 62,560 colonoscopies

Purpose

The purpose of this study is to estimate the detection rates of adenomas and serrated polyps and to identify proximalization and associate risk factors in patients from Southern China.

Methods

Consecutive patients undergoing colonoscopy from 2004 to 2013 in Guangzhou were included. The proportions of proximal adenomas to advanced adenomas and serrated polyps were compared and potential predictors were evaluated.

Results

Colonoscopies (n?=?62,560) were performed, and 11,427 patients were diagnosed with polyps. Detection rates for adenomas, hyperplastic polyps, and serrated adenomas were 12.0, 2.5, and 0.2 patients per 100 colonoscopies. When comparing the 1st (2004–2008) to the 2nd period (2009–2013), adenoma and serrated polyp detection in proximal and distal colon both increased significantly (proximal colon [adenoma 3.9 vs. 6.1 patients/100 colonoscopies, P?<?0.001; serrated polyp 0.4 vs. 1.1 patients/100 colonoscopies, P?<?0.001]; distal colon [adenoma 6.6 vs. 7.2 patients/100 colonoscopies, P?=?0.003; serrated polyp 1.2 vs. 2.4 patients/100 colonoscopies, P?<?0.001]). Advanced adenoma detection increased over these two periods only in proximal colon (1st vs. 2nd period: 1.5 vs. 2.4 patients/100 colonoscopies, P?<?0.001), not the distal colon (P?=?0.114). Multivariate analyses showed that diagnostic period was an independent predictor for adenoma proximalization (OR?=?1.36, 95% CI 1.25–1.48, P?<?0.001), but not for advanced adenomas (P?=?0.117) or serrated polyps (P?=?0.928).

Conclusions

Adenomas and serrated polyps were increasingly detected throughout the colon, whereas advanced adenomas were only in proximal colon. A proximal shift tendency detected by colonoscopy was observed for adenomas, but not advanced adenomas or serrated polyps, in Southern China. The screening for proximal polyps should be emphasized and colonoscopy might be a preferred initial screening tool.

     

Prediabetes Is Associated with a High-Risk Colorectal Adenoma

Background

Type 2 diabetes mellitus is associated with an increased risk of colorectal neoplasia. However, association between prediabetes and colorectal adenoma has not been reported.

Aims

The aim of this study was to evaluate the relationship between prediabetes and the presence of colorectal adenomas.

Methods

Consecutive prediabetic subjects who underwent screening colonoscopy were enrolled at Kyung Hee University Hospital in Gangdong, Seoul, Korea, between June 2006 and May 2012. Non-prediabetic subjects were separately pooled from the database of the Center for Health Promotion between January 2012 and May 2012. Prediabetes was defined according to the recommendations of the American Diabetes Association. The prevalence of colorectal adenomas and their characteristics were compared between prediabetic and non-prediabetic groups.

Results

The prevalence of colorectal adenoma was higher in prediabetic subjects than in non-prediabetic subjects (39.6 vs. 30.6 %, respectively, p = 0.019). Prediabetic subjects had more multiple and high-risk adenomas than the control group in non-matched analysis (p = 0.000, respectively). In age-matched analysis, the prevalence of multiple and high-risk adenomas were significantly higher in a prediabetic group than those in a control group (44.4 vs. 28.4 %, p = 0.034; 51.9 vs. 34.6 %, p = 0.026, respectively). Furthermore, prediabetes (odds ratio = 2.198; 95 % confidence interval = 1.042–4.637; p = 0.039) was found to be an independent risk factor for a high-risk adenoma by multivariate analysis.

Conclusions

The prevalence of multiple and high-risk colorectal adenomas is significantly higher in the prediabetic subjects than those in the control group. Furthermore, prediabetes was found to be an independent risk factor for a high-risk colorectal adenoma.     

Five-year risk of colorectal neoplasia after normal baseline colonoscopy in asymptomatic Chinese Mongolian over 50?years of age

Background

After normal colonoscopy, the 5-year risk of colorectal neoplasia is sufficiently low for asymptomatic people over 50?years of age. In China, the incidence of colorectal carcinoma of Mongolian people is higher than that of Han people. The aim of this study was to assess the 5-year risk of colorectal neoplasia after normal colonoscopy in asymptomatic Chinese Mongolian population.

Patients and methods

A cohort of asymptomatic Chinese Mongolian people (??50?years old) were recruited and followed up with colonoscopy 5?years after colonoscopy. Baseline colonoscopy and follow-up colonoscopy findings were categorized based on the most advanced lesions: no adenoma, nonadvanced adenoma, and advanced adenoma. Five-year risk of colorectal neoplasia in these people was assessed according to the rates of no baseline adenoma and advanced adenoma at the end of 5?years.

Results

A total of 480 of the 538 recruited people underwent follow-up colonoscopy at the end of 5?years. In people with no baseline adenoma, 27.3?% (82/301) was found to have any adenoma, and 1.7?% had advanced adenoma at follow-up colonoscopy. The risk of an advanced adenoma did not differ significantly between people with no adenoma at baseline and those with nonadvanced adenoma (relative risk (RR), 1.06; 95?% confidence interval (CI), 0.19?C6.07). Advanced adenoma at baseline colonoscopy was the independent risk factor for advanced adenoma recurrence, compared with no adenoma at baseline (RR, 8.25; 95?% CI, 1.90?C35.77).

Conclusion

The risk of advanced adenoma is low 5?years after the normal baseline colonoscopy, even in asymptomatic Chinese Mongolian population over 50?years of age.     

Associations Between Markers of Colorectal Cancer Stem Cells and Adenomas Among Ethnic Groups

Background and Purposes

Most colorectal tumors develop from adenomatous polyps, which are detected by colonoscopy. African Americans (AAs) have higher incidence of colorectal cancer (CRC) and greater mortality from this disease than Caucasian Americans (CAs). We investigated whether differences in predisposition to CRC and its surrogate (colonic adenomas) between these ethnic groups were related to numbers of cancer stem or stem-like cells (CSCs) in colonocytes.

Methods

We analyzed colonic effluent from 11 AA and 14 CA patients who underwent scheduled colonoscopy examinations at the John D. Dingell Veterans Affairs Medical Center. We determined proportions of cells that expressed the CSC markers CD44 and CD166 by flow cytometry.

Results

The proportion of colonocytes that were CD44⁺CD166^? in effluent from patients with adenomas was significantly greater than from patients without adenomas (P?=?0.01); the proportion of CD44⁺CD166⁺ colonocytes was also greater (P?=?0.07). Effluent from AAs with adenomas had 60?% more CD44⁺166^? colonocytes than from CAs with adenomas. Using cutoff values of 8?% for AAs and 3?% for CAs, the proportion of CD44⁺166^? colonocytes that had positive predictive value for detection of adenomas was 100?% for AAs and CAs, determined by receiver operator characteristic curve analysis.

Conclusion

The proportion of CD44⁺166^? colonocytes in colonic effluent can be used to identify patients with adenoma. AAs with adenomas have a higher proportion of CD44⁺166^? colonocytes than CA. The increased proportion of CSCs in colonic tissue from AA might be associated with the increased incidence of CRC in this population.     

Do We Need Colonoscopy Following Acute Diverticulitis Detected on Computed Tomography to Exclude Colorectal Malignancy?

Background

Although colonoscopy verification is warranted after an acute event of diverticulitis to exclude underlying malignancy, little evidence is available to support the recommendations.

Aim

The aim of this study was to examine whether subsequent colonoscopy is warranted in patients with diverticulitis on computed tomography (CT).

Methods

The study was composed of patients diagnosed with acute diverticulitis on CT scan from January 2001 to March 2013. Patients who had subsequent colonoscopy within a year from the date of CT were included. For each diverticulitis case, two age- (±5 years) and sex-matched controls were identified from healthy individuals who had received screening colonoscopy. We evaluated the diagnostic yield of advanced colonic neoplasia in colonoscopy.

Results

One hundred and forty-nine patients underwent subsequent colonoscopy within a year from the date of CT. Among the patients, 11 (7.4 %) had colon cancer and 5 (3.4 %) had advanced adenoma. A case–control study revealed that the odds of detecting an advanced neoplasia among patients with diverticulitis on CT were approximately 8.8 times greater than in the age- and sex-matched controls [OR 8.84; 95 % CI 2.90–26.96; p < 0.001]. On analysis of the diverticulitis group, age (≥50 years) is an independent risk factor for detecting advanced colonic neoplasia.

Conclusions

The yield of advanced colonic neoplasia was substantially higher in patients with acute diverticulitis than in asymptomatic, average-risk individuals. Colonoscopy verification is warranted in patients with diverticulitis detected on CT, especially in those aged 50 years or older.     

Benefits and Limitations of Cap-Fitted Colonoscopy in Screening Colonoscopy

Background

Colonoscopy is widely used to detect colorectal cancer and to remove precancerous lesions to reduce the risk of colonic cancer.

Aims

To examine the benefits and limitations of cap-fitted colonoscopy compared to conventional colonoscopy in terms of technical performance and colorectal adenoma detection rate.

Methods

Screening colonoscopies performed from 2009 to 2010 with or without a transparent cap were retrospectively examined to compare the rate of successful intubation, cecal intubation time, and number, size, shape, and location of adenomas detected. An inclusion criterion was visualization of >95 % of the right colon.

Results

Data from 2,301 colonoscopies (1,165 with cap-fitted colonoscopy, 1,136 without the transparent cap) were retrospectively analyzed. Procedures were performed by four experienced endoscopists. The subjects’ demographic characteristics and technical performances were similar between the two methods. The only significant difference in the technical performance between the two techniques was a shorter cecal intubation time with cap-fitted colonoscopy (5.3 vs. 6.6 min; p = 0.045) by one endoscopist. The total number of adenomas detected was significantly higher with cap-fitted colonoscopy than without the cap (586 vs. 484, respectively; p < 0.0001). Adenoma detection with cap-fitted endoscopy was significantly higher in the right colon than in the left colon (19 vs. 12 %, respectively; p = 0.0001).

Conclusion

Cap-fitted colonoscopy did not improve the technical aspects of colonoscopy but significantly increased adenoma detection, especially in the right colon. It did not increase the detection rate of flat or depressed adenomas.     

The Day of the Week Does Not Affect the Adenoma Detection Rate

Background

The role of operator fatigue on adenoma detection rate (ADR) is still controversial.

Aims

The purpose of this study was to determine if fatigue towards the end of the week affects the ADR.

Methods

A retrospective chart review of consecutive colonoscopies was done at a tertiary care teaching institution. Patients 45 years of age or older undergoing screening or surveillance colonoscopy from June 2007 to August 2010 were included in the study.

Results

A total of 3,085 patients were included in the study, with an overall 31 % ADR. ADR was between 31 and 32 % throughout the week, with no statistically significant variation (p = 0.8697). The total number of adenomas and advanced adenomas was also similar throughout the week (p = 0.8, p = 0.59, respectively).

Conclusions

ADR is not influenced by the day of the week in which a colonoscopy is performed.     

Malignant recurrence and distal metastasis after complete local resection of colorectal “high-grade intraepithelial neoplasia”: incidence and risk factors

Background

Colorectal high-grade intraepithelial neoplasia is defined as a high-grade neoplastic lesion with no invasion of submucosa. Because pathological evaluation has inevitable sampling errors, invasive cancer may be underdiagnosed as high-grade intraepithelial neoplasia by regarding submucosa invasion as an indispensable criterion for malignancy. This study was to evaluate the reliability of colorectal “high-grade intraepithelial neoplasia” diagnosis and identify predictive factors of underdiagnosis.

Methods

Colorectal high-grade intraepithelial neoplasia patients treated with complete local excision were followed up. Clinicopathologic features were compared between cases with malignant recurrence or distal metastasis and those without.

Results

Of 491 lesions reviewed, 13 (2.6 %) developed local malignant recurrence or distal metastasis, which were statistically significantly associated with rectal location (p?=?0.047), sessile growth (p?=?0.002), large diameter (p?=?0.005), villous adenoma (p?=?0.00), transanal local resection (p?=?0.001), and piecemeal specimens (p?=?0.009). Of the 13 cases, 11 were located in the rectum, including 10 in the low position (<=6 cm from the anal verge, mean 3.6 cm). Deeper pathological examination was performed on the paraffin-embedded tissue blocks of the 13 primary tumors and revealed no evidence of submucosa invasion.

Conclusion

The diagnosis of colorectal high-grade intraepithelial neoplasia based on local resection is relatively reliable. However, regarding invasion of submucosa as an indispensable criterion for malignancy may contribute to the choice of overly conservative treatment, especially in the situation that the radical resection requires removing the anus.     

Complication and local recurrence rate after endoscopic resection of large high-risk colorectal adenomas of ≥3 cm in size

Purpose

Endoscopic resection is a widely used technique for treatment of large colorectal adenomas, but few data are available including only lesions larger than ≥2 cm. The aim of this study is to evaluate the complication and recurrence rate after endoscopic resection of high-risk colorectal adenomas ≥3 cm in size.

Methods

Retrospective analysis of a prospectively maintained database of patients undergoing polypectomy of large colorectal polyps of ≥3 cm.

Results

In 341 patients, 360 colorectal adenomas with a mean size of 3.9 cm were resected endoscopically. In 25 patients, a complication including 22 delayed bleedings (6.5 %) and three perforations (0.9 %) occurred. Single-variate analysis showed an increasing risk of complications for larger adenomas (3.9 vs. 4.6 cm; p?≤?0.05). Two hundred twelve patients with 224 adenomas had undergone at least one documented follow-up endoscopy with a medium follow-up period of 16 months. In 95 resected lesions (42.4 %), a residual adenoma occurred in the first follow-up colonoscopy (n?=?88, 92.6 %) or a recurrent adenoma occurred after at least one negative follow-up colonoscopy (n?=?7, 7.4 %). In multivariate analysis, risk factors were lesion size, sessile growth pattern, and the performing endoscopist. The complication and recurrence rate correlated inversely between endoscopists.

Conclusions

The present study is the largest study showing complication and recurrence rates after colorectal polypectomy of advanced colorectal adenomas of ≥3 cm in size. Polyp size was identified as the most important risk factor for complications. For the first time, this study shows that the complication rate after colorectal polypectomy of large adenomas is correlated inversely with the residual and/or recurrence rate.

     

Risk of Colorectal Adenomas in Women with Prior Breast Cancer

Background and Aims

Longer life expectancy in patients with prior breast cancer may increase their risk of developing other primary cancers, including colorectal cancer (CRC). Whether the risk of developing CRC in this patient population is higher in comparison to those with no prior cancer remains unclear. The purpose of this study was to compare the prevalence of colorectal adenomas and any CRC in breast cancer survivors with those who have no history of prior cancer and assess any difference with use of antiestrogen therapy.

Methods

We compared the prevalence of colorectal cancer and adenomas in breast cancer survivors with that of a group of matched controls. Eligible survivors were ??85?years of age; had initially been diagnosed with stage 0, I, II, or III breast cancer; had completed all cancer treatments with the exception of adjuvant antiestrogen therapy; and had no evidence of recurrence on follow-up. We used the screening colonoscopy database at our institution to identify age-, sex-, and race-matched controls with no history of cancer.

Results

We identified 302 study-eligible breast cancer survivors and 302 matched controls. No colorectal cancers were found in either group. Forty-one breast cancer survivors and 30 controls had tubular adenomas; four survivors and three controls had villous adenoma; and eight survivors and ten controls had advanced adenoma. Multivariate regression analysis revealed that adjuvant antiestrogen therapy was not significantly associated with an increased risk of advanced adenoma.

Conclusions

The prevalence of colorectal adenomas in breast cancer survivors and controls was similar. Breast cancer survivors, including those receiving adjuvant antiestrogen therapies may follow the colorectal screening guidelines used for average-risk population.     

Whites and Blacks Have Similar Risk of Metachronous Advanced Colorectal Neoplasia

Background

Current guidelines for surveillance of colonic neoplasia are based on data from predominantly white populations, yet whether these recommendations are applicable to blacks is unknown.

Aim

To define the prevalence of advanced colorectal neoplasia (ACN) among whites and blacks undergoing surveillance colonoscopy.

Methods

This was a retrospective, cross-sectional analysis of asymptomatic, average-risk non-Hispanic white (N = 246) and non-Hispanic black (N = 203) patients with colorectal neoplasia who underwent baseline screening colonoscopy between January 1, 2000, and December 31, 2007, and a surveillance colonoscopy before December 31, 2010, at an academic safety-net hospital. The main outcome measure was the prevalence of ACN, defined as a tubular adenoma or sessile serrated adenoma (SSA) ≥10 mm, any adenoma with villous histology or high-grade dysplasia, any serrated lesion with dysplasia, or invasive cancer at surveillance.

Results

During a median follow-up of 4.3 years, the overall prevalence of ACN at surveillance was similar among blacks and whites (11.3 vs. 9.8 %; P = 0.59) with an odds ratio of 1.18 (95 % CI 0.65–2.26). Blacks and whites with non-advanced neoplasia had similar rates of ACN at the 1–3, 4–5, and >5 year follow-up intervals. Blacks with ACN or multiplicity at baseline had higher rates of ACN at the 1- to 3-year interval compared with whites, but the difference was non-significant (26.7 vs. 12.5 %; P = 0.32). No interval cancers were observed for either group.

Conclusions

The overall prevalence of ACN was similar between non-Hispanic blacks and non-Hispanic whites undergoing surveillance in a safety-net healthcare setting suggesting that current surveillance guidelines are appropriate for both blacks and whites.     

A simplified, non-invasive fecal-based DNA integrity assay and iFOBT for colorectal cancer detection

Purpose

Neoplasia cells exfoliated from colorectal epithelium have dysfunctional apoptotic mechanisms, thus it is possible to identify high-molecular weight DNA fragments in feces. This prospective single-center study was performed to evaluate the sensitivity and specificity of fecal-based DNA integrity versus immunological fecal occult blood test (iFOBT) and calprotectin for colorectal cancer (CRC) and adenoma detection.

Methods

Feces were collected from 204 subjects and DNA integrity was quantified by quantitative-denaturing high performance liquid chromatography (QdHPLC). Calprotectin and iFOBT were assessed using commercial kits. The diagnostic performance was calculated by receiver operating characteristic (ROC) curves analysis.

Results

A total of 192 fecal specimens were analyzed and 12 samples were excluded due to DNA degradation. We found long DNA (L-DNA) occurrence in feces with a sensitivity of 86% (n?=?24/28) and a specificity of 81% for CRC detection. To minimize false-positive cases of the developed test, area under the curve of ROC was evaluated such that the specificity was increased to 92% with decreased sensitivity to 79%, p?=?0.0001 for CRC detection. iFOBT was positive in 51% (n?=?14/27) while calprotectin was positive in 75% (n?=?18/27). The combination of iFOBT and L-DNA identified a greater number of CRC cases with a sensitivity of 89% and a specificity of 95%, p?p?=?0.0015) as opposed to a single evaluation assay (17?C21%).

Conclusions

This study illustrates the usefulness of fecal DNA integrity assay by QdHPLC as a non-invasive, easy-to-perform, and reproducible method with a high level of sensitivity in detecting individuals with colorectal neoplasia. Combination of iFOBT and L-DNA improves the sensitivity for CRC and adenoma detection.     

Increased prevalence of colorectal neoplasia in korean patients with sporadic duodenal adenomas: a case-control study

Background/Aims

Recent data from Western populations have suggested that patients with sporadic duodenal adenomas are at a higher risk for the development of colorectal neoplasia. In this study, we compared the frequency of colorectal neoplasia in patients with sporadic duodenal adenomas to healthy control subjects.

Methods

This retrospective case-control study used the databases of 3 teaching hospitals in Gyeonggi-do Province, South Korea. The colonoscopy findings of patients with sporadic duodenal adenomas were compared with those of age- and gender-matched healthy individuals who had undergone gastroduodenoscopies and colonoscopies during general screening examinations.

Results

Between 2001 and 2008, 45 patients were diagnosed endoscopically with sporadic duodenal adenomas; 26 (58%) of these patients received colonoscopies. Colorectal neoplasia (42% vs 21%; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1 to 7.4) and advanced colorectal adenoma (19% vs 3%; OR, 9.0; 95% CI, 1.6 to 50.0) were significantly more common in patients with sporadic duodenal adenomas than in healthy control subjects.

Conclusions

Compared with healthy individuals, patients with sporadic duodenal adenomas were at a significantly higher risk for developing colorectal neoplasia. Such at-risk patients should undergo routine screening colonoscopies.     

Evaluation of autofluorescence colonoscopy for diagnosis of superficial colorectal neoplastic lesions

Background and aim

Autofluorescence (AF) imaging, which can potentially differentiate tissue types based on differences in fluorescence emission, may be useful in the diagnosis and treatment of colorectal malignancies. This study was designed to assess the potential usefulness of AF colonoscopy for evaluating superficial colorectal neoplastic lesions.

Methods

A total of 49 colorectal lesions in 43 patients were investigated. All superficial colorectal neoplastic lesions were identified with white light (WL) colonoscopy. Each detected lesion was investigated by WL colonoscopy, AF colonoscopy, and chromoendoscopy using 0.2% indigo carmine dye. Three endoscopists, blinded to each patient's history, evaluated the still images (as obtained with these three methods) in random order and evaluated their influence on the assessment of lesion visualization. All the lesions were biopsied or resected endoscopically, with the pathological results used as the gold standard.

Results

For visualization of the surface appearance and differences in color of the lesions compared with the surrounding mucosa, AF colonoscopy was superior to WL colonoscopy (p?<?0.01) and comparable to chromoendoscopy (Mann–Whitney U test). For visualization of the circumferential margin, AF colonoscopy was superior to WL colonoscopy (p?<?0.05) but inferior to chromoendoscopy (p?<?0.01).

Conclusions

AF colonoscopy may be a valuable tool for detection and diagnosis of superficial colorectal neoplastic lesions.     

Local calprotectin production in colorectal cancer and polyps--active neutrophil recruitment in carcinogenesis

Aim

The aim of this study is to examine the expression level and localization of calprotectin in cancer tissue, tumor-adjacent mucosa, and polyps in colonic biopsies. Calprotection expression was correlated with neutrophil infiltration, markers of bacteremia, and systemic inflammation.

Materials and methods

Patients with colorectal cancer (n?=?28) and adenoma (n?=?38) were compared with healthy controls (n?=?33). Calprotectin expression levels were measured by ELISA, and its localization was visualized by immunohistochemistry and correlated with the degree of neutrophil infiltration (visualized by Esterase staining). The expression of tumor necrosis factor (TNF)-alpha, procalcitonin, endotoxemia, carcinoembryonic antigen (CEA), and C-reactive protein was also investigated.

Results

Mucosal calprotectin was expressed in significantly higher concentrations in carcinoma (94.2?±?31.2?ng/mg total protein) and adenoma (122.8?±?60.3?ng/mg total protein) in comparison with mucosal biopsies from healthy controls (20.4?±?5.4?ng/mg total protein), tumor-adjacent mucosa from patients with colorectal carcinoma (21.6?±?5.1?ng/mg total protein), and adenoma (45?±?14.6?ng/mg total protein, all p?<?0.05). Immunohistochemistry showed calprotectin reactivity mainly in granulocytes and macrophages with only singular reactive epithelial cells. Positive staining (quantified by the number of positive cells per square millimeter) was markedly increased in carcinoma tissue (85?±?21.5) and in adenoma (67.5?±?20) as compared with tumor-adjacent epithelia (18.8?±?4.3, p?=?0.0007, p?=?0.003, respectively), and there was a highly significant correlation, r?=?0.89, p?=?0.001) between calprotectin staining and neutrophil infiltration. No significant differences were found in the systemic levels of TNF-alpha, procalcitonin, and endotoxemia, whereas CEA and C-reactive protein levels were significantly higher in the cancer group (p?<?0.05).

Conclusion

Our results support the evidence that increased calprotectin expression is an early step in the neoplastic transformation during colorectal carcinogenesis. Moreover, its expression is closely related to an inflammatory response and points out a possible biological link between inflammation and neoplastic transformation in colorectal cancer.     

Factors associated with reclassification of hyperplastic polyps after pathological reassessment from screening and surveillance colonoscopies

Introduction

A substantial interobserver variation in the differential diagnosis of hyperplastic polyps (HPs) and sessile or traditional serrated adenomas (SSAs/TSAs) has been described.

Methods

The aim of this study is to determine the magnitude of reclassification of HPs and associated factors after pathological reassessment of specimens from screening and surveillance colonoscopies, and to estimate its consequences for follow-up recommendations.

Results

Among 1694 screening and surveillance colonoscopies, a total of 536 polyps were initially diagnosed as HPs and remained unchanged in 88.5 % (n?=?474), whereas 7.6 (n?=?41) and 1.1 % (n?=?6) were reclassified as SSA and TSA, respectively. Compared to definite HPs, SSAs were found more frequently in men than in women (82.9 vs. 61.2 %, p?<?0.05), and in individuals ≥65.0 years (51.2 vs. 31.6 %, p?=?0.05). Also, more SSAs were >5 mm in size (36.6 vs. 6.3 %, p?<?0.05) and were localized in the proximal colon (31.7 vs. 11.8 %, p?<?0.05). In a mixed model analysis, age ≥65.0 years (OR 4.13, 95 % CI 1.22–14.2), snare polypectomy (OR 23.6, 95 % CI 4.86–115), and coincident advanced adenomas (OR 7.56, 95 % CI 1.31–43.5) were significantly (p?<?0.05) associated with reclassification to SSAs. Only 0.53 % of patients had received false recommendations for follow-up visits based on the incorrect HP diagnosis. A c.1799T>A, p.V600E BRAF mutation was detected in 21.9 % (n?=?9) of reclassified SSAs.

Conclusion

Considering these factors may be helpful in serrated lesions that are difficult to allocate. Incorrect recommendations regarding control colonoscopy intervals due to misdiagnosed HPs can explain only a small fraction of interval colorectal cancers.

     

Helicobacter Pylori Infection Increases the Risk of Colorectal Adenomas: Cross-Sectional Study and Meta-Analysis

Background

The studies concerning the association between Helicobacter pylori status and colorectal adenoma, premalignant lesions of colorectal cancers, are not consistent.

Methods

This cross-sectional study investigated the association of colorectal adenoma with H. pylori infection in a consecutive series of 2,195 asymptomatic average-risk subjects who underwent screening colonoscopy and H. pylori testing. Multivariate analyses were adjusted for potential relevant confounders, including age, sex, smoking, alcohol consumption, family history of colorectal cancer, and regular use of aspirin. Furthermore, we performed a systematic literature review and meta-analysis of available studies, including the current study, to clarify whether H. pylori infection is associated with an increased risk of colorectal adenoma.

Results

Among 2,195 eligible subjects, 1,253 subjects were H. pylori seropositive and 942 subjects were seronegative. In the H. pylori (+) group, the prevalence of colorectal adenoma and advanced adenoma was significantly higher than in the H. pylori (?) group (25.3 vs. 20.1 %, p = 0.004 and 6.1 vs. 2.9 %, p < 0.001, respectively). In our multivariate analysis, H. pylori seropositivity was an independent risk factor for overall colorectal adenoma (OR = 1.36, 95 % CI = 1.10–1.68) and advanced adenoma (OR = 2.21, 95 % CI = 1.41–3.48). The positive association was confined in cases with any proximal adenoma. In the meta-analysis, which included ten studies and 15,863 patients, the pooled OR for colorectal adenoma related to H. pylori infection was 1.58 (95 % CI = 1.32–1.88).

Conclusion

Our results from this cross-sectional study and current studies included in our meta-analysis indicated that H. pylori infection was associated with a modest increase in the risk for colorectal adenoma.