Rural–urban differences in the long-term risk of colorectal cancer after adenoma removal: A population-based study

BackgroundWe investigated the impact of municipality of residence on colonoscopic surveillance and colorectal cancer risk after adenoma resection in a French well-defined administrative area.MethodsThis registry-based study included all patients residing in Côte d’Or (n = 5769) first diagnosed with colorectal adenomas between January 1, 1990, and December 31, 1999. Information about colonoscopic surveillance and colorectal cancer incidence was collected until December 31, 2003.ResultsA rural place of residence reduced the probability of colonoscopic surveillance in men [HR = 0.89 (95%CI: 0.79–0.99), p = 0.041] and in patients without family history of colorectal cancer [HR = 0.91(0.82–0.99), p = 0.044]. After a median follow-up of 7.7 years, 87 patients developed invasive colorectal cancer. After advanced adenoma removal, the standardized incidence ratio for colorectal cancer was 3.03 (95%CI: 1.92–4.54) for rural patients and 1.87 (95%CI: 1.26–2.66) for urban patients compared with the general population. The risk of colorectal cancer was higher in rural patients than in urban ones only after removal of the initial advanced adenoma [HR = 1.73 (95%CI: 1.01–3.00, p = 0.048)]. Further adjustment for surveillance colonoscopy, physician location, and other confounders had little impact on these results.ConclusionThe increased risk of subsequent colorectal cancer after advanced adenoma removal in French rural patients was not explained by a lower rate of colonoscopic surveillance. The role of socio-economic and environmental factors requires further exploration.     

Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: A meta-analysis

ObjectivesPrevious meta-analysis including nonrandomized studies showed marginal benefit of underwater endoscopic mucosal resection(U-EMR) compared to conventional EMR(C-EMR) in terms of polypectomy outcomes. We evaluated U-EMR compared to C-EMR in the treatment of colorectal polyps with respect to effectiveness and safety by analyzing only randomized controlled trials(RCTs).Material and MethodsPubMed and Cochrane Library databases were searched for RCTs published until 11/2020, evaluating U-EMR vs. C-EMR regarding en bloc resection, post-endoscopic resection adenoma recurrence, complete resection, adverse events rates and difference in resection time. Abstracts from Digestive Disease Week, United European Gastroenterology Week and ESGE Days meetings were also searched. Effect size on outcomes is presented as risk ratio(RR; 95% confidence interval[CI]) or mean difference(MD; 95%CI). The I² test was used for quantifying heterogeneity, while Grading of Recommendations Assessment, Development and Evaluation(GRADE) was used to assess strength of evidence.ResultsSix RCTs analyzing outcomes from 1157 colorectal polypectomies(U-EMR589;C-EMR,568) were included. U-EMR associated with significant higher rate of en bloc resection compared to C-EMR [RR(95%CI):1.26(1.01–1.58); Chi² for heterogeneity=30.43, P<0.0001; I²=84%, GRADE: Very low]. This effect was more prominent regarding resection of polyps sized ≥20 mm compared to polyps <20 mm [RR(95%CI):1.64(1.22–2.20) vs. 1.10(0.98–1.23)]. Post-resection recurrence [RR(95%CI):0.52(0.28–0.94);GRADE:Low] was lower significantly in U-EMR group. In contrast, no significant difference was detected between U-EMR and C-EMR regarding complete resection [RR(95%CI): 1.06(0.91–1.24) GRADE:Very low] and adverse events occurrence[RR(95%CI):1.00 (0.72–1.39); GRADE:Low].ConclusionMeta-analysis of RCTs supports that U-EMR resection achieves higher rate of en bloc resection compared to conventional EMR. This effect is driven when resecting large(≥20 mm) polyps.     

Meta-analysis for evaluating the accuracy of endoscopy with narrow band imaging in detecting colorectal adenomas

Background and Aim: The aim of this study was to determine whether the use of the narrow band imaging (NBI) system could enhance the accuracy of adenoma detection during an endoscopic examination of the colon and rectum. Methods: MEDLINE, EMBASE, and the Cochrane Library databases were searched along with a hand search of abstracts from relevant conferences up to June 2011. The rates of adenoma and flat adenoma detection, and withdrawal time were analyzed using Review Manager 4.2. Results: A total of 3049 subjects in eight trials were included. Meta‐analysis revealed that there was no statistically significant difference in the rates of adenoma detection between the NBI group and the white light colonoscopy group (pooled relative risk [RR]: 1.09, 95% confidence interval [CI]: 1.00–1.19, P = 0.05). However, after exclusion of high‐definition television modalities, the rate of adenoma detection by NBI was significantly higher than that by white light, particularly for patients with one adenoma (pooled RR 1.36, 95%CI 1.07–1.71, P = 0.02). Endoscopy with the NBI system significantly increased the rate of flat adenoma detection (pooled RR 1.96, 95%CI 1.09–3.52, P = 0.02). However, endoscopy with NBI had longer withdrawal time than that with white light (pooled weighted mean difference: 0.90, 95%CI: 0.38–1.42, P = 0.0006). Conclusions: Endoscopy with NBI seems to improve the detection of flat adenomas, particularly with high‐definition technology, but prolongs the withdrawal time. These results indicate that endoscopy routinely using the NBI system for the surveillance of adenomas may be recommended after the technique is further modified.     

Patient,Physician, and Procedure Characteristics Are Independently Predictive of Polyp Detection Rates in Clinical Practice

Background

Variability in colon polyp detection impacts patient outcomes. However, the relative influence of physician, patient, and procedure-specific factors on polyp detection is unclear. Therefore, determining how these factors contribute to adenoma and sessile serrated polyp (SSP) detection is important to contextualize measures of colonoscopy quality such as adenoma detection rate and patient outcomes.

Aims

To determine the relative contribution of physician, patient, and procedure-specific factors in total polyp, adenoma, and SSP detection rates.

Methods

We performed a retrospective study of patients undergoing screening colonoscopy and used a two-level generalized linear mixed regression model to identify factors associated with polyp detection.

Results

7799 average risk screening colonoscopies were performed between July 2016 and October 2017. The patient factor most strongly associated with increased risk of adenoma and sessile serrated polyp detection was white race (OR 1.21, 95% CI 1.05–1.39 and OR 3.17, 95% CI 2.34–4.30, respectively). Adenomatous (OR 1.92, 95% CI 1.04–3.57) and sessile serrated polyps (OR 5.56, 95% CI 1.37–20.0) were more likely to be found during procedures performed with anesthesia care as compared to those with moderate sedation. Physician with a luminal gastrointestinal focus had increased odds of adenoma detection (OR 1.61, 95% CI 1.02–2.50).

Conclusions

In a multi-level model accounting for clustering effects, we identified patient, provider and procedural factors independently influence adenoma and sessile serrated polyp detection. Our findings suggest that to compare polyp detection rates between endoscopists, even at the same institution, risk adjustment by characteristics of the patient population and practice is necessary.

     

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.     

Trends in the age-related incidence of colon and rectal cancers in China, 2005–2015

BackgroundRecent evidences showed that the incidence of colorectal cancer decreased among older adults, yet this decline didn't appear in adults younger than 50 years. Our aim was to evaluate age-related incidence trends of colon and rectal cancers in China during 2005-2015.MethodsA retrospective study of colon and rectal cancers was conducted using population-based data from the Chinese Cancer Registry Annual Report. Age at diagnosis was analyzed in five sub-groups (0–19, 20–34, 35–49, 50–64 and 65 years). Data including new cases, incidence, and age-standardized rates (ASRs) were classified by sex and area. Temporal trends of ASRs were determined with Joinpoint regression analysis.ResultsFrom 2005 to 2015, colon cancer incidence decreased by -2.2% (95%CI: -3.1, -1.3) per year. A more steady decrease was seen in rectal cancer with AAPC of -0.9% (95%CI: -1.4, -0.4). Stratified by age at diagnosis, incidence trends followed a similar pattern, without age-related disparity. Females showed pronounced declines relative to males. The exception was that rural individuals showed opposite increasing trends, with 2.7% of AAPCs for colon cancer and 2.0% for rectal cancer.ConclusionA slight decline was observed in colon and rectal cancers during 2005–2015, regardless of age at diagnosis.     

Place of residence and distance to medical care influence the diagnosis of hepatitis C: a population-based study

BACKGROUND/AIMS: In France, geographic access to medical care may affect the diagnosis of hepatitis C. The aims of this study were to compare the detection rates of hepatitis C in urban and rural areas after adjusting for distance to medical care, and evaluating the impact of the place of residence on patients' clinical characteristics. METHODS: Between 1994 and 2001, 1938 newly detected cases were recorded in a French population of 1,005,817 inhabitants. Age and sex-adjusted detection rates for 10(5) inhabitants were estimated for urban and rural areas and for classes of distance to the nearest practitioner. RESULTS: Detection rates were lower in rural than in urban areas [14.1, (95CI: 12.5-15.7) versus 24.7, (95CI: 23.5-26.0)] and decreased as the distance to the general practitioner increased [27.0, (95CI: 25.5-28.4) versus 13.7, (95CI: 12.1-15.3) for a cutoff value of 1.5 km]. In multivariate analyses, detection rates were only influenced by the distance to general practitioner. Hepatocellular carcinoma at diagnosis was more frequent among rural than among urban patients (adjusted OR = 2.28, 95CI: 0.97-5.39, P = 0.059). CONCLUSIONS: A poorer geographic access to care explained the lower detection of hepatitis C in rural areas. Hepatocellular carcinoma was more frequent in rural patients. It may result from later detection and/or involvement of environmental factors on hepatocarcinogenesis.     

Characteristics of and risk factors for colorectal neoplasms in young adults in a screening population

AIM: To investigate prevalence and risk factors for colorectal neoplasms in adults aged 50 years, for whom screening is not recommended.METHODS: This cross-sectional study compared prevalence and characteristics of colorectal and advanced adenomas in patients aged 50 years who underwent colonoscopy screening with subjects aged ≥ 50 years. To evaluate risk factors for colorectal and advanced adenoma in young adults, we used multivariable logistic regression models. Colorectal neoplasm characteristics were evaluated and compared with those in older patients.RESULTS: Among 2819 patients included, prevalences of colorectal adenoma and advanced adenoma were 19.7% and 1.5%, respectively. As patient age increased, so did the prevalence of colorectal neoplasm. However, prevalence of advanced adenoma did not differ between age-groups 45-49 years and ≥ 50 years(OR = 0.43, 95%CI: 0.17-1.07, P = 0.070). In younger age-group( 50 years), colorectal adenoma was significantly associated with older age, waist circumference(OR = 1.72, 95%CI: 1.15-2.55, P = 0.008), and current smoking(OR = 1.60, 95%CI: 1.07-2.41, P = 0.023). Alcohol consumption was an independent risk factor for colorectal advanced adenoma(OR = 3.69, 95%CI: 1.08-12.54, P = 0.037). Multiple neoplasms and large neoplasms(≥ 1 cm) were more prevalent in subjects ≥ 50 years.CONCLUSION: Current screening strategies for colorectal cancer may need to be amended to account for patient age, especially in young subjects with abdominal obesity, current smoking and alcohol consumption.     

Colorectal cancer death after adenoma removal in Scandinavia

Objectives: Improved understanding of the subsequent risk death from colorectal cancer (CRC) among individuals who had adenomas removed is needed. We aimed to quantify this risk using prospectively collected data from population-based cohorts.

Materials and methods: Using Norwegian and Swedish registries, a cohort of 90,864 individuals with colorectal adenomas removed between 1980 and 2013 was identified. Surveillance was only recommended for high-risk adenomas. The validity of the registry data did not allow classification into low- and high-risk adenomas. Virtually complete follow-up was achieved through linkage to nationwide registers. We calculated incidence-based standardised mortality ratios (SMRs) with 95% confidence intervals (CI).

Results: The median follow-up was 7.2 years; 48,058 individuals were followed for more than 10 years. We observed 819 deaths (0.9%) from CRC and expected 731 CRC deaths (0.8%), corresponding to an absolute excess risk of 88 cases (0.1%) and a relative risk of 12% (SMR 1.12; 95%CI 1.05–1.20). The relative risk of CRC death following adenoma removal was slightly higher in Sweden (SMR 1.22; 95%CI 1.11–1.34) than in Norway (SMR 1.03; 95%CI 0.93–1.14), and higher in women (SMR 1.24; 95%CI 1.12–1.36) than in men (SMR 1.02; 95%CI 0.93–1.13). Among individuals with more than 10 years of follow-up, the estimates were similar to the overall cohort, absolute excess risk 0.1% (SMR 1.15; 95%CI 1.06–1.24).

Conclusion: The excess risk of CRC death following adenoma removal is small. Optimal surveillance recommendations should be tested in randomised trials.     

The impact of portal pedicle clamping on survival from colorectal liver metastases in the contemporary era of liver resection: a matched cohort study

IntroductionPortal pedicle clamping (PPC) may impact micro‐metastases’ growth. This study examined the association between PPC and survival after a hepatectomy for colorectal liver metastases (CRLM).MethodsA matched cohort study was conducted on hepatectomies for CRLM at a single institution (2003–2012). Cohorts were selected based on PPC use, with 1:1 matching for age, time period and the Clinical Risk Score. Outcomes were overall and recurrence‐free survival (OS and RFS). Cox regression was performed to assess the association between PPC and survival.ResultsOf 481 hepatectomies, 26.9% used PPC. One hundred and ten pairs of patients were matched in the cohorts. There was no significant difference in OS [hazard ratio (HR) 1.18; 95% confidence interval (CI): 0.76–1.83], with a 5‐year OS of 57.8% (95%CI: 52.4–63.2%) with PPC versus 62.3% (95%CI: 57.1–67.5%) without. Five‐year RFS did not differ (HR 0.98; 95%CI: 0.71–1.35) with 29.7% (95%CI: 24.9–34.5%) with PPC versus 28.0% (95%CI: 23.2–32.8%) without. When adjusting for extent of resection, transfusion, operative time and surgeon, there was no difference in OS (HR 0.91; 95%CI: 0.52–1.60) or RFS (HR: 0.86; 95%CI: 0.57–1.30).ConclusionsPPC was not associated with a significant difference in OS or RFS in a hepatectomy for CRLM. PPC remains a safe technique during hepatectomy.     

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.     

To cap/cuff or ring: do distal attachment devices improve the adenoma detection?

Introduction: Colonoscopy reduces the risk of colorectal cancer, by interrupting the adenoma–carcinoma sequence enabling the detection and removal of adenomas before they turn into colorectal cancer. Colonoscopy has its limitations as adenoma miss rates as high as 25% have been reported. The reasons for missed pathology are complicated and multi-factorial. The recent drive to improve adenoma detection rates has led to a plethora of new technologies.

Areas covered: An increasing number of advanced endoscopes and distal attachment devices have appeared in the market. Advanced endoscopes aim to improve mucosal visualization by widening the field of view. Distal attachment devices aim to increase adenoma detection behind folds by flattening folds on withdrawal. In this review article, we discuss the three following distal attachment devices: the transparent cap, the Endocuff, and the Endoring.

Expert commentary: The authors believe that the distal attachment devices will have a greater benefit for endoscopists with low baseline adenoma detection rates.     

Prevalence of metabolic syndrome in sub-Saharan Africa: A systematic review and meta-analysis

Background and aimsThere are rising levels of cardiovascular diseases (CVDs) and diabetes in Sub-Saharan Africa (SSA). Metabolic syndrome (MS) is a precursor of these conditions, but the data on the prevalence of MS in SSA are fragmented. We conducted a systematic review and meta-analysis to estimate the prevalence of MS in SSA and determine the population groups that are most at risk.Methods and resultsWe systematically searched PubMed, Embase and African Journals Online for all published articles reporting MS prevalence in SSA populations. Random effects models were used to calculate the pooled prevalence overall and by major study-level characteristics. A total of 65 studies across fourteen different countries comprising 34,324 healthy participants aged ≥16 years were included in the meta-analysis. The overall prevalence of MS according to the different diagnostic criteria was: IDF: 18.0% (95%CI:13.3–23.3), IDF-ethnic: 16.0% (95%CI:11.3–21.4), JIS: 23.9% (95%CI: 16.5–32.3), NCEP-ATP III: 17.1% (95%CI:12.8–22.0) and WHO: 11.1% (95%CI:5.3–18.9). The prevalence of MS was higher in women than in men, and higher in (semi-)urban than in rural participants. The MS prevalence was highest in Southern Africa, followed by Eastern, Western and Central Africa. Substantial heterogeneity in the prevalence estimates across studies were not explained by major study-level characteristics, while apparent publication biases were likely artefactual.ConclusionsMS is not rare in SSA. The prevalence of MS was highest for women, populations in urban areas, and populations in Southern Africa. Public health intervention efforts are needed to prevent further increases in the burden of MS in the region.     

The risk of advanced neoplasia after polypectomy of one to two non-advanced adenomas less than 5 mm in size vs. normal colonoscopy

BackgroundCurrent guidelines are inconsistent regarding the follow-up of patients with 1–2 diminutive (1–5 mm) non-advanced adenomas (DNAAs).AimsTo evaluate the risk of metachronous advanced neoplasia (AN), defined as cancer or advanced adenoma (AA), among patients with either normal colonoscopy or 1–2 DNAAs.MethodsA retrospective cohort study. Cohort I included 2,347 subjects with normal colonoscopy and 483 subjects with polypectomy of 1–2 DNAAs followed by colonoscopy. Cohort II included 11,881 subjects with normal colonoscopy and 1,342 subjects with 1–2 DNAAs followed through the cancer registry.ResultsIn cohort I, the rate of AN, cancer and AA among the polypectomy group vs. normal colonoscopy was 5.0% vs. 2.5%, Hazard Ratio (HR) 2.96 (95%CI [Confidence Interval]1.86–4.78) for AN; 0.6% vs. 0.3%, HR 3.32 (95%CI 0.85–13) for cancer; 4.3% vs. 2.2% HR 2.91 (95%CI 1.75–4.86) for AA. In cohort II, cancer occurred in 0.4% of the polypectomy group and 0.2% of the normal colonoscopy group, HR 2.27 (95% CI 0.56–9.19).ConclusionCompared to subjects with normal colonoscopy, subjects with polypectomy of 1–2 DNAAs, are at increased risk for AA when followed by colonoscopy, while the risk for cancer is non-significantly increased. Our findings suggest that patients with 1–2 DNNAs should be followed more tightly than patients with normal colonoscopy.     

Prevalence of coronary heart disease in rural and urban Vellore: A repeat cross-sectional survey

BackgroundWith the increase of cardiovascular risk factors in India, the prevalence of coronary heart disease (CHD) is also expected to rise. A cross-sectional study in 2010–2012 assessed the prevalence and risk factors for CHD in urban and rural Vellore, Tamil Nadu. The secondary objectives were to compare the current prevalence with the prevalence of CHD in the same areas in 1991–1994.MethodsA cross-sectional survey was carried out among adults aged 30–64 years to determine the prevalence of CHD (previously diagnosed disease, symptoms detected using Rose angina questionnaire, or ischemic changes on electrocardiography). The study used the WHO STEPS method in addition to the Rose angina questionnaire and resting electrocardiography and was conducted in nine clusters of a rural block in Vellore district and 48 wards of Vellore town. The results were compared with a similar study in the same area in 1991–1994.ResultsThe prevalence of CHD was 3.4% (95% CI: 1.6–5.2%) among rural men, 7.4% (95% CI: 4.7–10.1%) among rural women, 7.3% (95% CI: 5.7–8.9%) among urban men, and 13.4% (95% CI: 11.2–15.6%) among urban women in 2010–2012. The age-adjusted prevalence in rural women tripled and in urban women doubled, with only a slight increase among males, between 1991–1994 and 2010–2012.ConclusionsThe large increase in prevalence of CHD, among both pre- and post-menopausal females, suggests the need for further confirmatory studies and interventions for prevention in both rural and urban areas.     

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.     

Urbanization and Daily Exposure to Biomass Fuel Smoke Both Contribute to Chronic Bronchitis Risk in a Population with Low Prevalence of Daily Tobacco Smoking

Objective: Risk factors beyond tobacco smoking associated with chronic bronchitis are not well understood. We sought to describe the prevalence and risk factors of chronic bronchitis across four distinct settings in Peru with overall low prevalence of tobacco smoking yet varying degrees of urbanization, daily exposure to biomass fuel smoke and living at high altitude. Methods: We analyzed data of 2,947 participants from rural and urban Puno, Lima and Tumbes including spirometry, blood samples, anthropometry and administered questionnaires about respiratory symptoms. We used multivariable Poisson regression to assess biologic, socioeconomic and environmental risk factors associated with chronic bronchitis. Results: Overall prevalence of chronic bronchitis was 5.9% (95%CI 5.1%–6.9%) with variation by setting: prevalence was lower in semi-urban Tumbes (1.3%) vs. highly urbanized Lima (8.9%), urban Puno (7.0%) and rural Puno (7.8%; p < 0.001). Chronic bronchitis was more common among participants with vs. without COPD based on FEV₁/FVC< LLN (12.1% vs 5.6%, p < 0.01) and it was associated with increased reporting of dyspnea on exertion (p < 0.001), hospitalization (p = 0.003) and workdays missed due to respiratory symptoms (p < 0.001). Older age (Prevalence ratio [PR] = 1.23 for each 10-years of age, 95%CI 1.09–1.40) past history of asthma (PR = 2.87, 95%CI 1.80–4.56), urbanization (PR = 3.34, 95%CI 2.18–5.11) and daily exposure to biomass fuel smoke (PR = 2.00, 95%CI 1.30–3.07) were all associated with chronic bronchitis. Conclusions: We found important variations in the prevalence of chronic bronchitis across settings. Prevalence increased with both urbanization and with daily exposure to biomass fuel smoke. Having chronic bronchitis was also associated with worse patient-centered outcomes including dyspnea, hospitalization and missed workdays.     

Delays in colonoscopy start time are associated with reductions in adenoma detection rates

BackgroundPrior investigations of the impact of case delays on adenoma detection rates have not found a significant association, though these studies included modest delays, with few cases delayed by more than one hour.AimsThe aim of this study was to measure the impact of prolonged case delays on the colonoscopy outcome measures of adenoma detection rate and withdrawal time.MethodsWe performed a single center cohort study including patients aged ≥50 years undergoing screening colonoscopy during a 4.5 year period. Using multivariate regression, we measured the impact of delays on adenoma detection rate and withdrawal time, adjusting for age, gender, endoscopist, time of day of the procedure, and bowel preparation quality.ResultsOf 7905 screening colonoscopies, 2503 (32%) were delayed by >1 h. On multivariable analysis, cases delayed 1–2 h were associated with a significant decrease in adenoma detection rate relative to cases delayed ≤1 h (OR 0.88, 95% CI 0.78–1.00, p = 0.049). Withdrawal time was not significantly associated with case delays.ConclusionsProlonged case delays over 1 h are associated with reduced adenoma detection rates. Future research on factors underlying prolonged delays may help mitigate these barriers to care and improve quality outcomes.