Predictive factors and model validation of post-colon polyp surgery Helicobacter pylori infection

BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.

Exploiting Deep Learning Techniques for Colon Polyp Segmentation

As colon cancer is among the top causes of death, there is a growinginterest in developing improved techniques for the early detection of colonpolyps. Given the close relation between colon polyps and colon cancer,their detection helps avoid cancer cases. The increment in the availability ofcolorectal screening tests and the number of colonoscopies have increasedthe burden on the medical personnel. In this article, the application of deeplearning techniques for the detection and segmentation of colon polyps incolonoscopies is presented. Four techniques were implemented and evaluated:Mask-RCNN, PANet, Cascade R-CNN and Hybrid Task Cascade (HTC).These were trained and tested using CVC-Colon database, ETIS-LARIBPolyp, and a proprietary dataset. Three experiments were conducted to assessthe techniques performance: (1) Training and testing using each databaseindependently, (2) Mergingd the databases and testing on each database independently using a merged test set, and (3) Training on each dataset and testingon the merged test set. In our experiments, PANet architecture has the bestperformance in Polyp detection, and HTC was the most accurate to segmentthem. This approach allows us to employ Deep Learning techniques to assisthealthcare professionals in the medical diagnosis for colon cancer. It is anticipated that this approach can be part of a framework for a semi-automatedpolyp detection in colonoscopies.

Is endoscopic mucosal ablation a valid option for treating colon polyps?

The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA should be determined for a further large number of studies.EMA should be used with caution for larger lesions.

What can be the criteria of outpatient-based endoscopic resection for colon polyp?

AIM: To investigate whether out-patient based endo-scopic mucosal resection(EMR) for colon polyps ≤ 10 mm is safe.METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors.RESULTS: The size of the polyp(95%CI: 1.096-1.164, P < 0.001) and patients with chronic renal failure(95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multi-variate analysis. 95%CI for percent of delayed bleedingaccording to polyp size was determined for the fol-lowing conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size > 10 mm, 0.54%-2.08%; size > 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION: It seems acceptable to perform outpa-tient-based EMR for colon polyps ≤ 10 mm.

Diagnostic value of high-resolution micro-endoscopy for theclassification of colon polyps

AIM: To study a new imaging equipment, highresolution micro-endoscopy(HRME), in the diagnosis and pathological classification of colon polyps.METHODS: We selected 114 specimens of colon polyps, 30 of which were colon polyps with known pathological types and 84 that were prospective polyp specimens; 10 normal colon mucosa specimens served as controls. We obtained images of 30 colon polyp specimens with known pathological types using HRME and analyzed the characteristics of these images to develop HRME diagnostic criteria for different pathological types of colon polyps. Based on these criteria, we performed a prospective study of 84 colon polyp specimens using HRME and compared the results with those of the pathological examination to evaluate the diagnostic value of HRME in the pathological classification of different types of colon polyps. RESULTS: In the 30 cases of known pathological type of colon polyp samples, there were 21 cases of adenomatous polyps, which comprised nine cases of tubular adenoma, seven cases of villous adenoma and five cases of mixed adenomas. The nine cases of non-adenomatous polyps included four cases of inflammatory polyps and five cases of hyperplastic polyps five. Ten cases of normal colonic mucosa were confirmed pathologically. In a prospective study of 84 cases using HRME, 23 cases were diagnosed as inflammatory polyps, 11 cases as hyperplastic polyps, 18 cases as tubular adenoma, eight cases as villous adenoma and 24 cases as mixed adenomas. After pathological examination, 24 cases were diagnosed as inflammatory polyps, 11 cases as hyperplastic polyps, 19 cases as tubular adenoma, eight cases as villous adenoma and 22 cases as mixed adenomas. Compared with the pathological examinations, the sensitivities, specificities, accuracies, and positive and negative predictive values of HRME in diagnosing inflammatory polyps(87.5%, 96.7%, 94.0%, 91.3% and 95.1%), hyperplastic polyps(72.7%, 95.9%, 92.9%, 72.7% and 95.9%), tubular adenomas(73.7%, 93.8%, 89.3%, 77.8% and 92.4%), villous adenomas(75.0%, 97.4%, 95.2%, 75.0% and 97.4%), and mixed adenomas(75.0%, 93.3%, 88.1%, 81.8% and 90.3%) were relatively high.CONCLUSION: HRME has a relatively high diagnostic value in the pathological classification of colon polyps. Thus, it may be an alternative to confocal microendoscopy in lower-resource or community-based settings.

Assessment of colon polyp morphology: Is education effective?

AIM To determine the inter-observer variability for colon polyp morphology and to identify whether education can improve agreement among observers.METHODS For purposes of the tests, we recorded colonoscopy video clips that included scenes visualizing the polyps. A total of 15 endoscopists and 15 nurses participated in the study. Participants watched 60 video clips of the polyp morphology scenes and then estimated polyp morphology(pre-test). After education for 20 min, participants performed a second test in which the order of 60 video clips was changed(post-test). To determine if the effectiveness of education was sustained, four months later, a third, follow-up test was performed with the same participants.RESULTS The overall Fleiss' kappa value of the inter-observer agreement was 0.510 in the pre-test, 0.618 in the post-test, and 0.580 in the follow-up test. The overall diagnostic accuracy of the estimation for polyp morphology in the pre-, post-, and follow-up tests was 0.662, 0.797, and 0.761, respectively. After education, the inter-observer agreement and diagnostic accuracy of all participants improved. However, after four months, the inter-observer agreement and diagnostic accuracy of expert groups were markedly decreased, and those of beginner and nurse groups remained similar to pre-test levels. CONCLUSION The education program used in this study can improve inter-observer agreement and diagnostic accuracy in assessing the morphology of colon polyps; it is especially effective when first learning endoscopy.

Multicenter randomised controlled trial comparing the high definition white light endoscopy and the bright narrow band imaging for colon polyps

AIM To compare high definition white light endoscopy and bright narrow band imaging for colon polyps' detection rates. METHODS Patients were randomised to high definition white light endoscopy(HD-WLE) or the bright narrow band imaging(b NBI) during withdrawal of the colonoscope. Polyps identified in either mode were characterised using b NBI with dual focus(b NBI-DF) according to the Sano's classification. The primary outcome was to compare adenoma detection rates(ADRs) between the two arms. The secondary outcome was to assess the negative predictive value(NPV) in differentiating adenomas from hyperplastic polyps for diminutive rectosigmoid lesions.RESULTS A total of 1006 patients were randomised to HD-WLE(n = 511) or b NBI(n = 495). The mean of adenoma per patient was 1.62 and 1.84, respectively. The ADRs in b NBI and HD-WLE group were 37.4% and 39.3%, respectively. When adjusted for withdrawal time(OR = 1.19, 95%CI: 1.15-1.24, P < 0.001), the use of b NBI was associated with a reduced ADR(OR = 0.69, 95%CI: 0.52-0.92). Nine hundred and thirty three polyps(86%) in both arms were predicted with high confidence. The sensitivity(Sn), specificity(Sp), positive predictive value and NPV in differentiating adenomatous from non-adenomatous polyps of all sizes were 95.9%, 87.2%, 94.0% and 91.1% respectively. The NPV in differentiating an adenoma from hyperplastic polyp using b NBI-DF for diminutive rectal polyps was 91.0%.CONCLUSION ADRs did not differ between b NBI and HD-WLE, however HD-WLE had higher ADR after adjustment of withdrawal time. b NBI surpassed the PIVI threshold for diminutive polyps.

Difficult colon polypectomy

Colorectal cancer (CRC) is one of the leading causes of death from cancer in the world. We now know that 90% of CRC develop from adenomatous polyps. Polypectomy of colon adenomas leads to a significant reduction in the incidence of CRC. At present most of the polyps are removed endoscopically. The vast majority of colorectal polyps identified at colonoscopy are small and do not pose a significant challenge for resection to an appropriately trained and skilled endoscopist. Advanced polypectomy techniques are intended for the removal of difficult colon polyps. We have defined a "difficult polyp" as any lesion that due to its size, shape or location represents a challenge for the colonoscopist to remove. Although many "difficult polyps" will be an easy target for the advanced endoscopist, polyps that are larger than 15 mm, have a large pedicle, are flat and extended, are difficult to see or are located in the cecum or any angulated portion of the colon should be always considered difficult. Although very successful,advanced resection techniques can potentially cause serious, even life-threatening complications. Moreover, post polypectomy complications are more common in the presence of difficult polyps. Therefore, any endos-copist attempting advanced polypectomy techniques should be adequately supervised by an expert or have an excellent training in interventional endoscopy. This review describes several useful tips and tricks to deal with difficult polyps.

Can optical diagnosis of small colon polyps be accurate? Comparing standard scope without narrow banding to high definition scope with narrow banding

AIM: To study the accuracy of using high definition(HD) scope with narrow band imaging(NBI) vs standard white light colonoscope without NBI(ST), to predict the histology of the colon polyps, particularly those < 1 cm.METHODS: A total of 147 African Americans patients who were referred to Howard University Hospital for screening or, diagnostic or follow up colonoscopy, during a 12-mo period in 2012 were prospectively recruited. Some patients had multiple polyps and total number of polyps was 179. Their colonoscopies were performed by 3 experienced endoscopists who determined the size and stated whether the polyps being removed were hyperplastic or adenomatous polyps using standard colonoscopes or high definition colonoscopes with NBI. The histopathologic diagnosis was reported by pathologists as part of routine care. RESULTS: Of participants in the study, 55(37%) were male and median(interquartile range) of age was 56(19-80). Demographic, clinical characteristics, past medical history of patients, and the data obtained by two instruments were not significantly different and two methods detected similar number of polyps. In ST scope 89% of polyps were < 1 cm vs 87% in HD scope(P = 0.7). The ST scope had a positive predictive value(PPV) and positive likelihood ratio(PLR) of 86% and 4.0 for adenoma compared to 74% and 2.6 for HD scope. There was a trend of higher sensitivity for HD scope(68%) compare to ST scope(53%) with almost the same specificity. The ST scope had a PPV and PLR of 38% and 1.8 for hyperplastic polyp(HPP) compared to 42% and 2.2 for HD scope. The sensitivity and specificity of two instruments for HPP diagnosis were similar.CONCLUSION: Our results indicated that HD scope was more sensitive in diagnosis of adenoma than ST scope. Clinical diagnosis of HPP with either scope is less accurate compared to adenoma. Colonoscopy diagnosis is not yet fully matched with pathologic diagnosis of colon polyp. However with the advancement of both imaging and training, it may be possible to increase the sensitivity and specificity of the scopes and hence save money for eliminating time and the cost of Immunohistochemistry/pathology.

Simple colonoscopy reporting system checking the detection rate of colon polyps

AIM: To present a simple colonoscopy reporting system that can be checked easily the detection rate of colon polyps.METHODS: A simple colonoscopy reporting system Kosin Gastroenterology(KG quality reporting system) was developed. The polyp detection rate(PDR),adenoma detection rate(ADR),serrated polyp detection rate(SDR),and advanced adenoma detection rate(AADR) are easily calculated to use this system.RESULTS: In our gastroenterology center,the PDR,ADR,SDR,and AADR test results from each gastroenterologist were updated,every month. Between June 2014,when the program was started,and December 2014,the overall PDR and ADR in our center were 62.5% and 41.4%,respectively. And the overall SDR and AADR were 7.5% and 12.1%,respectively.CONCLUSION: We envision that KG quality reporting system can be applied to develop a comprehensive system to check colon polyp detection rates in other gastroenterology centers.

Is forceps more useful than visualization for measurement of colon polyp size?

AIM: To identify whether the forceps estimation is more useful than visual estimation in the measurement of colon polyp size.METHODS: We recorded colonoscopy video clips that included scenes visualizing the polyp and scenes using open biopsy forceps in association with the polyp, which were used for an exam. A total of 40 endoscopists from the Busan Ulsan Gyeongnam Intestinal Study Group Society(BIGS) participated in this study. Participants watched 40 pairs of video clips of the scenes for visual estimation and forceps estimation, and wrote down the estimated polyp size on the exam paper. When analyzing the results of the exam, we assessed interobserver differences, diagnostic accuracy, and error range in the measurement of the polyp size.R E S U LT S : The overall intra-class correlation coefficients(ICC) of inter-observer agreement for forceps estimation and visual estimation were 0.804(95%CI: 0.731-0.873, P < 0.001) and 0.743(95%CI: 0.656-0.828, P < 0.001), respectively. The ICCs of each group for forceps estimation were higher than those for visual estimation(Beginner group, 0.761 vs 0.693; Expert group, 0.887 vs 0.840, respectively). The overall diagnostic accuracy for visual estimation was 0.639 and for forceps estimation was 0.754(P < 0.001). In the beginner group and the expert group, the diagnostic accuracy for the forceps estimation was significantly higher than that of the visual estimation(Beginner group, 0.734 vs 0.613, P < 0.001; Expert group, 0.784 vs 0.680, P < 0.001, respectively). The overall error range for visual estimation and forceps estimation were 1.48 ± 1.18 and 1.20 ± 1.10, respectively(P < 0.001). The error ranges of each group for forceps estimation were significantly smaller than those for visual estimation(Beginner group, 1.38 ± 1.08 vs 1.68 ± 1.30, P < 0.001; Expert group, 1.12 ± 1.11 vs 1.42 ± 1.11, P < 0.001, respectively).CONCLUSION: Application of the open biopsy forceps method when measuring colon polyp size could help reduce inter-observer differences and error rates.

Analysis of the Pathological Examination Results of 100 Colon Polyps Cases after EMR or ESD Operation

Aim: To study the characteristics of EMR (endoscopic mucosal resection) or ESD (endoscopic submucosal dissection) postoperative pathological examination of colonic polyps in different age groups, and the difference of pathological examination after EMR or ESD operation. Methods: A retrospective analysis was made of the EMR or ESD postoperative pathological data of 100 cases of colonic polyps patients in the Jingzhou Central Hospital digestive internal medicine. The time is from March 2016 to March 2018. Results: In 100 cases of EMR or ESD operation, there are 65 cases of young and middle-aged group. Pathological examination results include: 34 cases of adenomatous polyp, 18 cases of inflammatory polyp, 11 cases of benign tumors, 1 case of malignant tumor, 1 case of hyperplastic polyp. There are 35 cases of elderly group. Pathological examination results include: 27 cases of adenomatous polyp, 2 cases of inflammatory polyp, 2 cases of benign tumors, 4 cases of malignant tumor. 71 cases of complete EMR operation include: 51 cases of adenomatous polyp, 17 cases of inflammatory polyp, 3 cases of benign tumors;29 cases of complete ESD operation include: 10 cases of adenomatous polyp, 3 cases of inflammatory polyp, 10 cases of benign tumors, 5 cases of malignant tumor, 1 case of hyperplastic polyp. Conclusion: For the pathological examination results after EMR or ESD operation, the proportion of inflammatory polyps in the young and middle-aged group was greater than that in the elderly group. The proportion of adenomatous polyps in the elderly group was larger than that in the young and middle-aged group. The proportion of adenomatous polyps in EMR was greater than that of ESD. The proportion of benign tumors and malignant tumors in ESD was greater than that of EMR. The difference has statistical significance.

Management of malignant colon polyps:Current status and controversies

Colon cancer remains a significant clinical problem worldwide and in the United States it is the third most common cancer diagnosed in men and women.It is generally accepted that most malignant neoplasms of the colon arise from precursor adenomatous polyps.This stepwise progression of normal epithelium to carcinoma,often with intervening dysplasia,occurs as a result of multiple sequential,genetic mutations-some are inherited while others are acquired.Malignant polyps are defined by the presence of cancer cells invading through the muscularis mucosa into the underlying submucosa(T1).They can appear benign endoscopically but the presence of malignant invasion histologically poses a difficult and often controversial clinical scenario.Emphasis should be initially focused on the endoscopic assessment of these lesions.Suitable polyps should be resected en-bloc,if possible,to facilitate thorough evaluation by pathology.In these cases,proper attention must be given to the risks of residual cancer in the bowel wall or in the surrounding lymph nodes.If resection is not feasible endoscopically,thenthese patients should be referred for surgical resection.This review will discuss the important prognostic features of malignant polyps that will most profoundly affect this risk profile.Additionally,we will discuss effective strategies for their overall management.

Detection and analysis of serum bile acid profile in patients with colonic polyps

BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.

Pleomorphic leiomyosarcoma of the maxilla with metastasis to the colon:A case report

BACKGROUND Pleomorphic leiomyosarcomas make up around 8.6%of all leiomyosarcomas.They behave aggressively and often have poor prognoses.They can affect the gastrointestinal tract and retroperitoneum.To date,pleomorphic leiomyosarcoma involving the mesocolon have been reported in nine patients.CASE SUMMARY The patient was a 44-year-old man with a history of pleomorphic leiomyosarcoma of the left maxilla with metastasis to the lung and liver.His most recent positron emission tomography-computed tomography(PET-CT)scan showed uptake in the ascending and transverse colons.A colonoscopy revealed a 5.0 cm×3.5 cm×3.0 cm pedunculated polyp in the ascending colon.The polyp was removed using hot snare polypectomy technique and retrieved with Rothnet.Histopathologic examination of the polyp showed a metastatic pleomorphic leiomyosarcoma.CONCLUSION Uptake(s)on PET-CT in a patient with pleomorphic leiomyosarcoma should raise suspicion for metastasis.

Automated Colonic Polyp Detection and Classification Enabled Northern Goshawk Optimization with Deep Learning

The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer growth.Endoscopy is the conventional technique for detecting colon polyps,and considerable research has proved that automated diagnosis of image regions that might have polyps within the colon might be used to help experts for decreasing the polyp miss rate.The automated diagnosis of polyps in a computer-aided diagnosis(CAD)method is implemented using statistical analysis.Nowadays,Deep Learning,particularly throughConvolution Neural networks(CNN),is broadly employed to allowthe extraction of representative features.This manuscript devises a new Northern Goshawk Optimization with Transfer Learning Model for Colonic Polyp Detection and Classification(NGOTL-CPDC)model.The NGOTL-CPDC technique aims to investigate endoscopic images for automated colonic polyp detection.To accomplish this,the NGOTL-CPDC technique comprises of adaptive bilateral filtering(ABF)technique as a noise removal process and image pre-processing step.Besides,the NGOTL-CPDC model applies the Faster SqueezeNet model for feature extraction purposes in which the hyperparameter tuning process is performed using the NGO optimizer.Finally,the fuzzy Hopfield neural network(FHNN)method can be employed for colonic poly detection and classification.A widespread simulation analysis is carried out to ensure the improved outcomes of the NGOTL-CPDC model.The comparison study demonstrates the enhancements of the NGOTL-CPDC model on the colonic polyp classification process on medical test images.

Endoscopic mucosal ablation-an alternative treatment for colonic polyps:Three case reports

BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and are prone to complications.Endoscopic mucosal ablation(EMA)is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions.CASE SUMMARY In this case series we report the successful treatment of three flat colonic polyps using the EMA technique.Two lesions were treatment naïve and 1 was a recurrence after an endoscopic mucosal resection.The sizes ranged from 2 to 4 cm.All three polyps were ablated successfully with no immediate or delayed complications.The recurrence rate at 1 year of follow up was 0%.CONCLUSION Based on this initial experience,we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.

Higher prevalence of colon polyps in patients with Barrett’s esophagus:a case-control study

Background and aims:Barrett’s esophagus(BE)and colorectal neoplasms share similar risk factors.Previous studies have shown variable prevalence of colon polyps in patients with BE.Our aims were to determine the prevalence and incidence of colon polyps in patients with BE,compared to those without BE.Methods:In this case-control study,the study group included patients,aged 50–75 years,with biopsy-proven BE,who underwent colonoscopy at Cleveland Clinic from January 2002 to December 2011.The control group consisted of age-and sex-matched patients who underwent colonoscopy and also an endoscopy with no evidence of BE during the same time period.Exclusion criteria for both groups were family-or personal previous history of colon cancer or polyps,prior colonic resection,inflammatory bowel disease and familial polyposis syndromes.Patient demographics,comorbidities,medication use and endoscopic and colonoscopic details were collected,including biopsy results.Results:A total of 519 patients were included in the study;173 patients with BE in the study group and 346 without BE in the control group.Mean age at index colonoscopy was 618 years and 75%of patients were male.On index colonoscopy,patients with BE were more likely to have polyps than controls(45%vs 32%,respectively;P=0.003).Patients underwent between one and five colonoscopies during the follow-up.On multivariate analysis—after adjusting for age,gender and diabetes—patients with BE were 80%more likely to have any type of polyp,and 50%more likely to have adenomas found during colonoscopy.Conclusions:Patients with BE had higher prevalence and incidence of colon polyps.This has important clinical implications for screening and surveillance in BE patients.

Colonoscopic polypectomy and associated techniques

Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy.A variety of polypectomy techniques and devices are available,and their use can vary greatly based on local availability and preferences.In general,cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps,and hot snare has been the method of choice for larger polyps.The use of hot forceps has mostly fallen out of favor.Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve.As a result,the vast majority of polyps today can be removed endoscopically.Since electrocautery is frequently used for polypectomy,endoscopists should be thoroughly familiar with the basic principles of electrosurgery as it pertains to polypectomy.Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance.The two most common post-polypectomy complications are bleeding and perforation.Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers.This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.

Association between CYP24A1 polymorphisms and the risk of colonic polyps and colon cancer in a Chinese population

AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.