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Ability of lactulose breath test results to accurately identify Colorectal polyps through the measurement of small intestine bacterial overgrowth

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World Journal of Gastrointestinal Surgery 2023年第6期15卷 1138-1148页

作者： Lan Li Xue-Yuan Zhang Jin-Sheng Yu Hui-Min Zhou Yan Qin Wen-Rui Xie Wen-Jing Ding Xing-Xiang He Department of Gastroenterology The First Affiliated Hospital of Guangdong Pharmaceutical UniversityGuangzhou 510080Guangdong ProvinceChina Washing Microbiota Transplantation Engineering Techniques of Microbiota-Targeted Therapies of Guangdong ProvinceGuangzhou 510080Guangdong ProvinceChina Department of Gastroenterology People's Hospital of Nanxiong CountyNanxiong 512400Guangdong ProvinceChina Department of Genetics Washington University School of MedicineSaint LouisMO 63110United States North America Medical Education Foundation CaliforniaCA 91710United States

BACKGROUND While Colorectal polyps are not cancerous,some types of polyps,known as adenomas,can develop into colorectal cancer over time.polyps can often be found and removed by colonoscopy;however,this is an invasive and expensive test.Thus,there is a need for new methods of screening patients at high risk of developing polyps.AIM To identify a potential association between Colorectal polyps and small intestine bacteria overgrowth(SIBO)or other relevant factors in a patient cohort with lactulose breath test(LBT)results.METHODS A total of 382 patients who had received an LBT were classified into polyp and non-polyp groups that were confirmed by colonoscopy and pathology.SIBO was diagnosed by measuring LBTderived hydrogen(H)and methane(M)levels according to 2017 North American Consensus recommendations.Logistic regression was used to assess the ability of LBT to predict Colorectal polyps.Intestinal barrier function damage(IBFD)was determined by blood assays.RESULTS H and M levels revealed that the prevalence of SIBO was significantly higher in the polyp group than in the non-polyp group(41%vs 23%,Ppolyp patients were significantly higher than those in the non-polyp group(Ppolyps than those without(15%vs 5%,PColorectal polyps were most accurately predicted with models using M peak values or combined H and M values limited by North American Consensus recommendations for SIBO.These models had a sensitivity of≥0.67,a specificity of≥0.64,and an accuracy of≥0.66.CONCLUSION The current study made key associations among Colorectal polyps,SIBO,and IBFD and demonstrated that LBT has moderate potential as an alternative noninvasi

关键词： Lactulose breath test Colorectal polyp Small intestine bacteria overgrowth Intestinal barrier function Retrospective study

polyposis found on index colonoscopy in a 56-year-old female-BMPR1A variant in juvenile polyposis syndrome:A case report

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World Journal of Gastrointestinal Endoscopy 2023年第10期15卷 623-628页

作者： Michael Yulong Wu Christopher Toon Michael Field May Wong Department of Gastroenterology and Hepatology Royal North Shore HospitalSydney 2065New South WalesAustralia Northern Clinical School The University of SydneySydney 2065New South WalesAustralia NSW Health Pathology Department of Anatomical PathologyRoyal North Shore HospitalSydney 2065New South WalesAustralia Clinical Genetics Royal North Shore HospitalSydney 2065New South WalesAustralia

BACKGROUND Juvenile polyposis syndrome(JPS)is a rare hereditary polyposis disease frequently associated with an autosomal-dominant variant of the SMAD4 or BMPR1A gene.It often manifests with symptoms in children and adolescents and is infrequently diagnosed in asymptomatic adults.Establishing the diagnosis is important as patients with JPS have a high risk of developing gastrointestinal cancer and require genetic counselling and close routine follow-up.CASE SUMMARY We report on the case of a 56-year-old female diagnosed with JPS after genetic testing revealed a rare variant of the BMPR1A gene BMPR1A c.1409T>C(p.Met470Thr).She was initially referred for colonoscopy by her general practitioner after testing positive on a screening faecal immunochemical test and subsequently found to have polyposis throughout the entire colorectum on her index screening colonoscopy.The patient was asymptomatic with a normal physical examination and no related medical or family history.Blood tests revealed only mild iron deficiency without anemia.To date,there has only been one other reported case of JPS with the same genetic variant.Subsequent colonoscopies were organised for complete polyp clearance and the patient was returned for surveillance follow-up.CONCLUSION JPS patients can present with no prior symptoms or family history.Genetic testing plays an important diagnostic role guiding management.

关键词： Juvenile polyposis syndrome polyps Colorectal polyp Hereditary polyposis Cancer Case report

Genetic heterogeneity of colorectal cancer and the microbiome

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World Journal of Gastrointestinal Oncology 2023年第3期15卷 443-463页

作者： Marina A Senchukova Department of Oncology Orenburg State Medical UniversityOrenburg 460000Russia

In 2020,the International Agency for Research on Cancer and the World Health Organization's GLOBOCAN database ranked colorectal cancer(CRC)as the third most common cancer in the world.Most cases of CRC(>95%)are sporadic and develop from Colorectal polyps that can progress to intramucosal carcinoma and CRC.Increasing evidence is accumulating that the gut microbiota can play a key role in the initiation and progression of CRC,as well as in the treatment of CRC,acting as an important metabolic and immunological regulator.Factors that may determine the microbiota role in CRC carcinogenesis include inflammation,changes in intestinal stem cell function,impact of bacterial metabolites on gut mucosa,accumulation of genetic mutations and other factors.In this review,I discuss the major mechanisms of the development of sporadic CRC,provide detailed characteristics of the bacteria that are most often associated with CRC,and analyze the role of the microbiome and microbial metabolites in inflammation initiation,activation of proliferative activity in intestinal epithelial and stem cells,and the development of genetic and epigenetic changes in CRC.I consider longterm studies in this direction to be very important,as they open up new opportunities for the treatment and prevention of CRC.

关键词： Gut microbiota Bacterial metabolites colorectal cancer Colorectal polyp Stem cells Epigenetic changes

Real-world local recurrence rate after cold polypectomy in Colorectal polyps less than 10 mm using propensity score matching

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World Journal of Gastroenterology 2021年第47期27卷 8182-8193页

作者： Masashi Saito Takeshi Yamamura Masanao Nakamura Keiko Maeda Tsunaki Sawada Eri Ishikawa Yasuyuki Mizutani Takuya Ishikawa Naomi Kakushima Kazuhiro Furukawa Eizaburo Ohno Hiroki Kawashima Masatoshi Ishigami Mitsuhiro Fujishiro Department of Gastroenterology and Hepatology Nagoya University Graduate School of MedicineNagoya 4668550Japan Department of Endoscopy Nagoya University HospitalNagoya 4668550Japan

BACKGROUND Cold polypectomy(CP)is a simple and safe procedure for polyps less than 10 mm in size;however,there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation.Some clinical trials have evaluated local persistent recurrence;their results suggest that a higher rate of local recurrence has not been documented so far.There were few reports that observed the course over long periods of time after CP in clinical practice.AIM To evaluate the presence of local recurrence following CP and hot polypectomy(HP)using propensity score matching.METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated Colorectal polyps less than 10 mm(959 Lesions)between October 2016 and 2017 and underwent follow-up endoscopy subsequently.We divided them into the CP group(706 Lesions),wherein CP was performed,and the HP group(253 Lesions),wherein HP was performed.Using propensity score matching,we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records.RESULTS After propensity score matching,there were no significant differences in the patients’and their endoscopic background(age,use of antithrombotics,indications,size,morphology,location of polyps,and polypectomy device)between the groups.The mean duration between Colorectal polypectomy and the next follow-up colonoscopy was 17.5±7.1(range,6-39)mo in the CP group and 15.7±6.0(range,6-35)mo in the HP group,which was significantly longer in the CP group(P=0.005).The local recurrence rate was 0.93%in the CP group and 0.93%in the HP group,without a significant difference(P=0.688).Additionally,no differences were observed in the macroscopic en bloc resection rate,histopathological complete resection rate,and pathological results between the groups.Adverse events did not occur in either group.CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical prac

关键词： Cold polypectomy Colorectal polyp Hot polypectomy Local recurrence Safety Propensity score matching

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

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World Journal of Gastroenterology 2021年第31期27卷 5232-5246页

作者： Sheng-Bing Zhao Wei Yang Shu-Ling Wang Peng Pan Run-Dong Wang Xin Chang Zhong-Qian Sun Xing-Hui Fu Hong Shang Jian-Rong Wu Li-Zhu Chen Jia Chang Pu Song Ying-Lei Miao Shui-Xiang He Lin Miao Hui-Qing Jiang Wen Wang Xia Yang Yuan-Hang Dong Han Lin Yan Chen Jie Gao Qian-Qian Meng Zhen-Dong Jin Zhao-Shen Li Yu Bai Changhai Hospital Second Military Medical University/Naval Medical UniversityShanghai 200433China Tencent AI Lab National Open Innovation Platform for Next Generation Artificial Intelligence on Medical ImagingShenzhen 518063Guangdong ProvinceChina Department of Gastroenterology Changhai HospitalSecond Military Medical University/Naval Medical UniversityShanghai 200433China Tencent Healthcare(Shenzhen)Co.LTD. Shenzhen 518063Guangdong ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Kunming Medical UniversityKunming 650000Yunnan ProvinceChina Department of Gastroenterology The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'an 710061Shaanxi ProvinceChina Institute of Digestive Endoscopy and Medical Center for Digestive Disease The Second Affiliated Hospital of Nanjing Medical UniversityNanjing 210011Jiangsu ProvinceChina Department of Gastroenterology The Second Hospital of Hebei Medical UniversityHebei Key Laboratory of GastroenterologyHebei Institute of GastroenterologyShijiazhuang 050000Hebei ProvinceChina Department of Gastroenterology 900th Hospital of Joint Logistics Support ForceFuzhou 350025Fujian ProvinceChina Department of Gastroenterology No.905 Hospital of The Chinese People's Liberation ArmyShanghai 200050China

BACKGROUND Artificial intelligence in colonoscopy is an emerging field,and its application may help colonoscopists improve inspection quality and reduce the rate of missed polyps and adenomas.Several deep learning-based computer-assisted detection(CADe)techniques were established from small single-center datasets,and unrepresentative learning materials might confine their application and generalization in wide practice.Although CADes have been reported to identify polyps in colonoscopic images and videos in real time,their diagnostic performance deserves to be further validated in clinical practice.AIM To train and test a CADe based on multicenter high-quality images of polyps and preliminarily validate it in clinical colonoscopies.METHODS With high-quality screening and labeling from 55 qualified colonoscopists,a dataset consisting of over 71000 images from 20 centers was used to train and test a deep learning-based CADe.In addition,the real-time diagnostic performance of CADe was tested frame by frame in 47 unaltered full-ranged videos that contained 86 histologically confirmed polyps.Finally,we conducted a selfcontrolled observational study to validate the diagnostic performance of CADe in real-world colonoscopy with the main outcome measure of polyps per colonoscopy in Changhai Hospital.RESULTS The CADe was able to identify polyps in the test dataset with 95.0%sensitivity and 99.1%specificity.For colonoscopy videos,all 86 polyps were detected with 92.2%sensitivity and 93.6%specificity in frame-by-frame analysis.In the prospective validation,the sensitivity of CAD in identifying polyps was 98.4%(185/188).Folds,reflections of light and fecal fluid were the main causes of false positives in both the test dataset and clinical colonoscopies.Colonoscopists can detect more polyps(0.90 vs 0.82,Ppolypspolyps(0.65 vs 0.57,P<0.001;0.74 vs 0.67,P=0.001,respectively).However,high efficacy is not realized in colonoscopies with inadequ

关键词： Computer-assisted detection Artificial intelligence Deep learning Colonoscopy Clinical validation Colorectal polyp

Analysis of 234 cases of Colorectal polyps treated by endoscopic mucosal resection

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World Journal of Clinical Cases 2020年第21期8卷 5180-5187页

作者： Lu Yu Na Li Xiao-Mei Zhang Tao Wang Wei Chen Department of Gastroenterology Maanshan Central HospitalMaanshan 243000Anhui ProvinceChina Department of Gastroenterology Affiliated Hospital of Southeast UniversityNanjing 210009Jiangsu ProvinceChina

BACKGROUND Colorectal polyps refer to all neoplasms that protrude into the intestinal cavity.Researchers believe that 50%-70%of colorectal cancers originate from adenomatous polyps.AIM To investigate the endoscopic morphologic features,pathologic types,and clinical situation;evaluate the efficacy and safety of endoscopic mucosal resection(EMR);and guide clinicians in their daily practice.METHODS Two hundred thirty-four patients who underwent EMR in our hospital from January 1,2018 to December 31,2019 were recruited.Data including sex,age,endoscopic morphology of the polyps,and pathological characteristics were analyzed among groups.RESULTS A total of 295 polyps were resected from the 234 subjects enrolled in the study,of which 4(1.36%)were Yamada type I.There were 75(25.42%)type II,101(34.24%)type III,and 115(38.98%)type IV adenomas.Among them,41 were nonadenomas,110 were low-risk adenomas,139 were high-risk adenomas,and 5 were carcinomas.The differences in distribution were not statistically significant,with P values greater than 0.05.The risk of cancer significantly increased for polyps≥1 cm in diameter(c2=199.825,P=0.00).Regarding the endoscopic morphological features,congestion,erosion,and lobulation were more common on the surface morphology of high-risk adenomas and cancerous polyps(c2=75.257,P=0.00),and most of them were Yamada types III and IV.In all,6 of the 295 polyps could not be removed completely,with a one-time resection rate of 97.97%.There were two cases of postoperative bleeding and no cases of perforation,with an overall complication rate of 0.09%.CONCLUSION Colorectal polyps ranging from non-adenomatous polyps,low-risk adenomas,and high-risk adenomas to adenocarcinomas each has their own endoscopic features,while EMR,as a mature intervention,has good safety and operability and should be promoted clinically,especially at the primary care level.

关键词： Colorectal polyp Endoscopic mucosal resection High-risk adenoma Risk factors Adenocarcinomas 1,4-bis(diphenylphosphino)butane

Impact of looping on premalignant polyp detection during colonoscopy

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World Journal of Gastrointestinal Endoscopy 2022年第11期14卷 694-703页

作者： Osamu Toyoshima Toshihiro Nishizawa Shuntaro Yoshida Tatsuya Matsuno Toru Arano Ryo Kondo Kazunori Kinoshita Yuki Yasumi Yosuke Tsuji Mitsuhiro Fujishiro Department of Gastroenterology Toyoshima Endoscopy ClinicTokyo 157-0066Japan Department of Gastroenterology and Hepatology International University of Health and WelfareNarita HospitalNarita 286-8520Japan Department of Obstetrics and Gynecology Seijo Kinoshita HospitalTokyo 157-0066Japan Department of Internal Medicine Yasumi HospitalMorioka 028-4125Japan Department of Gastroenterology Graduate School of MedicineThe University of TokyoTokyo 113-8655Japan

BACKGROUND The presence of premalignant polyps on colonoscopy is an indicator of metachronous colorectal cancer.Looping during colonoscopy is associated with old age,female sex,and colonoscopy insertion time.However,the clinical significance of looping is not fully understood.We aimed to clarify the effect of looping on colorectal premalignant polyp detection.AIM To assess the effects of looping on premalignant polyp detection using logistic regression analyses.METHODS We retrospectively investigated patients who underwent colonoscopy at Toyoshima Endoscopy Clinic between May,2017 and October,2020.From the clinic’s endoscopy database,we extracted data on patient age,sex,endoscopist-assessed looping,colonoscopy duration,endoscopist experience,detection rate,and number of premalignant polyps.RESULTS We assessed 12259 patients(mean age,53.6 years;men,50.7%).Looping occurred in 54.3%of the patients.Mild and severe looping were noted in 4399 and 2253 patients,respectively.The detection rates of adenomas,advanced adenomas,high-risk adenomas,clinically significant serrated polyps(CSSPs),and sessile serrated lesions(SSLs)were 44.7%,2.0%,9.9%,8.9%and 3.5%,respectively.The mean numbers of adenomas and SSLs were 0.82 and 0.04,respectively.The detection rates of adenomas,high-risk adenomas,and CSSPs increased with looping severity(all Ppolyps.Therefore,looping may predict the risk of metachronous colorectal cancer.Endoscopists should carefully examine the colorectum of patients with looping.

关键词： Looping Colorectal polyp Colonoscopy Adenoma Serrated polyp colorectal neoplasm