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Mucosa color and size may indicate malignant transformation of chicken skin mucosa-positive colorectal neoplastic polyps

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 750-760页

作者： Ying-Jie Zhang Meng-Xia Yuan Wu Wen Fan Li Yi Jian Chuan-Ming Zhang Ye Yang Feng-Lin Chen Department of Digestive Diseases Chengdu Second People’s HospitalChengdu 610000Sichuan ProvinceChina Graduate School Chengdu Medical CollegeChengdu 610000Sichuan ProvinceChina

BACKGROUND Lipid metabolism reprogramming is suspected to exist in pre-cancerous lesions,including colorectal adenoma.Screening colonoscopy frequently reveals chicken skin mucosa(CSM;white or yellow-white speckled mucosa)surrounding colo-rectal polyps,caused by macrophages engulfing and accumulating the lipids decomposed by colon cells or adjacent tumors.CSM-positive colorectal polyps are associated with various diseases;however,their prognosis varies greatly.Cold snare polypectomy is commonly used to resect lesions up to 10 to 15 mm in diameter without signs of submucosal invasion but is controversial for CSM-positive colorectal polyps.Improved imaging is required to diagnose and treat CSM-positive colorectal polyps.METHODS This retrospective cohort study included 177 patients with CSM-positive colorectal polyps diagnosed using endoscopy.All patient-related information was extracted from the Goldisc soft-clinic DICOM system or electronic medical record system.Based on the pathological results,patients were classified as non-neoplastic polyps(five juvenile polyps),neoplastic polyps,non-invasive high-grade neoplasia(NHGN),or submucosal invasive carcinoma(SM stage cancer).We analyzed and compared the clinical features,suspected risk factors for malignant transformation of neoplastic polyps,and early infiltration of sub-mucosal carcinoma.RESULTS The diameters of NHGN and SM polyps were much smaller than those of neoplastic polyps.Most NHGN polyps had a deeper red mucosal color.On logistic regression analyses,diameter and deeper red mucosal color were independent risk factors for malignant transformation of neoplastic polyps.Type 1 CSM was more common in high-grade intraepithelial neoplasia and SM;type 2 CSM was more common in neoplastic polyps.Logistic regression analyses revealed no significant differences in the malignant transformation of neoplastic polyps or early submucosal invasion of CSM-positive colorectal cancer.Changes in the CSM mucosa surrounding neoplastic polyps and submucosal invasion of colorectal ca

关键词： Chicken skin mucosa colorectal cancer colorectal polyps Endoscopic resection Malignant transformation White light endoscopy

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Transient elastography with controlled attenuation parameter for the diagnosis of colorectal polyps in patients with nonalcoholic fatty liver disease

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World Journal of Clinical Cases 2024年第12期12卷 2050-2055页

作者： Lan Wang Yan-Fei Li Li-Feng Dong Department of Gastroenterology Beijing Chuiyangliu HospitalBeijing 100022China

BACKGROUND The severity of nonalcoholic fatty liver disease(NAFLD)and lipid metabolism are related to the occurrence of colorectal polyps.Liver-controlled attenuation parameters(liver-CAPs)have been established to predict the prognosis of hepatic steatosis patients.AIM To explore the risk factors associated with colorectal polyps in patients with NAFLD by analyzing liver-CAPs and establishing a diagnostic model.METHODS Patients who were diagnosed with colorectal polyps in the Department of Gastroenterology of our hospital between June 2021 and April 2022 composed the case group,and those with no important abnormalities composed the control group.The area under the receiver operating characteristic curve was used to predict the diagnostic efficiency.Differences were considered statistically significant when Pcolorectal polyps,with ORs of 2.338(95%CI:1.154–4.733)and 1.019(95%CI:1.006–1.033),respectively(P0.05).When the liver-CAP was greater than 291 dB/m,colorectal polyps were more likely to occur.CONCLUSION The levels of TG and liver-CAP in patients with colorectal polyps are significantly greater than those patients without polyps.Liver-CAP alone can be used to diagnose NAFLD with colorectal polyps.

关键词： colorectal polyps Nonalcoholic fatty liver disease Liver-controlled attenuation parameter Liver fibroscan Diagnostic model

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Association between triglyceride-glucose index and colorectal polyps:A retrospective cross-sectional study

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World Journal of Gastrointestinal Endoscopy 2024年第2期16卷 55-63页

作者： Ya-Jie Teng Ying-Xue Yang Jing-Jing Yang Qiu-Yan Lu Jia-Yi Shi Jian-Hao Xu Jie Bao Qing-Hua Wang Department of Gastroenterology The First People's Hospital of KunshanSuzhou 215300Jiangsu ProvinceChina Department of Pathology The First People's Hospital of KunshanSuzhou 215300Jiangsu ProvinceChina

BACKGROUND colorectal polyps(CPs)are frequently occurring abnormal growths in the colorectum,and are a primary precursor of colorectal cancer(CRC).The triglyceride-glucose(TyG)index is a novel marker that assesses metabolic health and insulin resistance,and has been linked to gastrointestinal cancers.AIM To investigate the potential association between the TyG index and CPs,as the relation between them has not been documented.METHODS A total of 2537 persons undergoing a routine health physical examination and colonoscopy at The First People's Hospital of Kunshan,Jiangsu Province,China,between January 2020 and December 2022 were included in this retrospective cross-sectional study.After excluding individuals who did not meet the eligibility criteria,descriptive statistics were used to compare characteristics between patients with and without CPs.Logistic regression analyses were conducted to determine the associations between the TyG index and the prevalence of CPs.The TyG index was calculated using the following formula:Ln[triglyceride(mg/dL)×glucose(mg/dL)/2].The presence and types of CPs was determined based on data from colonoscopy reports and pathology reports.RESULTS A nonlinear relation between the TyG index and the prevalence of CPs was identified,and exhibited a curvilinear pattern with a cut-off point of 2.31.A significant association was observed before the turning point,with an odds ratio(95% confidence interval)of 1.70(1.40,2.06),P<0.0001.However,the association between the TyG index and CPs was not significant after the cut-off point,with an odds ratio(95% confidence interval)of 0.57(0.27,1.23),P=0.1521.CONCLUSION Our study revealed a curvilinear association between the TyG index and CPs in Chinese individuals,suggesting its potential utility in developing colonoscopy screening strategies for preventing CRC.

关键词： Triglyceride-glucose index colorectal polyps colorectal cancer Insulin resistance Cross-sectional study

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Endoscopic management of colorectal polyps

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Gastroenterology Report 2023年第1期11卷 114-122页

作者： Pingting Gao Kaiqian Zhou Wei Su Jia Yu Pinghong Zhou Endoscopy Center and Endoscopy Research Institute Zhongshan HospitalFudan UniversityShanghaiP.R.China Surgery Department Zhongshan HospitalFudan UniversityShanghaiP.R.China Shanghai Medical College Fudan UniversityShanghaiP.R.China

colorectal polyps are premalignant lesions in the lower gastrointestinal tract.Endoscopic polypectomy is an effective strategy to prevent colorectal cancer morbidity and more invasive procedures.Techniques for the endoscopic resection of polyps keep evolving,and endoscopists are required to perform the most appropriate technique for each polyp.In this review,we outline the evaluation and classification of polyps,update the recommendations for optimal treatment,describe the polypectomy procedures and their strengths/weaknesses,and discuss the promising innovative methods or concepts.

关键词： therapeutic endoscopy polypectomy colorectal polyps colonic lesion

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Effect of cold snare polypectomy for small colorectal polyps

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World Journal of Clinical Cases 2022年第19期10卷 6446-6455页

作者： Qing-Qing Meng Min Rao Pu-Jun Gao Department of Hepatology and Gastroenterology The Second Part of First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina Department of Hepatology The First Hospital of Jilin UniversityChangchun 130021Jilin ProvinceChina

BACKGROUND colorectal cancer remains a considerable challenge in healthcare nowadays.Approximately 60%-80%of colorectal cancer is caused by intestinal polyps,and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer.The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically.Therefore,more attention has been paid to the development of endoscopic resection of intestinal polyps.In this study,we compared the efficacy and safety of cold snare polypectomy(CSP)and hot snare polypectomy(HSP).AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.METHODS Between January and December 2020,301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital,and were divided into the CSP group(n=154)and HSP group(n=147).The operating time,incidence of bleeding and perforation,use of titanium clips,and complete resection rate were compared between the two groups.RESULTS We included 249 patients(301 polyps).No differences in gender,age,and polyp size,location,shape and type were observed between the CSP and HSP groups,and the resection rates in these two groups were 93.4%and 94.5%,respectively,with no significant difference.The use of titanium clips was 15.6%and 95.9%,the operating time was 3.2±0.5 min and 5.6±0.8 min,the delayed bleeding rate was 0%and 2.0%,and delayed perforation was 0%and 0.7%,in the CSP and HSP groups,respectively.CONCLUSIONFor sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrityas traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe andeffective method for polypectomy.

关键词： colorectal polyps Cold snare polypectomy Hot snare polypectomy Complete polypectomy rate Immediate bleeding Delayed bleeding

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Is endoscopic mucosal resection-precutting superior to conventional methods for removing sessile colorectal polyps?

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1838-1840页

作者： Qun-Ying Yang Qian Zhao Jian-Wen Hu Department of Gastroenterology Dongyang People's HospitalDongyang 322100Zhejiang ProvinceChina

We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection(EMR)precutting and conventional EMR for removing non-pedunculated,10-20 mm sized colorectal polyps.We identified some statistical deficiencies in this study.In addition,we believe that the differences between the treatments failed to achieve significance,and therefore,further analysis is required.

关键词： Comparative analysis Endoscopic mucosal resection precutting Endoscopic mucosal resection colorectal polyps

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Endoscopic treatment of scarred polyps with a non-thermal device(Endorotor):A review of the literature

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World Journal of Gastroenterology 2024年第12期30卷 1706-1713页

作者： Mariam Zaghloul Hameed Rehman Stefano Sansone Konstantinos Argyriou Adolfo Parra-Blanco Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversitKafr-Elshikh 33516Egypt Department of Gastroenterology Service Nottingham City Hospital CampusNottingham University Hospitals NHS TrustNottingham NG51PBUnited Kingdom Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of NottinghamNottingham NG72UHUnited Kingdom

Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic devices.ER procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness resection.Complete resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these goals.The EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such device.The EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA clearance.This review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.

关键词： EndoRotor Scarred polyps Recurrent polyps colorectal cancer colorectal polyps

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Endoscopic mucosal resection-precutting vs conventional endoscopic mucosal resection for sessile colorectal polyps sized 10-20 mm

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World Journal of Gastroenterology 2022年第45期28卷 6397-6409页

作者： Xue-Qun Zhang Jian-Zhong Sang Lei Xu Xin-Li Mao Bo Li Wan-Lin Zhu Xiao-Yun Yang Chao-Hui Yu Department of Gastroenterology The First Affiliated HospitalSchool of MedicineZhejiang UniversityHangzhou 310003Zhejiang ProvinceChina Department of Gastroenterology Renmin Hospital of Yuyao CityYuyao 315499Zhejiang ProvinceChina Department of Gastroenterology Ningbo First HospitalNingbo 315010Zhejiang ProvinceChina Department of Gastroenterology Taizhou HospitalTaizhou 317099Zhejiang ProvinceChina Department of Gastroenterology The Central Hospital of Lishui CityLishui 323020Zhejiang ProvinceChina Department of Gastroenterology Jinhua Municipal Central HospitalJinhua 321099Zhejiang ProvinceChina

BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain.Piecemeal and incomplete resection are major limitations in current practice,such as endoscopic mucosal resection(EMR)and cold or hot snare polypectomy.Recently,EMR with circumferential precutting(EMR-P)has emerged as an effective technique,but the quality of current evidence in comparative studies of conventional EMR(CEMR)and EMR-P is limited.AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps.METHODS This multicenter randomized controlled trial involved seven medical institutions in China.Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR.EMR-P was performed following submucosal injection,and a circumferential mucosa incision(precutting)was conducted using a snare tip.Primary outcomes included a comparison of the rates of en bloc and R0 resection,defined as one-piece resection and one-piece resection with histologically assessed clear margins,respectively.RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated.In the per-protocol analysis,the proportion of en bloc resections was 94.3%[95%confidence interval(CI):88.2%-97.4%]in the EMR-P group and 86%(95%CI:78.2%-91.3%)in the CEMR group(P=0.041),while subgroup analysis showed that for lesions>15 mm,EMR-P also resulted in a higher en bloc resection rate(92.0%vs 58.8%P=0.029).The proportion of R0 resections was 81.1%(95%CI:72.6%-87.4%)in the EMR-P group and 76.6%(95%CI:68.8%-84.4%)in the CEMR group(P=0.521).The EMR-P group showed a longer median procedure time(6.4 vs 3.0 min;Pcolorectal polyps sized 10-20 mm,particularly polyps>15 mm in diameter,with higher R0 and en bloc resection rates and without increasi

关键词： colorectal polyps Medium size Polypectomy Endoscopic mucosal resection with circumferential precutting Conventional endoscopic mucosal resection

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Optical diagnosis of colorectal polyps using convolutional neural networks

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World Journal of Gastroenterology 2021年第35期27卷 5908-5918页

作者： Rawen Kader Andreas V Hadjinicolaou Fanourios Georgiades Danail Stoyanov Laurence B Lovat Wellcome/EPSRC Centre for Interventional and Surgical Sciences University College LondonLondon W1W 7TYUnited Kingdom Division of Surgery and Interventional Sciences University College LondonLondon W1W 7TYUnited Kingdom MRC Cancer Unit Department of GastroenterologyUniversity of CambridgeCambridge CB20QQUnited Kingdom Department of Surgery University of CambridgeCambridge CB20QQUnited Kingdom Department of Computer Science University College LondonLondon W1W 7TYUnited Kingdom

Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced endoscopy are widely available,optical diagnosis has not been incorporated into routine clinical practice,mainly due to significant inter-operator variability.In recent years,there has been a growing number of studies demonstrating the potential of convolutional neural networks(CNN)to enhance optical diagnosis of polyps.Data suggest that the use of CNNs might mitigate the inter-operator variability amongst endoscopists,potentially enabling a“resect and discard”or“leave in”strategy to be adopted in real-time.This would have significant financial benefits for healthcare systems,avoid unnecessary polypectomies of non-neoplastic polyps and improve the efficiency of colonoscopy.Here,we review advances in CNN for the optical diagnosis of colorectal polyps,current limitations and future directions.

关键词： Artificial intelligence Deep learning Convolutional neural networks Computer aided diagnosis Optical diagnosis colorectal polyps

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Potential applications of artificial intelligence in colorectal polyps and cancer: Recent advances and prospects

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World Journal of Gastroenterology 2020年第34期26卷 5090-5100页

作者： Ke-Wei Wang Ming Dong Department of Gastrointestinal Surgery the First Affiliated Hospital of China Medical UniversityShenyang 110001Liaoning ProvinceChina

Since the advent of artificial intelligence(AI)technology,it has been constantly studied and has achieved rapid development.The AI assistant system is expected to improve the quality of automatic polyp detection and classification.It could also help prevent endoscopists from missing polyps and make an accurate optical diagnosis.These functions provided by AI could result in a higher adenoma detection rate and decrease the cost of polypectomy for hyperplastic polyps.In addition,AI has good performance in the staging,diagnosis,and segmentation of colorectal cancer.This article provides an overview of recent research focusing on the application of AI in colorectal polyps and cancer and highlights the advances achieved.

关键词： Artificial intelligence Deep learning Computer-assisted diagnosis colorectal polyps colorectal cancer

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