ENDOSCOPIC ASSESSMENT OF ADVANCED SERRATED LESIONS OF THE COLORECTUM

Background and Aims: The importance of sessile serrated lesions (SSLs) in the pathogenesis of colorectal carcinoma has been recently established. These are supposed to cause the so-called “interval cancer”, having a rapidly progressive growth and being difficult to detect and to obtain an endoscopic complete resection. We aimed to establish the most important metabolic risk factors for sessile serrated lesions. Methods: We performed a retrospective case-control study, on a series of 2918 consecutive patients who underwent colonoscopy in Gastroenterology and Endoscopy Unit, County Clinical Emergency Hospital, Târgu-Mureș, Romania between 1 st of January 2015-31 th of December 2017. In order to evaluate the metabolic risk factors for polyps’ development, enrolled participants were stratified in two groups, a study group, 33 patients with SSLs lesions, and a control group, 138 patients with adenomatous polyps, selected by systematic sampling for age and anatomical site. Independent variables investigated were: gender, smoking, alcohol consumption, obesity, arterial hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, nonalcoholic liver disease. Results: For SSLs the most common encountered localization was the right colon in 30.55% of cases. By comparative bivariate analysis between SSLs group and control group, it was observed that hypertension (p=0.03, OR 2.33, 95 %CI 1.03-5.24), obesity (p=0.03, OR 2.61, 95 %CI 1.08-6.30), hyperuricemia (p=0.04, OR 2.72, 95 %CI 1.28-7.55), high cholesterol (p=0.002, OR 3.42; 95 %CI 1.48-7.87), and high triglycerides level (p=0.0006, OR 5.75; 95 %CI 1.92-17.2) were statistically associated with SSLs development. By multivariate analysis hypertension and hypertriglyceridemia retained statistical significance. Conclusions: Our study showed that the highest prevalence of SSLs was in the right colon and hypertension and increased triglycerides levels were associated with the risk of SSLs development. These risk factors are easy to detect in clinical practice and may help identifying groups with high risk for colorectal cancer, where screening is recommended.

Download Full-text

Clinical usefulness of endoscopic assessment in ulcerative colitis using linked color imaging: a preliminary pilot study with 10 patients

10.26226/morressier.59a6b348d462b80290b54e65 ◽

2017 ◽

Author(s):

Kohei Yamanouchi

Keyword(s):

Ulcerative Colitis ◽

Pilot Study ◽

Clinical Usefulness ◽

Color Imaging ◽

Linked Color Imaging ◽

Endoscopic Assessment

Download Full-text

Faculty Opinions recommendation of Agrin in the Muscularis Mucosa Serves as a Biomarker Distinguishing Hyperplastic Polyps from Sessile Serrated Lesions.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.737113093.793570364 ◽

2020 ◽

Author(s):

Noam Harpaz ◽

Alexandros Polydorides

Keyword(s):

Muscularis Mucosa ◽

Hyperplastic Polyps ◽

Serrated Lesions

Download Full-text

Serrated lesions of the colon and rectum: Emergent epidemiological data and molecular pathways

Open Medicine ◽

10.1515/med-2020-0226 ◽

2020 ◽

Vol 15 (1) ◽

pp. 1087-1095

Author(s):

Michele Sacco ◽

Fatima Domenica Elisa De Palma ◽

Elia Guadagno ◽

Mariano Cesare Giglio ◽

Roberto Peltrini ◽

...

Keyword(s):

Malignant Transformation ◽

Detection Rate ◽

Epidemiological Data ◽

Screening Colonoscopy ◽

Current Evidence ◽

Surveillance Program ◽

Cancer Risk Factors ◽

Serrated Polyps ◽

Serrated Lesions ◽

Molecular Aspects

AbstractIn 2010, serrated polyps (SP) of the colon have been included in the WHO classification of digestive tumors. Since then a large corpus of evidence focusing on these lesions are available in the literature. This review aims to analyze the present data on the epidemiological and molecular aspects of SP. Hyperplastic polyps (HPs) are the most common subtype of SP (70–90%), with a minimal or null risk of malignant transformation, contrarily to sessile serrated lesions (SSLs) and traditional serrated adenomas (TSAs), which represent 10–20% and 1% of adenomas, respectively. The malignant transformation, when occurs, is supported by a specific genetic pathway, known as the serrated-neoplasia pathway. The time needed for malignant transformation is not known, but it may occur rapidly in some lesions. Current evidence suggests that a detection rate of SP ≥15% should be expected in a population undergoing screening colonoscopy. There are no differences between primary colonoscopies and those carried out after positive occult fecal blood tests, as this screening test fails to identify SP, which rarely bleed. Genetic similarities between SP and interval cancers suggest that these cancers could arise from missed SP. Hence, the detection rate of serrated-lesions should be evaluated as a quality indicator of colonoscopy. There is a lack of high-quality longitudinal studies analyzing the long-term risk of developing colorectal cancer (CRC), as well as the cancer risk factors and molecular tissue biomarkers. Further studies are needed to define an evidence-based surveillance program after the removal of SP, which is currently suggested based on experts’ opinions.

Download Full-text

Is jumbo biopsy forceps comparable to cold snare for diminutive colorectal polyps? – a meta-analysis

Endoscopy International Open ◽

10.1055/a-1293-6965 ◽

2021 ◽

Vol 09 (01) ◽

pp. E9-E13

Author(s):

Sachin Srinivasan ◽

Peter D. Siersema ◽

Madhav Desai

Keyword(s):

Meta Analysis ◽

Complete Removal ◽

Colorectal Polyps ◽

Comparable Efficacy ◽

Incomplete Resection ◽

Complication Rates ◽

Biopsy Forceps ◽

Significant Difference ◽

Leave One Out ◽

Endoscopic Assessment

Abstract Background and study aims Diminutive colorectal polyps are increasingly being detected and it is not clear whether jumbo biopsy forceps (JBF) has comparable efficacy to that of cold snare polypectomy (CSP) for management of these lesions. Methods An electronic literature search was performed for studies comparing resection rates of JBF and CSP for diminutive polyps (≤ 5 mm). The primary outcome was incomplete resection rate (IRR). Secondary outcomes included failure of tissue retrieval and complication rates (post-polypectomy bleeding, perforation etc.). Leave-one-out analysis was performed to examine the disproportionate role of any of the studies. Meta-analysis outcomes and heterogeneity (I2) were computed using Comprehensive meta-analysis software. Results A total of 4 studies (3 randomized controlled trials and 1 retrospective study) with 407 patients and 569 total polyps (mean size of 3.62 mm) was included for analysis. IRR of JBF was slightly higher than that of CSP (10.2 % vs 7.2 %) but this was not statistically significantly different (Pooled OR 1.76; 95 % CI 0.94–3.28; I2 = 0). Leave-one-out analysis showed no significant difference in the pooled OR comparison either. Two of the 4 studies reported 0 % failure of tissue retrieval for JBF and 1 % and 4.3 % for CSP. There were no complications for either group from the 2 studies that reported this outcome. The quality of the included studies was moderate to high. Conclusions This systematic review with only limited data shows that JBF and CSP are not statistically different in completely removing diminutive polyps, although careful endoscopic assessment is needed to ensure complete removal of all polyp tissue.

Download Full-text

Effects of Somatic Methylation in Colonic Polyps on Risk of Developing Metachronous Advanced Colorectal Lesions

Cancers ◽

10.3390/cancers13020246 ◽

2021 ◽

Vol 13 (2) ◽

pp. 246

Author(s):

Oscar Murcia ◽

Alejandro Martínez-Roca ◽

Miriam Juárez ◽

Mar Giner-Calabuig ◽

Miren Alustiza ◽

...

Keyword(s):

Cpg Island ◽

Risk Estimation ◽

Colonic Polyps ◽

Cpg Island Methylator Phenotype ◽

Polyp Size ◽

Serrated Lesions ◽

Amplification Technique ◽

Methylator Phenotype ◽

The Relationship ◽

Dependent Probe

The utility of molecular markers for predicting the risk of metachronous advanced colorectal lesions (MACLs) remains poorly investigated. We examined the relationship between somatic hypermethylation in polyps at baseline and the risk of developing MACL. This retrospective cohort study included 281 consecutive patients with colonic polyps who were enrolled between 2007 and 2009 and followed-up until 2014. MACLs were defined as adenomas of >10 mm, high-grade dysplasia, or with a villous component; and serrated lesions of >10 mm or with dysplasia. In total, 595 polyps were removed at baseline colonoscopy and analyzed for pathological characteristics and CpG island methylator phenotype (CIMP) using the MS-MLPA (Methylation-Specific -- Multiplex Ligation-dependent Probe Amplification) technique. Forty-five patients (16.0%) showed at least one CIMP+ polyp. MACL risk was higher in patients with CIMP+ polyps (odds ratio (OR), 4.50; 95% CI, 1.78–11.4; p = 0.002). Patients with CIMP+ polyps also exhibited shorter time to MACL development (33.8 months vs. 50.1 months; p < 0.001), even with adjustment for polyp size and number (OR, 2.40; 95% CI, 1.33–4.34). Adding CIMP analysis improved the sensitivity (57.0% to 70.9%), negative predictive value (71.1% to 77.3%), and overall accuracy (49.8% to 52.0%) for MACL risk estimation. These results highlight that CIMP may be a useful marker for endoscopic surveillance.

Download Full-text

Towards personalised management for non-variceal upper gastrointestinal bleeding

Gut ◽

10.1136/gutjnl-2020-323846 ◽

2021 ◽

pp. gutjnl-2020-323846

Author(s):

Joseph J Y Sung ◽

Loren Laine ◽

Ernst J Kuipers ◽

Alan N Barkun

Keyword(s):

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Point Of Care ◽

Management Strategies ◽

Patient Characteristics ◽

Professional Societies ◽

Assessment And Treatment ◽

Three Stages ◽

Endoscopic Assessment ◽

Upper Gastrointestinal

Guidelines from national and international professional societies on upper gastrointestinal bleeding highlight the important clinical issues but do not always identify specific management strategies pertaining to individual patients. Optimal treatment should consider the personal needs of an individual patient and the pertinent resources and experience available at the point of care. This article integrates international guidelines and consensus into three stages of management: pre-endoscopic assessment and treatment, endoscopic evaluation and haemostasis and postendoscopic management. We emphasise the need for personalised management strategies based on patient characteristics, nature of bleeding lesions and the clinical setting including available resources.

Download Full-text