Detection of Colon Polyps in India—A Large Retrospective Cohort Study (DoCPIr)

Objective Colorectal cancer (CRC) is an emerging public health problem in Asia and India. However, there is scarcity of data on CRC and adenoma. We aimed to study prevalence and characteristics of colonic polyps in a large retrospective cohort. Methods For this retrospective single center study, all patients with age > 18 years undergoing colonoscopy from January 2018 to December 2019 were included. Age, gender, and polyp characteristics were collected from endoscopy and histology database. Patients with incomplete histology reports and anal canal polyps were excluded. Based on histology, polyps were divided into adenocarcinoma, adenoma with advanced pathology (AAP; size > 10 mm, villous morphology or high-grade dysplasia), nonadvanced adenomas (nAAP), and nonadenomas. Results Overall colon polyp prevalence was 10.18% (3551/34893). The mean age (standard deviation [SD]) was 51.51 (14.84) with 75.4% males, of which 128 (3.6%) were adenocarcinoma. A total of 1514 (42.64%) were adenomas; 344 (9.7%) were AAP and 1170 (32.9%) were nAAP. The remaining 1909 (53.8%) were nonadenomas. Colonic adenoma prevalence after excluding adenocarcinoma was 4.35% (1514/34893). Adenocarcinoma (68.8% vs. 31.2%), AAP (70.6% vs. 29.4%), other adenomas (75.4% vs. 24.6%), and nonadenomas (76.7% vs. 23.3%) were significantly higher in male compared with female (p < 0.05). Adenomas and adenocarcinomas were more common in left colon and rectum than right colon (p < 0.05). The mean age (SD) were significantly lower in nonadenomas than adenocarcinomas, AAP, and other adenomas (p 0.0001; 49.25 [14.84] vs. 55.97 [12.47], 54.78 [16.40], 53.76 [13.71]). Conclusions The prevalence of colonic adenoma in India is 4.35%. Male gender and increased age were associated with increased risk of colonic adenoma and adenocarcinoma, which is more common in left colon and rectum. Prospective multicenter studies are required for evaluation of other risk factors of CRC and colonic adenomas.

Correlation Between Late-stage Schistosoma Infection and Colorectal Cancer: a Colorectal Cancer Screening Among Elderer in the Qingpu District of Shanghai

Cancer monitoring of Shanghai showed a rapid increase in the incidence of colorectal cancer. Colorectal cancer risk assessment allows for rapid screening of high-risk populations. The colorectal cancer screening of elderly residents is ongoing since 2013 in Shanghai. This initiative screened 85,525 people from 11 communities of the Qingpu District. Screening included a questionnaire-based risk assessment and two Fecal Occult Blood Tests (FOBTs). We conducted a retrospective case study of patients with positive screening results that underwent fibro-colonoscopy examinations to investigate their histories of schistosoma infection, smoking, alcohol consumption, and dietary habits. A total of 85,525 people were screened in this study. Colorectal cancer was resulted in a prevalence of 59.84/100,000. And the prevalence of schistosoma infection was 400/100,000. Among patients with schistosoma infection, the positive rate of FOBT was 67.01%, in contrast to an overall positive rate of FOBT among all subjects of 17.00% [(Pearson ⎥2=672.42, P < 0.0001, OR = 3.94 (3.67,4.23)]. The prevalence of colorectal cancer among patients with schistosoma japonicum infections was 4,155.84/100,000, while the prevalence of colorectal cancer among all subjects was 44.15/100,000 [Pearson2 = 980.62, P < 0.001, OR = 94.12 (53.05, 166.97)]. Our study found a high degree of correlation between late stage schistosoma infection of the intestinal tract and the occurrence of colorectal cancer and colonic adenoma. For patients with lesions caused by schistosoma infections of intestinal tract, the risk of colorectal cancer was higher than that of patients without intestinal schistosoma infections. Early screening and risk assessment can facilitate early diagnosis and treatment of colorectal cancer and colonic adenoma.

let-7e downregulation characterizes early phase colonic adenoma in APCMin/+ mice and human FAP subjects

The crypt-villus axis represents the essential unit of the small intestine, which integrity and functions are fundamental to assure tissue and whole-body homeostasis. Disruption of pathways regulating the fine balance between proliferation and differentiation results in diseases development. Nowadays, it is well established that microRNAs (miRNAs) play a crucial role in the homeostasis maintenance and perturbation of their levels may promote tumor development. Here, by using microarray technology, we analysed the miRNAs differentially expressed between the crypt and the villus in mice ileum. The emerged miRNAs were further validated by Real Time qPCR in mouse model (ApcMin/+), human cell lines and human tissue samples (FAP) of colorectal cancer (CRC). Our results indicated that miRNAs more expressed in the villi compartment are negatively regulated in tumor specimens, thus suggesting a close association between these microRNAs and the differentiation process. Particularly, from our analysis let-7e appeared to be a promising target for possible future therapies and a valuable marker for tumor staging, being upregulated in differentiated cells and downregulated in early-stage colonic adenoma samples.

Long term outcomes of colon polyps with high grade dysplasia following endoscopic resection

Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3–12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06–9.04 95% CI), 3.47 (1.67–7.22 95% CI), 2.55 (1.11–5.89 95% CI), 2.46 (1.16–5.22 95% CI), 2.89 (1.44–5.78 95% CI), respectively. Multivariate analysis revealed gender (male) [P = 0.010; OR 3.09(1.32–7.25 95% CI)] and adenoma count ≥ 3 [P = 0.002; OR 3.08(1.52–6.24 95% CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.

Long Term Outcomes of Colon Polyps with High Grade Dysplasia Following Endoscopic Resection

Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3-12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06-9.04 95%CI), 3.47 (1.67-7.22 95%CI), 2.55 (1.11-5.89 95%CI), 2.46 (1.16-5.22 95%CI), 2.89 (1.44-5.78 95%CI), respectively. Multivariate analysis revealed gender (male) [P=0.010; OR 3.09(1.32-7.25 95% CI)] and adenoma count ≥ 3 [P=0.002; OR 3.08(1.52-6.24 95%CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.