Colonoscopic Yield in Patients with Lower Gastrointestinal Bleeding – A Study of 309 Cases

Introduction: This retrospective study was done to see colonoscopic yields in patients presenting with lower gastrointestinal bleeding. Materials & Methods: Reports of patients undergoing colonoscopy due to bleeding per rectum were retrieved from endoscopy records. Patients’ particulars and colonoscopic findings were recorded in a data sheet. Analysis was done using SPSS 20 version. Results: A total of 309 patients (male 211 (68.3%) and female 98 (31.7) with mean age 40.3 years %)) were included in this study. According to colonoscopic yield, causes of LGIB were haemorrhoids 137 (44.33% ), rectal and colonic growth 58(18.77% ) rectal and colonic polyps 54 (17.47% ), anal fissure 38 (12.29% ), proctitis 18 (5.82%), colitis 18(5.82%), ileal ulcer and ileitis 34(11.0%). Colorectal growth was more common among patients age 26 to 60years. Among male rectal growth was slightly higher than female. Conclusion: Lower gastrointestinal bleeding is more common among males. Commonest cause of LGIB are internal haemorrhoids, rectal growth, rectal and colonic polyps and anal fissure. Colorectal neoplasm, proctitis, colitis and ileal inflammation and ulcers constitute small part. Medicine Today 2021 Vol.33(2): 120-122

Risk Factors Associated With Early-Onset Colorectal Neoplasm in Chinese Youth: A Prospective Population-Based Study

Evidence of the risk factors associated with early-onset colorectal neoplasm from prospective population-based studies is limited. We enrolled 17,293 participants younger than 50 years from the Shanghai colorectal cancer (CRC) screening program cohort. Face-to-face interviews were performed by trained primary care physicians using a standardized questionnaire to collect the information on potential risk factors at baseline entry. Furthermore, 124 cases of early-onset colorectal neoplasm, including six CRC cases and 118 colorectal adenoma (CRA) cases, were detected between 2012 and 2016. Multivariable logistic regression models and restricted cubic spline (RCS) were used to evaluate the risk factors associated with early-onset colorectal neoplasm. We found that sex, body mass index (BMI), and family history of CRC were associated with the early onset of colorectal neoplasm. The RCS model showed a positive dose–response and linear association between BMI and risk of early-onset colorectal neoplasm among young participants (p-overall = 0.19, p-nonlinear = 0.97). The findings indicated that it was beneficial for normal people younger than 50 years to start opportunistic CRC screening. As for those at high risk, increased surveillance is strongly recommended. Further close follow-up is required for research on the underlying causes of early-onset CRC.

Implications of Lifestyle Factors and Polygenic Risk Score for Absolute Risk Prediction of Colorectal Neoplasm and Risk-Adapted Screening

Background: Estimation of absolute risk of developing colorectal neoplasm is essential for personalized colorectal cancer (CRC) screening. We developed models to determine relative and absolute risks of colorectal neoplasm based on lifestyle and genetic variants and to validate their application in risk-adapted screening.Methods: We prospectively collected data from 203 advanced neoplasms, 464 non-advanced adenomas, and 1,213 healthy controls from a CRC screening trial in China in 2018–2019. The risk prediction model based on four lifestyle factors and a polygenic risk score (PRS) consisted of 19 CRC-associated single-nucleotide polymorphisms. We assessed the relative and 10-year absolute risks of developing colorectal neoplasm and the yield of a risk-adapted screening approach incorporating risk models, fecal immunochemical test, and colonoscopy.Results: Compared to the participants with favorable lifestyle and lower PRS, those with unfavorable lifestyle and higher PRS had 2.87- and 3.79-fold higher risk of colorectal neoplasm in males and females, respectively. For a 50-year-old man or a 50-year-old woman with the highest risk profile, the estimated 10-year absolute risk of developing colorectal neoplasm was 6.59% (95% CI: 6.53–6.65%) and 4.19% (95% CI: 4.11–4.28%), respectively, compared to 2.80% (95% CI: 2.78–2.81%) for men and 2.24% (95% CI: 2.21–2.27%) for women with the lowest risk profile. The positive predictive value for advanced neoplasm was 31.7%, and the number of colonoscopies needed to detect one advanced neoplasm was 3.2.Conclusion: The risk models, absolute risk estimates, and risk-adapted screening presented in our study would contribute to developing effective personalized CRC prevention and screening strategies.