Types, differences and prognosis of colonic polyps

Colon polyps might originate from the submucosa including lymphoid aggregates, carcinoids and lipomas. On the other hand, most polyps usually arise from the mucosa and include various types, whether neoplastic or not. The prognosis and treatment of these lesions depend on establishing an adequate diagnosis to rule out the presence of malignancy. Therefore, clinicians should be aware of each subclassification's different types and presentations to achieve the best outcomes. When conducting colonoscopy screening for colorectal cancer, colorectal polyps are commonly discovered. The prevalence of these lesions is high. However, most of them do not have any clinical significance. On the other hand, evidence shows that some polyps might have premalignant characteristics, which are usually challenging to manage in clinical practice. Therefore, evidence shows that the most appropriate approach to managing these lesions and achieving the best prognosis would be identifying and treating them as early as possible before complications appear to intervene against potential morbidities and mortality. Clinicians should consider the wide variations of colorectal cancer to establish the most appropriate diagnosis. A histological diagnosis is essential in these events to exclude malignancy and decide the most appropriate treatment plan.

Comparison of the Human Gut Microbiota between Normal Control Subjects and Patients with Colonic Polyps and Colorectal Cancer

Background: The human gut microbiota has been related to numerous colonic diseases. To identify colorectal cancer (CRC)-associated microbiota, the gut microbiomes of patients with colonic polyps and CRC compared to normal controls were analyzed.Methods: Between July and December 2020, forty-four stool samples were obtained from participants older than 50 years who were scheduled for elective colonoscopies at the Surgery Clinic, Songklanagarind Hospital. The samples were divided into 3 groups (17 normal control, 17 colonic polyps, and 10 CRC) and were collected for analysis with a 16s metagenomic sequencing library preparation with MiSeq Reporter software (MSR) following the protocol of the 16s metagenomics workflow. The microbiome data were analyzed with Kruskal–Wallis test with the Dunn-Bonferroni post hoc method.Results: The relative proportions of beneficial butyrate-producers Kineothrix alysoides, Eubacterium rectale, and Roseburia inulinsivorans were significantly higher in healthy control and colonic polyp groups compared with the CRC group at the top three lowest p-values. The recommended CRC biomarker Clostridium symbiosum was shown in a significantly higher proportion in the CRC group than in the normal control group. The prevalences and relative proportion of the novel CRC-associated species Acutalibacter muris and the familiar CRC-associated species Christensenella massiliensis and lntestinimonas butyriciproducens were significantly higher in the CRC group than in the normal control and colonic polyp groups at the top three lowest p-values.Conclusions: A correlation between specific bacteria and clinical outcomes was found in this pilot study. The microbiome data revealed possible microbial biomarkers associated with CRC. Studies with larger numbers of stool samples are required to substantiate our findings.

Alterations in Co-abundant Bacteriome in Colorectal Cancer and Persistent Microbial Dysbiosis After Surgery

ObjectiveThere is growing interest in the role of gut microbiome in colorectal cancer (CRC), ranging from screening to disease recurrence. Our study aims to identify microbial markers characteristic of CRC and to examine if changes in bacteriome persist after surgery. Design49 fecal samples from non-cancer (NC) individuals and CRC patients, before and after surgery, were collected for analysis by bacterial 16S rRNA gene sequencing. ResultsBacterial richness and diversity were reduced in the CRC patients compared to NC individuals. Pro-carcinogenic bacteria such as Bacteroides fragilis and Odoribacter splanchnicus were increased in pre-op CRC compared to NC group. These differences were no longer observed after surgery. Comparison between post- and pre-op CRC showed increased abundance of probiotic bacteria after surgery. Concomitantly, bacteria associated with CRC progression were observed to have increased after surgery, implying persistent dysbiosis. ConclusionMicrobiome signatures characteristic of CRC likely comprise a set of significant alteration in specific bacterial strains. Elements of these dysbiotic signatures persists even after surgery, suggesting possible field-change in remnant non-diseased colon. Future studies should seek to examine if these signatures are also associated with pre-malignant colonic polyps and, explore if these profiles can be used to guide CRC screening and surveillance.

Medical Image Classification Based on Information Interaction Perception Mechanism

Colorectal cancer originates from adenomatous polyps. Adenomatous polyps start out as benign, but over time they can become malignant and even lead to complications and death which will spread to adherent and surrounding organs over time, such as lymph nodes, liver, or lungs, eventually leading to complications and death. Factors such as operator’s experience shortage and visual fatigue will directly affect the diagnostic accuracy of colonoscopy. To relieve the pressure on medical imaging personnel, this paper proposed a network model for colonic polyp detection using colonoscopy images. Considering the unnoticeable surface texture of colonic polyps, this paper designed a channel information interaction perception (CIIP) module. Based on this module, an information interaction perception network (IIP-Net) is proposed. In order to improve the accuracy of classification and reduce the cost of calculation, the network used three classifiers for classification: fully connected (FC) structure, global average pooling fully connected (GAP-FC) structure, and convolution global average pooling (C-GAP) structure. We evaluated the performance of IIP-Net by randomly selecting colonoscopy images from a gastroscopy database. The experimental results showed that the overall accuracy of IIP-NET54-GAP-FC module is 99.59%, and the accuracy of colonic polyp is 99.40%. By contrast, our IIP-NET54-GAP-FC performed extremely well.

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

Hybrid endoscopic mucosal resection and full-thickness resection for large colonic polyps harboring a small focus of invasive cancer: a case series

Endoscopic treatment of large laterally spreading tumors (LSTs) with a focus of submucosally invasive colorectal cancer (T1 CRC) can be challenging. We evaluated outcomes of a hybrid resection technique using piecemeal endoscopic mucosal resection (pEMR) and endoscopic full-thickness resection (eFTR) in patients with large colonic LSTs containing suspected T1 CRC. Six hybrid pEMR-eFTR procedures for T1 CRCs were registered in a nationwide eFTR registry between July 2015 and December 2019. In all cases, the invasive part of the lesion was successfully isolated with eFTR; with eFTR, histologically complete resection of the invasive part was achieved in 5 /6 patients (83.3 %). No adverse events occurred during or after the procedure. The median follow-up time was 10 months (range 6–27), with all patients having undergone ≥ 1 surveillance colonoscopy. One patient had a small adenomatous recurrence, which was removed endoscopically. In conclusion, hybrid pEMR-eFTR is a promising noninvasive treatment modality that seems feasible for a selected group of patients with large LSTs containing a small focus of T1 CRC.

Classification of the canonical splice alteration MUTYH c.934-2A>G is likely benign based on RNA and clinical data

MUTYH-associated polyposis (MAP) is an autosomal recessive disorder characterized by the development of multiple adenomatous colonic polyps and an increased lifetime risk of colorectal cancer. Germline biallelic pathogenic variants in MUTYH are responsible for MAP. The MUTYH c.934-2A>G (NM_001128425.1) variant, which is also known as c.850-2A>G for NM_001048174.2, has been identified in our laboratory in more than 800 patients, including homozygous and compound heterozygote carriers. The variant was initially classified as a variant of uncertain significance (VUS) due to lack of a MAP phenotype in biallelic carriers. In two unrelated female patients who were heterozygous carriers of this variant, further testing by RNA sequencing identified an aberrant transcript with a deletion of 9 nucleotides at the start of exon 11 (MUTYH r.934_942del9). This event is predicted to lead to an in-frame loss of 3 amino acids in a non-critical domain of the protein. This was the only splice defect identified in these patients which was not present in the controls and the aberrant transcript is derived exclusively from the variant allele, strongly supporting the cause of this splice defect as being the intronic variant, MUTYH c.934-2A>G. The splicing analysis demonstrating a small in-frame skipping of 3 amino acids in a non-critical domain along with the absence of a MAP phenotype in our internal cohort of biallelic carriers provides evidence that the variant is likely benign and not of clinical significance.

Gardner-associated fibroma presenting as an unusual floor of mouth mass in a child

Floor of mouth lesions in the paediatric population are uncommon. The spectrum of pathology that afflicts the floor of mouth spans inflammatory conditions, developmental anomalies, vascular malformations and benign tumours or malignancies. We report a rare case of Gardner-associated fibroma (GAF) presenting as a slow-growing floor of mouth mass in a 10-year-old boy. GAF is associated with Gardner’s syndrome (GS) and familial adenomatous polyposis (FAP), both of which are associated with multiple colonic polyps and increased risk of colorectal malignancy. To our knowledge, this case report represents the first case in the literature of a GAF presenting in the floor of mouth of a paediatric patient, and discusses the clinical implications of this rare diagnosis.

Inflammatory myoglandular colonic polyp with adenomatous changes mimicking malignant tumor

Inflammatory Myoglandular polyps (IMGPs) are rare intestinal polyps that occur frequently in the left colon and may present with hematochezia. Only a small number of cases have been reported in the right colon (2%). We present a case of IMGP in the proximal ascending colon. A 46-year-old woman of mixed ethnicity presented with a history of abdomino-pelvic pain and constipation. CT scan suggested possibility of malignancy. On colonoscopy, a non- obstructive polyp in proximal ascending colon was biopsied followed by right hemicolectomy. Patient also underwent total abdominal hysterectomy at the same time for fibroids. The colonic polyp revealed features of IMGP with focal adenomatous changes. The polyp was characterized by epithelial erosion, inflamed granulation tissue, hyperplastic and dilated glands, and proliferating smooth muscle. IMGP needs to be distinguished from other non-neoplastic colonic polyps, which includes Peutz-Jeghers polyps, inflammatory pseudopolyps, juvenile polyps, and inflammatory fibroid polyps. We report a large sized inflammatory myoglandular polyp with suspicious imaging findings and presence of adenomatous changes that mimicked malignancy that requires comprehensive evaluation and follow up.