Predictive factors of spontaneously regressed uterine endometrial polyps during the waiting period before hysteroscopic polypectomy

Background The presence of uterine endometrial polyps is associated with not only abnormal uterine bleeding but also infertility, so the use of hysteroscopic polypectomy has been increasing. This operation is considered to increase cost-effectiveness when performed prior to infertility treatments. However, there are typical problems to consider, including the possibility of spontaneous regression of the polyp and the duration of complete endometrial wound healing after surgery. Meaningless interventions must be avoided, when possible. Therefore, data acquisition and analysis of various findings obtained from surgery have become important for improving treatment procedures and patient selection. To estimate the spontaneous regression rates and contributions of multiple factors to uterine endometrial polyps during the waiting period (approximately 2–3 months) before hysteroscopic polypectomy, we performed a multivariate analysis of data from the records in our hospital. Methods The medical records of 450 cases from September 2014 to April 2021 in our hospital were retrospectively reviewed under the approval of our Institutional Review Board. We included all cases of hysteroscopic polypectomy with postoperative pathological diagnosis. We defined cases as having a “spontaneously regressed polyp” when the target polyp was not detected by postoperative pathological examination. We extracted data on the following ten factors: “Advanced age” (≥ 42 years), “Small polyp” (< 10 mm), “High body mass index” (≥ 25 kg/m2), “Nulliparity,” “Single polyp,” “Infertility,” “Hypermenorrhea,” “Abnormal bleeding,” “No symptom,” and “Hormonal drug use.” We also classified cases into five groups according to the size of the polyp (≤ 4.9 mm, 5.0–9.9 mm, 10.0–14.9 mm, 15.0–19.9 mm, and ≥ 20.0 mm) and determined the frequency of spontaneously regressed polyp in each group. Results After exclusion of cases with insufficient data or other diseases, such as submucosal leiomyoma, 424 cases were analyzed. Among them, 28 spontaneously regressed polyps were identified, and the highest frequency of spontaneously regressed polyp was detected among the cases with polyps measuring 5.0–9.9 mm (16.4%). On multivariate analysis of the ten factors, “Small polyp” and “Hormonal drug use” were found to significantly impact the frequency of spontaneously regressed polyp. Conclusions On the basis of the factors identified in this analysis, the indications for observation or medical therapy adapted to small polyps might be expanded.

Combining Serum DNA Methylation Biomarkers and Protein Tumor Markers Improved Clinical Sensitivity for Early Detection of Colorectal Cancer

Background. Colorectal cancer (CRC) is one of the leading causes of cancer deaths worldwide and in China. Early CRC screening is the best approach to reduce its incidence and mortality rates. The ColoDefense test, a multiplex qPCR assay simultaneously detecting both methylated SEPT9 and SDC2 genes, has demonstrated improved clinical performance on either methylation biomarker alone for CRC screening with both blood and stool samples. Method. Leftover blood chemistry test samples from 125 CRC, 35 advanced adenoma, and 35 small polyp patients and 92 healthy control subjects were examined by the ColoDefense test. Among these samples, the levels of three circulating tumor markers, CEA, AFP, and CA19-9, were also measured for 106 CRC, 28 advanced adenoma, and 20 small polyp patients and all control subjects. Results. Due to the smaller volume and extended storage in nonfrozen state, the ColoDefense test with these samples exhibited reduced performance for all stages of CRC and advanced adenomas. The performance of CEA, AFP, and CA19-9 and their various combinations was also evaluated for CRC screening to identify the tumor marker combinations with the best performance. When combined with the ColoDefense test, the identified combinations did improve the clinical performance. Conclusion. These results suggested a rational path towards developing a CRC screening method that takes advantage of leftover blood chemistry test samples. The successful development of such a method will undoubtedly help promote early CRC screening by increasing its accessibility for the general public.

Colon Squamous Cell Carcinoma Hidden Under a Small Polyp: a Case Report

we report a case of colon squamous cell carcinoma incidentally diagnosed based on endoscopic polypectomy. Primary squamous cell carcinomas of the colon and rectum are extremely rare. This is not only a rare case, from this case we need to rethink how to choose the most appropriate polypectomy method.

EFFICACY OF COLD POLYPECTOMY TECHNIQUES FOR SMALL POLYP (< 1CM) IN THE COLORECTUM

Background/Aim: Colonoscopic polypectomy is a very important intervention for the prevention of colorectal cancer progression. Whereas various techniques are used for the removal of polyps, hot polypectomy with electrocautery is still a standard technique. However, this technique has been associated with an increased risk of electrocautery-related complications, including bleeding or perforation. To reduce these complications, recent studies have found a polypectomy technique without electrocautery, so-called cold polypectomy. This new technique shows more efficacious in diminutive/small polyps. This study aims to evaluate the complete retrieval rate and the complications of cold polypectomy technique. Patients/Methods: Prospectively study, 103 diminutive/small (< 1cm) polyps (53 patients) were removed by cold polypectomy technique from 11/2016 to 11/2017. Results: the complete retrieval rate was 97.1%. The immediate bleeding rate was 1.9%. No delayed bleeding and perforation occurred in any 103 polyps. Conclusion: Cold polypectomy is a safe and effective technique for diminutive/small polyps. Key words: cold polypectomy, hot polypectomy, colonoscopy, small polyp, diminutive polyp