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Colorectal polyps, precursors to colorectal cancer (CRC), require precise identification for appropriate diagnosis and therapy. This study aims to investigate the differences in hematological and inflammatory markers, specifically the CALLY index, HALP score, and immuno-inflammatory indexes, between neoplastic and nonneoplastic polyps. A retrospective cross-sectional study was conducted on 758 patients aged 61.0 ± 11.8 who underwent polypectomy between June 2021 and May 2024. Patients with colorectal adenocarcinoma (n = 22) were excluded. The polyps were classified into neoplastic and nonneoplastic categories based on histopathological evaluation. The study compared the CALLY index, HALP score, and various inflammatory indexes between neoplastic and nonneoplastic polyps. Out of 758 polyps analyzed, 514 were neoplastic, and 244 were nonneoplastic. Neoplastic polyps exhibited significantly lower CALLY and HALP scores (p < 0.05) and higher immuno-inflammatory indexes (p < 0.05) compared to nonneoplastic polyps. Dysplasia status, polyp diameter, and sigmoid colon localization were significant factors in determining neoplastic growth potential. No significant differences were observed in polyp localization in the proximal and distal colon segments or in solitary versus multiple polyps. The CALLY and HALP scores and immuno-inflammatory indexes can serve as valuable markers for distinguishing neoplastic from nonneoplastic polyps. These indexes reflect underlying inflammatory and immune responses, highlighting their potential utility in the early detection and risk stratification of colorectal polyps. Integrating these markers into clinical practice may enhance diagnostic accuracy and improve patient management, leading to timely interventions and better outcomes for individuals at risk of CRC. [ABSTRACT FROM AUTHOR]

Background: Polyps are the predominant precursors of colorectal cancer. In the past three decades, the incidence and mortality rates of colorectal cancer have been increasing in adults younger than 50 years. Aims: The aim of this clinical audit was to evaluate the prevalence, characteristics and clinical associations of polyps in adults aged 18–49 years presenting to an established private gastroenterology clinic in the Toowoomba Darling Downs region. Methods: The audit included data from 353 patient records held by the Toowoomba Gastroenterology Clinic. Data extracted from patient medical records through the Medical Director program software contained structured endoscopy/colonoscopy and histology reports of excised lesions of patients presenting to the clinic. The extract involved identifying all patients aged 18–49 years in the database from January 2019 to March 2022. Patients were screened based on audit inclusion and exclusion criteria. Patients were risk stratified for recommended surveillance intervals as per Australian Clinical Guidelines. Results: Of the sample population, 33.4% were identified with polyps and 22.4% were identified with neoplastic polyps (NPs). A total of 6.7% of 18‐ to 29‐year‐old patients were identified with intermediate risk for colorectal cancer (CRC) screening, and 19.8% and 19.3% of 30‐ to 39‐year‐old and 40‐ to 49‐year‐old patients identified with intermediate or high risk for CRC screening respectively. Increased age, greater size of polyps and surveillance of previous polyps were associated with increased NP prevalence. Conclusions: Data from this audit supported the temporal trend of increasing prevalence of polyps in adults younger than 50 years. Patient cohorts aged 30–39 and 40–49 years may benefit from earlier first colonoscopies. Findings could be the impetus for future research in young adults presenting for colonoscopy. [ABSTRACT FROM AUTHOR]

Evidence on serum biomarkers as a non-invasive tool to detect colorectal adenoma (CRA) in the general population is quite promising. However, the sensitivity and specificity of these serum biomarkers in detecting disease are still questionable. This study aimed to systematically review the evidence on the diagnostic performance of serum biomarkers associated with CRA. Database searches on PubMed, Scopus, and WoS from January 2014 to December 2023 using PRISMA guidelines resulted in 4,380 citations, nine of which met inclusion criteria. The quality of these studies was assessed using the QUADOMICS tool. These studies reported on 77 individual/panel biomarkers which were further analysed to find associated altered pathways using MetaboAnlyst 5.0. Diagnostic accuracy analysis of these biomarkers was conducted by constructing a receiver operating characteristic (ROC) curve using their reported sensitivity and specificity. This review identified six potential serum metabolite biomarkers with 0.7

Background: Colorectal Polyps are the main source of precancerous lesions in colorectal cancer. To increase the early diagnosis of tumors and improve their screening, we aimed to develop a simple and non-invasive diagnostic prediction model for colorectal polyps based on machine learning (ML) and using accessible health examination records. Methods: We conducted a single-center observational retrospective study in China. The derivation cohort, consisting of 5426 individuals who underwent colonoscopy screening from January 2021 to January 2024, was separated for training (cohort 1) and validation (cohort 2). The variables considered in this study included demographic data, vital signs, and laboratory results recorded by health examination records. With features selected by univariate analysis and Lasso regression analysis, nine machine learning methods were utilized to develop a colorectal polyp diagnostic model. Several evaluation indexes, including the area under the receiver-operating-characteristic curve (AUC), were used to compare the predictive performance. The SHapley additive explanation method (SHAP) was used to rank the feature importance and explain the final model. Results: 14 independent predictors were identified as the most valuable features to establish the models. The adaptive boosting machine (AdaBoost) model exhibited the best performance among the 9 ML models in cohort 1, with accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F1 score, and AUC (95% CI) of 0.632 (0.618–0.646), 0.635 (0.550–0.721), 0.674 (0.591–0.758), 0.593 (0.576–0.611), 0.673 (0.654–0.691), 0.608 (0.560–0.655) and 0.687 (0.626–0.749), respectively. The final model gave an AUC of 0.675 in cohort 2. Additionally, the precision recall (PR) curve for the AdaBoost model reached the highest AUPR of 0.648, positioning it nearest to the upper right corner. SHAP analysis provided visualized explanations, reaffirming the critical factors associated with the risk of colorectal polyps in the asymptomatic population. Conclusions: This study integrated the clinical and laboratory indicators with machine learning techniques to establish the predictive model for colorectal polyps, providing non-invasive, cost-effective screening strategies for asymptomatic individuals and guiding decisions for further examination and treatment. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Positron emission tomography/computed tomography (PET/CT) with 2-[18F]FDG (FDG) has been increasingly used to detect or monitor neoplasms. Gastrointestinal tract (GIT) is one of the most common sites of FDG uptake, leading to increasing requests for endoscopic examinations. We aimed to evaluate the nature and significance of unexpected PET/CT-FDG findings in the GIT. Patients and Methods: We retrospectively analyzed 371 consecutive patients with incidental GIT findings on PET/CT-FDG between June 2016 and October 2021 who were subsequently referred to endoscopic examinations. Demographic data, PET/CT-FDG results, endoscopic findings, and histological analysis were analyzed. Results: Of 194 colonic incidental uptakes, 102 (52.6%) corresponded to at least premalignant lesions, being 57 (29.4%) advanced adenomas and 23 (11.9%) adenocarcinomas. Of 193 upper GIT incidental uptakes, there were 11 (13.8%) esophageal and 14 (14.4%) gastric malignant/premalignant lesions. The maximum standardized uptake value (SUVmax) significantly varied according to the nature of the lesion, being higher in malignant lesions (in the esophagus, stomach, and colon). However, an optimal SUVmax cutoff was only found for stomach (SUVmax 8.2; sensitivity of 79% and specificity of 76%). There was a significant association between the site of uptake and the nature of the lesion – left colon and gastric body uptake were associated with neoplastic origin whereas rectum and lower esophagus were associated with inflammatory or no endoscopic changes. Conclusions: Any incidental uptake in the lower GIT should be investigated provided that patients are suitable for further treatment. However, in the upper GIT the characteristics of uptake on 18F‐FDG‐PET/CT may allow to select those who need endoscopic examination.

Background:A colorectal polyp (CRP) is a growth on the lining of the colon or rectum. The incidence of CRPs is rapidly increasing with age. They are most often benign. The rectum is the most commonly affected site. Objectives:To determine the incidence, clinical presentation, and histopathologic types of CRP in Iraqi patients. Materials and Methods:It is a cross-sectional screening study conducted in the medical city of Baghdad,Iraq. The total number of colonoscopies done in the medical city/GIT center was 2658 from May 2020–September 2022, where 100 patients with the diagnosis of CRP has collected. The males comprised 60/100 and their ages ranged from 4 to 75 years. Results:The most common age group affected was 46–59 years. There was a significant relationship between site and types of CRP, where the rectum showed 48% involvement, followed by the sigmoid colon at 34%. The villous adenomatous polyps look of large size ranging from 1.5 to 4 cm. The tubulovillous adenoma is the most common type, 25%. Lower gastrointestinal bleeding is the most common presentation, 25%. Conclusion:The most common age group affected was 46–59 years, with male-to-female ratio is 1.17. The most common site affected by CRPs was the rectum 48%, villous adenoma has the most significant size among all types (1.5–4 cm). No dysplasia was the most common finding (45%), and lower GIT bleeding and positive family history were the most common clinical presentation.

Colorectal polyps are noteworthy because of their role in the development of various clinical conditions and their malignant potential. McKittrick-Wheelock syndrome, one of these clinical conditions, is characterized by dehydration, tenesmus, secretory diarrhea, fluid-electrolyte disturbance (hyponatremia, hypokalemia, hypochloremia, metabolic acidosis), and prerenal acute renal failure accompanied by large colorectal villous adenomas. Large villous adenomas, which cause the syndrome due to the hormones and secretions they produce, carry a high risk of invasive cancer because of their size and histological type. Definitive surgery or endoscopic resection following supportive treatment for fluid-electrolyte disorders is essential in the syndrome’s treatment and leads to an increase in survival rate and quality of life. In this case report, we aim to present this rare syndrome and the synchronous tumor accompanying it for the first time in the literature.

Background: The guidelines recommend conventional cold snare polypectomy (C-CSP) for diminutive and small colorectal polyps (≤ 10 mm). However, it remains unclear whether CSP with sub-mucosal injection (SI-CSP) achieves comparable efficacy to C-CSP for managing these lesions. This study compares SI-CSP with C-CSP for patients with diminutive and small colorectal polyps. Methods: An electronic literature search was conducted to retrieve articles comparing resection outcomes between SI-CSP and C-CSP in diminutive and small colorectal polyps (registration number INPLASY2023100096). Our primary outcomes of interest were the complete resection rate (CRR), complications (namely immediate bleeding, delayed bleeding and perforation) and polypectomy time. Mean differences with 95% confidence intervals (CI) were employed for continuous variables, while odds ratios (OR) with 95% CI were calculated for categorical variables. Data was analyzed using a random effects model and the I2 test was utilized to assess heterogeneity. Results: Eight studies involving 1470 patients with 2223 polyps were included in our analysis. The CRR was not significantly higher in the SI-CSP group, with an OR of 95% CI 0.50 (0.22, 1.15). The incidences of immediate bleeding (OR 95% CI 0.60 [0.26–1.40]) and delayed bleeding (OR 95% CI 0.88 [0.32–2.42]) did not differ significantly between the two groups. On average, the mean polypectomy time was 64.75 seconds shorter in the C-CSP group (95% CI, − 102.96 to − 26.53). Notably, no perforation events were reported in the included studies. Conclusions: The use of SI-CSP was not superior to C-CSP in managing diminutive and small colorectal polyps and the procedure required significantly more time. [ABSTRACT FROM AUTHOR]

Abstract Background To investigate the effect of different working periods on missed diagnoses in patients with colorectal polyps in colonoscopy. Methods We conducted a retrospective analysis of patients who were diagnosed with colorectal polyps during colonoscopy in an outpatient department between July and December 2022. These patients were subsequently hospitalized for resection during this period. Patients with missed diagnoses were those who had newly discovered polyps in a second colonoscopy. The working periods were categorized as work, near the end of work, and delayed work, respectively, in the morning and afternoon. Results A total of 482 patients were included, and the miss rate of diagnosis was 48.1% (232/482), mainly in the transverse colon (25%), and the ascending colon (23%). Patient age was a risk factor for the miss rate of diagnosis (OR = 1.025, 95%CI: 1.009–1.042, P = 0.003) and was also associated with the number of polyps detected for the first colonoscopy (χ2 = 18.196, P = 0.001). The different working periods had no statistical effect on the missed rate of diagnosis (χ2 = 1.998, P = 0.849). However, there was an increasing trend in miss rates towards the end of work and delayed work periods, both in the morning and afternoon. The highest miss rate (60.0%) was observed during delayed work in the afternoon. Additionally, poor bowel preparation was significantly more common during delayed work in the afternoon. Conclusions The increasing trend in miss rates towards the end of work and delayed work periods deserves clinical attention. Endoscopists cannot always stay in good condition under heavy workloads.

Objectives: Artificial intelligence (AI) with white light imaging (WLI) is not enough for detecting non-polypoid colorectal polyps and it still has high false positive rate (FPR). We developed AIs using blue laser imaging (BLI) and linked color imaging (LCI) to detect them with specific learning sets (LS). Methods: The contents of LS were as follows, LS (WLI): 1991 WLI images of lesion of 2-10 mm, LS (IEE): 5920 WLI, BLI, and LCI images of non-polypoid and small lesions of 2-20 mm. LS (IEE) was extracted from videos and included both in-focus and out-of-focus images. We designed three AIs as follows: AI (WLI) finetuned by LS (WLI), AI (IEE) finetuned by LS (WLI)+LS (IEE), and AI (HQ) finetuned by LS (WLI)+LS (IEE) only with images in focus. Polyp detection using a test set of WLI, BLI, and LCI videos of 100 non-polypoid or non-reddish lesions of 2-20 mm and FPR using movies of 15 total colonoscopy were analyzed, compared to 2 experts and 2 trainees. Results: The sensitivity for LCI in AI (IEE) (83%) was compared to that for WLI in AI (IEE) (76%: p=0.02), WLI in AI (WLI) (57%: p

Abstract National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.

Background: To investigate the effect of different working periods on missed diagnoses in patients with colorectal polyps in colonoscopy. Methods: We conducted a retrospective analysis of patients who were diagnosed with colorectal polyps during colonoscopy in an outpatient department between July and December 2022. These patients were subsequently hospitalized for resection during this period. Patients with missed diagnoses were those who had newly discovered polyps in a second colonoscopy. The working periods were categorized as work, near the end of work, and delayed work, respectively, in the morning and afternoon. Results: A total of 482 patients were included, and the miss rate of diagnosis was 48.1% (232/482), mainly in the transverse colon (25%), and the ascending colon (23%). Patient age was a risk factor for the miss rate of diagnosis (OR = 1.025, 95%CI: 1.009–1.042, P = 0.003) and was also associated with the number of polyps detected for the first colonoscopy (χ2 = 18.196, P = 0.001). The different working periods had no statistical effect on the missed rate of diagnosis (χ2 = 1.998, P = 0.849). However, there was an increasing trend in miss rates towards the end of work and delayed work periods, both in the morning and afternoon. The highest miss rate (60.0%) was observed during delayed work in the afternoon. Additionally, poor bowel preparation was significantly more common during delayed work in the afternoon. Conclusions: The increasing trend in miss rates towards the end of work and delayed work periods deserves clinical attention. Endoscopists cannot always stay in good condition under heavy workloads. [ABSTRACT FROM AUTHOR]

Introduction: Nonalcoholic or metabolism-associated fatty liver disease (NAFLD or MAFLD) and colorectal polyps are chronic conditions strongly linked to lifestyle factors. However, the precise causal link between NAFLD or MAFLD and the development of colorectal polyps is not yet fully understood. This study aimed to evaluate the association between NAFLD or MAFLD and the risk of colorectal polyps based on a meta-analysis and two-sample Mendelian randomization (MR) analyses. Methods: PubMed, Embase, Cochrane Library databases were searched for eligible studies to be included in the meta-analysis. We conducted a thorough search of the PubMed, Embase, and Cochrane Library databases to identify eligible studies prior to 22 March 2024. Subgroup analyses were performed based on sex, age, and geographical region. Causality between NAFLD/MAFLD and colorectal polyps was explored by using two-sample Mendelian randomization (MR) analyses. Results: Based on an analysis of 17 studies encompassed within thismeta-analysis, a significant correlation was identified between the presence of NAFLD/MAFLD and elevated incidence of colorectal polyps (NAFLD: OR = 1.57, 95% CI: 1.43-1.73, I² = 38%, p = 0.06; MAFLD: OR = 1.67, 95% CI: 1.40-2.00, I² = 77%, p = 0.002). However, current evidence does not support a causal relationship between NAFLD/MAFLD and the prevalence of colorectal polyps (OR= 0.9998315, 95% CI: 0.9987566-1.000907, P = 0.7587638). Conclusion: NAFLD/MAFLD demonstrated a significant positive correlation with an elevated risk of developing colorectal polyps. However, the MR analysis suggested that no causal relationship existed between NAFLD/MAFLD and colorectal polyps. Therefore, further research is required to identify the underlying mechanism of causal link between these diseases. [ABSTRACT FROM AUTHOR]

Purpose: The available evidence regarding the role of fruit and vegetable consumption in the development of colorectal polyps remains inconclusive, and there is a lack of data on different histopathologic features of polyps. We aimed to evaluate the associations of fruit and vegetable consumption with the prevalence of colorectal polyps and its subtypes in a high-risk population in China. Methods: We included 6783 Chinese participants aged 40–80 years who were at high risk of colorectal cancer (CRC) in the Lanxi Pre-colorectal Cancer Cohort (LP3C). Dietary information was obtained through a validated food-frequency questionnaire (FFQ), and colonoscopy screening was used to detect colorectal polyps. Dose–response associations of fruit and vegetable intake with the prevalence of polyps were calculated using multivariate-adjusted regression models, which was reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: 2064 cases of colorectal polyps were ascertained in the LP3C during 2018–2019. Upon multivariable adjustments, including the diet quality, fruit consumption was inversely associated with the prevalence of polyps (P trend = 0.02). Participants in the highest tertile of fruit intake had a 25% lower risk (OR: 0.75; 95% CI 0.62‒0.92) compared to non-consumers, while vegetable consumption had no significant association with polyp prevalence (P trend = 0.86). In terms of colorectal histopathology and multiplicity, higher fruit intake was correlated with 24, 23, and 33% lower prevalence of small polyps (OR: 0.76; 95% CI 0.62‒0.94; P trend = 0.05), single polyp (OR: 0.77; 95% CI 0.62‒0.96; P trend = 0.04), and distal colon polyps (OR: 0.67; 95% CI 0.51‒0.87; P trend = 0.003), respectively. Conclusions: Fresh fruit is suggested as a protective factor to prevent colorectal polyps in individuals at high risk of CRC, and should be underscored in dietary recommendations, particularly for high-risk populations. [ABSTRACT FROM AUTHOR]

The Short Bowel Syndrome (SBS) Registry (NCT01990040) is a multinational real-world study evaluating the long-term safety of teduglutide in patients with SBS and intestinal failure (SBS-IF) in routine clinical practice. This paper describes the study methodology and baseline characteristics of adult patients who have (ever-treated) or have never (never-treated) received teduglutide. A total of 1411 adult patients (679 ever-treated; 732 never-treated) were enrolled at 124 sites across 17 countries. The mean (standard deviation [SD]) age at enrollment was 55.4 (15.46) years, and 60.2% of patients were women. Crohn's disease was the most common cause of major intestinal resection in both ever-treated (34.1%) and never-treated patients (20.4%). A similar proportion of ever-treated and never-treated patients had a prior history of colorectal polyps (2.7% vs. 3.6%), whereas proportionally fewer ever-treated patients reported a history of colorectal cancer (1.8% vs. 6.2%) or any malignancy (17.7% vs. 30.0%) than never-treated patients. Never-treated patients received a numerically greater mean (SD) volume of parenteral nutrition and/or intravenous fluids than ever-treated patients (12.4 [8.02] vs. 10.1 [6.64] L/week). Ever-treated patients received a mean teduglutide dosage of 0.05 mg/kg/day. This is the first report of patient baseline characteristics from the SBS Registry, and the largest cohort of patients with SBS-IF to date. Overall, ever-treated and never-treated patients had similar baseline characteristics. Differences between treatment groups may reflect variations in patient selection and degree of monitoring. [ABSTRACT FROM AUTHOR]

National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness. [ABSTRACT FROM AUTHOR]

Background: PolyDeep is a computer-aided detection and classification (CADe/x) system trained to detect and classify polyps. During colonoscopy, CADe/x systems help endoscopists to predict the histology of colonic lesions. Objective: To compare the diagnostic performance of PolyDeep and expert endoscopists for the optical diagnosis of colorectal polyps on still images. Methods: PolyDeep Image Classification (PIC) is an in vitro diagnostic test study. The PIC database contains NBI images of 491 colorectal polyps with histological diagnosis. We evaluated the diagnostic performance of PolyDeep and four expert endoscopists for neoplasia (adenoma, sessile serrated lesion, traditional serrated adenoma) and adenoma characterization and compared them with the McNemar test. Receiver operating characteristic curves were constructed to assess the overall discriminatory ability, comparing the area under the curve of endoscopists and PolyDeep with the chi- square homogeneity areas test. Results: The diagnostic performance of the endoscopists and PolyDeep in the characterization of neoplasia is similar in terms of sensitivity (PolyDeep: 89.05%; E1: 91.23%, p=0.5; E2: 96.11%, p<0.001; E3: 86.65%, p=0.3; E4: 91.26% p=0.3) and specificity (PolyDeep: 35.53%; E1: 33.80%, p=0.8; E2: 34.72%, p=1; E3: 39.24%, p=0.8; E4: 46.84%, p=0.2). The overall discriminative ability also showed no statistically significant differences (PolyDeep: 0.623; E1: 0.625, p=0.8; E2: 0.654, p=0.2; E3: 0.629, p=0.9; E4: 0.690, p=0.09). In the optical diagnosis of adenomatous polyps, we found that PolyDeep had a significantly higher sensitivity and a significantly lower specificity. The overall discriminative ability of adenomatous lesions by expert endoscopists is significantly higher than PolyDeep (PolyDeep: 0.582; E1: 0.685, p < 0.001; E2: 0.677, p < 0.0001; E3: 0.658, p < 0.01; E4: 0.694, p < 0.0001). Conclusion: PolyDeep and endoscopists have similar diagnostic performance in the optical diagnosis of neoplastic lesions. However, endoscopists have a better global discriminatory ability than PolyDeep in the optical diagnosis of adenomatous polyps. [ABSTRACT FROM AUTHOR]

Previous epidemiological and experimental studies have yielded conflicting results regarding the influence of human micronutrient levels on the risk of colorectal polyps (CP). In our study, we conducted a two-sample Mendelian randomization (MR) investigation to probe the link between 13 human micronutrients (calcium, selenium, magnesium, phosphorus, folate, vitamins B-6, B-12, C, D, beta-carotene, iron, zinc, and copper) and the genetic susceptibility to CP. Summary statistics for CP (n = 463,010) were obtained from pan-European genome-wide association studies, and instrumental variables for 13 micronutrients were screened from published genome-wide association studies (GWAS). After selecting suitable instrumental variables, we performed a two-sample MR study, deploying sensitivity analyses to judge heterogeneity and pleiotropy, using inverse variance weighted methods as our primary estimation tool. Our study identified that a genetic predisposition to elevated toenail and circulating selenium or serum β-carotene concentrations lowers the risk of CP occurrence. However, no statistically significant association was observed between the other 11 micronutrients and the risk of CP. The study findings provide evidence that the micronutrient selenium and β-carotene may confer protective effects against the development of CP. [ABSTRACT FROM AUTHOR]

Evidence on serum biomarkers as a non-invasive tool to detect colorectal adenoma (CRA) in the general population is quite promising. However, the sensitivity and specificity of these serum biomarkers in detecting disease are still questionable. This study aimed to systematically review the evidence on the diagnostic performance of serum biomarkers associated with CRA. Database searches on PubMed, Scopus, and WoS from January 2014 to December 2023 using PRISMA guidelines resulted in 4,380 citations, nine of which met inclusion criteria. The quality of these studies was assessed using the QUADOMICS tool. These studies reported on 77 individual/panel biomarkers which were further analysed to find associated altered pathways using MetaboAnlyst 5.0. Diagnostic accuracy analysis of these biomarkers was conducted by constructing a receiver operating characteristic (ROC) curve using their reported sensitivity and specificity. This review identified six potential serum metabolite biomarkers with 0.7

Accurate recognition of colorectal images assists doctors in screening for malignant intestinal diseases. Colorectal cancer can be induced by colorectal polyps, ulcerative colitis, and papillary adenoma. Colorectal polyp segmentation can be used to rapidly locate polyps using automated colorectal polyp segmentation technology, saving the time and cost of manual screening and providing patients with valuable treatment time. Therefore, designing an automatic identification and accurate segmentation method is crucial for clinicians to improve diagnosis efficiency. Aiming at the problems in colorectal polyp image segmentation, such as large regional scale variation, variable location, blurred edges, and low contrast between polyps and normal tissues, which lead to low accuracy of lesion segmentation and artifacts on the segmentation boundary, an adaptive network based on the Swin Transformer and graphical reasoning is proposed. First, the Swin Transformer encoder is used to extract the global context information of the input image layer by layer, weaken the interference of background information, and analyze the salient characteristics of the lesion area on a multiscale. Second, a global and local feature interaction module is proposed to enhance the spatial perception ability of the network on complex lesions, highlight the key position information of the target to be segmented, and accurately locate the target. Third, a region-guided graph inference module is used to mine the higher-order dominant relationship between prior information in the way of graph cyclic recurrence to promote the transmission of information between graphs. Fourth, an edge constraint graph inference module oriented to edge details is designed to integrate edge details and improve the segmentation effect and segmentation precision. Experiments were performed on the CVC-ClinicDB, Kvasir, CVC-ColonDB, and ETIS datasets. The Dice coefficients were 0.939, 0.926, 0.810, and 0.788, respectively, and the average intersection ratios were 0.889, 0.879, 0.731, and 0.710, respectively. The mean absolute errors were 0.006, 0.017, 0.030, and 0.012, respectively. Compared with the SSformer method based on the transformer structure, the Dice coefficients are increased by 2.3%, 0.1%, 3.8%, and 2.1%, respectively, and the average crossover ratio is increased by 1.6%, 0.1%, 3.4%, and 1.2%, respectively. The overall segmentation performance of the algorithm test is better than that of the existing method. The simulation results show that the image segmentation accuracy of colorectal polyps with complex shapes and structures, low contrast, and blurred edges is high.

Abstract Background To systematically analyze risk factors for delayed postpolypectomy bleeding (DPPB) in colorectum. Methods We searched seven large databases from inception to July 2022 to identify studies that investigated risk factors for DPPB. The effect sizes were expressed by relative risk (RR) and 95% confidence interval (95% CI). The heterogeneity was analyzed by calculating I 2 values and performing sensitivity analyses. Results A total of 15 articles involving 24,074 subjects were included in the study. The incidence of DPPB was found to be 0.02% (95% CI, 0.01–0.03), with an I 2 value of 98%. Our analysis revealed that male sex (RR = 1.64), history of hypertension (RR = 1.54), anticoagulation (RR = 4.04), polyp size (RR = 1.19), polyp size ≥ 10 mm (RR = 2.43), polyp size > 10 mm (RR = 3.83), polyps located in the right semicolon (RR = 2.48) and endoscopic mucosal resection (RR = 2.99) were risk factors for DPPB. Conclusions Male sex, hypertension, anticoagulation, polyp size, polyp size ≥ 10 mm, polyps located in the right semicolon, and endoscopic mucosal resection were the risk factors for DPPB. Based on our findings, we recommend that endoscopists should fully consider and implement effective intervention measures to minimize the risk of DPPB.

Background/Aims Colorectal cancer (CRC) and colorectal polyps are intimately linked, with polyps acting as precursors to CRC. Understanding the molecular mechanisms governing their development is crucial for advancing diagnosis and treatment. Employing a systems biology approach, we investigated the molecular similarities between polyp and CRC. Methods We analyzed gene expression profiles, protein-protein interactions, transcription factors, and gene ontology to identify common differentially expressed genes (DEGs) and unravel shared molecular pathways. Results Our analysis revealed 520 commonly dysregulated genes in polyps and CRC, serving as potential biomarkers and pivotal contributors to disease progression. Gene ontology analysis elucidated distinct biological processes associated with upregulated and downregulated DEGs in both conditions, highlighting common pathways, including signal transduction, cell adhesion, and positive regulation of cell proliferation. Moreover, protein-protein interaction networks shed light on subnetworks involved in rRNA processing, positive regulation of cell proliferation, mRNA splicing, and cell division. Transcription factor analysis identified major regulators and differentially expressed transcription factors in polyp and CRC. Notably, we identified common differentially expressed transcription factors, including ZNF217, NR3C1, KLF5, GATA6, and STAT3, with STAT3 and NR3C1 exhibiting increased expression. Conclusions This comprehensive analysis enriches our understanding of the molecular mechanisms underlying polyp formation and CRC development, providing potential targets for further investigation and therapeutic intervention. Our findings contribute substantively to crafting personalized strategies for refining the diagnosis and treatment of polyps and CRC.

Abstract Background Most colorectal cancers originate from precancerous polyps. This study aimed to determine the prevalence of colorectal polyps with diverse pathological morphologies and to explore the risk factors for colorectal carcinoma in situ (CCS) and neoplastic polyps. Methods Inpatients admitted from January 2018 to May 2023 were screened through the hospital information system. Polyps were classified according to pathological morphology. The prevalence of polyps was described by frequency and 95% confidence interval. Univariate and multivariate logistic regression analyses were used to explore the risk factors for CCS and neoplastic polyps. Results In total, 2329 individuals with 3550 polyps were recruited. Among all patients, 76.99% had neoplastic polyps and 44.31% had advanced adenomas. Tubular adenoma had the highest prevalence at 60.15%, and the prevalence of CCS was 3.86%. Patients with a colorectal polyp diameter ≥ 1.0 cm or number ≥ 3 were 8.07 times or 1.98 times more likely to develop CCS than were those with a diameter 1.0 cm) or multifocal polyps. The levels of the tumor markers CA724 and CA211 show some potential usefulness for predicting CCS and may be exploited for early identification of high-risk populations.

Colorectal cancer is a malignant tumor that mainly occurs in the tissues of the colon and rectum, and its early detection and treatment are of great significance. The early detection and prevention of colorectal cancer mainly involves visual examination of the patient??s intestines to screen for colorectal polyps, but manual examination has the disadvantage of high misdiagnosis rate. The auxiliary diagnostic system based on convolutional neural networks (CNN) has shown the most advanced performance in the diagnosis of colorectal polyps, and is currently a research hotspot in the field of computer-aided diagnosis. Based on important literature published in recent years, a systematic review of the application of convolutional neural networks in the auxiliary diagnosis of colorectal polyps is conducted. Firstly, the commonly used datasets in the field of colorectal polyp diagnosis are introduced, including image and video datasets. Secondly, the application of CNN in colorectal polyp detection, segmentation, and classification is systematically elaborated. The main improvement ideas, advantages and disadvantages, and performance of each algorithm are analyzed in depth, aiming to provide researchers with a more systematic reference, and summarize the interpretability of deep learning models. Finally, a summary of various algorithms for assisting the diagnosis of colorectal polyps based on CNN is provided, and future research directions are prospected.

Background: To systematically analyze risk factors for delayed postpolypectomy bleeding (DPPB) in colorectum. Methods: We searched seven large databases from inception to July 2022 to identify studies that investigated risk factors for DPPB. The effect sizes were expressed by relative risk (RR) and 95% confidence interval (95% CI). The heterogeneity was analyzed by calculating I2 values and performing sensitivity analyses. Results: A total of 15 articles involving 24,074 subjects were included in the study. The incidence of DPPB was found to be 0.02% (95% CI, 0.01–0.03), with an I2 value of 98%. Our analysis revealed that male sex (RR = 1.64), history of hypertension (RR = 1.54), anticoagulation (RR = 4.04), polyp size (RR = 1.19), polyp size ≥ 10 mm (RR = 2.43), polyp size > 10 mm (RR = 3.83), polyps located in the right semicolon (RR = 2.48) and endoscopic mucosal resection (RR = 2.99) were risk factors for DPPB. Conclusions: Male sex, hypertension, anticoagulation, polyp size, polyp size ≥ 10 mm, polyps located in the right semicolon, and endoscopic mucosal resection were the risk factors for DPPB. Based on our findings, we recommend that endoscopists should fully consider and implement effective intervention measures to minimize the risk of DPPB. [ABSTRACT FROM AUTHOR]

Introduction: The safety and efficacy of cold snare polypectomy (CSP) compared to those of cold endoscopic mucosal resection (CEMR) have been reported. This meta-analysis compared the efficacy and safety of CEMR and CSP. Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify randomized controlled trials comparing the efficacy and safety of CEMR and CSP in removing 3–10 mm polyps. The outcomes assessed included complete resection rate, intraoperative bleeding rate, delayed bleeding rate, perforation, and polyp removal time. The results are reported as risk ratios (RR) and 95% confidence intervals (CIs) derived from a Mantel-Haenszel random-effects model. Results: Seven studies comprising 1,911 polyps were included in the analysis. The complete resection rate of CEMR was comparable to that of CSP (RR: 1.01, 95% CI: 0.99–1.04, p = 0.32). Comparable results were also demonstrated for intraoperative bleeding rate (polyp-based analysis: RR: 1.22, 95% CI: 0.33–4.43, p = 0.77), delayed bleeding rate (polyp-based analysis: RR: 1.34, 95% CI: 0.44–4.15, p = 0.61), and polyp removal time (mean difference: 28.31 s, 95% CI: −21.40–78.02, p = 0.26). No studies reported cases of perforation. Conclusion: CEMR has comparable efficacy and safety to CSP in removing 3–10 mm polyps. Further randomized controlled trials with long-term follow-up are warranted to compare and validate efficacy. [ABSTRACT FROM AUTHOR]

Background: Most colorectal cancers originate from precancerous polyps. This study aimed to determine the prevalence of colorectal polyps with diverse pathological morphologies and to explore the risk factors for colorectal carcinoma in situ (CCS) and neoplastic polyps. Methods: Inpatients admitted from January 2018 to May 2023 were screened through the hospital information system. Polyps were classified according to pathological morphology. The prevalence of polyps was described by frequency and 95% confidence interval. Univariate and multivariate logistic regression analyses were used to explore the risk factors for CCS and neoplastic polyps. Results: In total, 2329 individuals with 3550 polyps were recruited. Among all patients, 76.99% had neoplastic polyps and 44.31% had advanced adenomas. Tubular adenoma had the highest prevalence at 60.15%, and the prevalence of CCS was 3.86%. Patients with a colorectal polyp diameter ≥ 1.0 cm or number ≥ 3 were 8.07 times or 1.98 times more likely to develop CCS than were those with a diameter < 1.0 cm or number < 3, respectively (OR 8.07, 95%CI 4.48–14.55, p < 0.0001; and OR 1.98, 95%CI 1.27–3.09, p = 0.002). The risk of CCS with schistosome egg deposition was also significantly increased (OR 2.70, 95%CI 1.05–6.98). The higher the levels of carbohydrate antigen (CA) 724 (OR 1.01, 95%CI 1.00–1.02) and CA211 (OR 1.16, 95%CI 1.03–1.32) in patients with colorectal polyps were, the greater the risk of CCS. When colorectal neoplastic polyps were analyzed, we discovered that for each 1-year increase in age, the risk of neoplastic polyps increased by 3% (OR 1.03, 95%CI 1.02–1.04), p < 0.0001. Patients with a polyp diameter ≥ 1.0 cm had a 2.11-fold greater risk of neoplastic polyps compared to diameter < 1.0 cm patients (OR 3.11, 95%CI 2.48–3.92), p < 0.0001. In addition, multiple polyps and CA199 levels are risk factors for neoplastic polyps. Conclusion: More than 3/4 of colorectal polyp patients have neoplastic polyps. Patients are more inclined to develop CCS and neoplastic polyps if they have large polyps (> 1.0 cm) or multifocal polyps. The levels of the tumor markers CA724 and CA211 show some potential usefulness for predicting CCS and may be exploited for early identification of high-risk populations. [ABSTRACT FROM AUTHOR]

Background/Aims: Colorectal cancer (CRC) and colorectal polyps are intimately linked, with polyps acting as precursors to CRC. Understanding the molecular mechanisms governing their development is crucial for advancing diagnosis and treatment. Employing a systems biology approach, we investigated the molecular similarities between polyp and CRC. Methods: We analyzed gene expression profiles, protein-protein interactions, transcription factors, and gene ontology to identify common differentially expressed genes (DEGs) and unravel shared molecular pathways. Results: Our analysis revealed 520 commonly dysregulated genes in polyps and CRC, serving as potential biomarkers and pivotal contributors to disease progression. Gene ontology analysis elucidated distinct biological processes associated with upregulated and downregulated DEGs in both conditions, highlighting common pathways, including signal transduction, cell adhesion, and positive regulation of cell proliferation. Moreover, protein-protein interaction networks shed light on subnetworks involved in rRNA processing, positive regulation of cell proliferation, mRNA splicing, and cell division. Transcription factor analysis identified major regulators and differentially expressed transcription factors in polyp and CRC. Notably, we identified common differentially expressed transcription factors, including ZNF217, NR3C1, KLF5, GATA6, and STAT3, with STAT3 and NR3C1 exhibiting increased expression. Conclusions: This comprehensive analysis enriches our understanding of the molecular mechanisms underlying polyp formation and CRC development, providing potential targets for further investigation and therapeutic intervention. Our findings contribute substantively to crafting personalized strategies for refining the diagnosis and treatment of polyps and CRC. [ABSTRACT FROM AUTHOR]

Background and Aims: The impact of submucosal injection during cold snare polypectomy (CSP) remains uncertain. We conducted an evidence-based comparison of conventional CSP (C-CSP) and CSP with submucosal injection (SI-CSP) for colorectal polyp resection. Methods: PubMed, Embase, and the Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing C-CSP with SI-CSP. Major outcomes included the rates of complete resection, en bloc resection, polyp retrieval, and adverse events, as well as the duration of polypectomy. Data were analyzed by using a random-effects model. Results: A total of seven RCTs were included. Complete resection rates for all polyps (RR 0.98; 95% CI 0.93–1.03), polyps ≤ 10 mm (RR 0.99; 95% CI 0.96–1.02) and polyps > 10 mm (RR 0.92; 95% CI 0.69–1.12) were not substantially different between C-CSP and SI-CSP groups. En bloc resection rate (RR 0.93; 95% CI 0.79–1.09) and polyp retrieval rate (RR 1.00; 95% CI 0.99–1.01) were also not significantly different between the two groups. The SI-CSP group required a prolonged polypectomy time than the C-CSP group (SMD − 0.89; 95% CI -1.29 to -0.49). Adverse events were rare in both groups. Conclusions: SI-CSP is not an optimal substitute for CSP in the resection of colorectal polyps, particularly diminutive and small polyps. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the effect of traditional Chinese medicine or traditional Chinese medicine characteristic therapy on the prevention and treatment of postoperative recurrence of colorectal polyps after operation and the improvement of clinical symptoms under the guidance of the theory of ′preventive treatment of disease′ in traditional Chinese medicine, so as to provide more methods for clinical treatment of this disease. Methods CNKI, Wanfang, VIP and PubMed database were selected for computer retrieval, and all randomized controlled trials of using traditional Chinese medicine to prevent and treat postoperative recurrence of colorectal polyps after operation under the guidance of the theory of ′preventive treatment of disease′ of traditional Chinese medicine were screened out. A total of 15 articles were included in 1 768 patients, including 886 patients in the control group (treated with or without western medicine after routine treatment), and 882 patients in the treatment group (treated with traditional Chinese medicine or oral or external treatment of traditional Chinese medicine on the basis of the control group). Meta-analysis was performed using RevMan 5. 4. 1 software. Results The recurrence rate and the improvement of related clinical symptoms (abdominal pain, diarrhea and hematochezia) in the treatment group were better than those in the control group at half a year, one year and two years after operation, and the differences were statistically significant (P＜0. 000 01). Sensitivity analysis (one year after operation) suggested that the results were stable and reliable. Conclusion The intervention of traditional Chinese medicine under the guidance of the theory of ′ preventive treatment of disease ′ of traditional Chinese medicine has a good effect on reducing the recurrence rate of colorectal polyps after operation and improving clinical symptoms. [ABSTRACT FROM AUTHOR]

Introduction: The virtual scale endoscope (VSE) is a newly introduced endoscope that helps endoscopists in measuring colorectal polyp size (CPS) during colonoscopy by displaying a virtual scale. This study aimed to determine the usefulness of the VSE for CPS measurement and the educational benefit of using VSE images to improve CPS estimation accuracy. Methods: This study included 42 colorectal polyps in 26 patients treated at Hiroshima University Hospital. In study 1, CPS measured using a VSE before endoscopic mucosal resection was compared with CPS measured on resected specimens, and the agreement between the two measurement methods was evaluated via Bland-Altman analysis. In study 2, 14 endoscopists (5 beginners, 5 intermediates, and 4 experts) took a pre-test to determine the size of 42 polyps. After the pre-test, a lecture on CPS measurement using VSE images was given. One month later, the endoscopists took a post-test to compare CPS accuracy before and after the lecture. Results: In study 1, Bland-Altman analysis revealed no fixed or proportional errors. The mean bias ±95% limits of agreement (±1.96 standard deviations) of the measurement error was −0.05 ± 0.21 mm, indicating that the agreement between two measurement methods was sufficient. In study 2, the accuracy of CPS measurement was significantly higher among beginners (59.5% vs. 26.7%, p < 0.01) and intermediates (65.2% vs. 44.3%, p < 0.05) in the post-test than in the pre-test. Conclusion: The VSE accurately measures CPS before resection, and its images are useful teaching tools for beginner and intermediate endoscopists. [ABSTRACT FROM AUTHOR]

There is scarce data focused on recurrence neoplasia rate (RR) after piecemeal endoscopic mucosal resection (pEMR) of 10–19 mm non-pedunculated colorectal lesions (NPL). We aimed to analyze the RR after pEMR of 10–19 mm NPL, identify risk factors for its development and compare it with RR after pEMR of ≥ 20 mm NPL. Retrospective cohort-study including all ≥10 mm NPL resected by pEMR in our center between 2018–2022 with an early repeat colonoscopy (ERC). RR was defined as recurrence neoplasia identified in the ERC EMR scar with virtual chromoendoscopy or histological confirmation. A total of 444 NPL were assessed, 124 (27.9%) with 10–19 mm. In the ERC, performed a median of 6 months after pEMR, RR was significantly lower for 10–19 mm NPL compared to ≥ 20 mm NPL (13/124 vs 68/320, p = 0.005). In subgroup analysis, RR after pEMR of 15–19 mm NPL was significantly higher compared to 10–14 mm NPL (13/98 vs 0, p = 0.041) but not significantly different compared to ≥ 20 mm NPL (13/98 vs 68/320, p = 0.073). In multivariable analysis, size of NPL (HR 1.501, 95% CI 1.012–2.227, p = 0.044) was the only independent risk factor identified for RR for 10–19 mm NPL. Although the early RR after pEMR of 10–19 mm NPL is significantly lower compared to ≥ 20 mm NPL, it is non-negligible (10.5%) and appears to be the highest among 15–19 mm NPL. The size of the lesion was the only independent risk factor for RR. Our findings should be accounted in the selection of the most appropriate post-polypectomy endoscopic surveillance. [ABSTRACT FROM AUTHOR]

Purpose: Recent studies suggested a protective role of metformin in the development of colorectal cancer (CRC) and its precursors. We aimed to investigate if metformin was associated with a lower prevalence and number of colorectal polyps in diabetic patients and also adenomas, high-risk adenomas, and CRC. Methods: Retrospective study on adult patients with diabetes mellitus followed in our hospital with a total colonoscopy between 2015 and 2019, treated with either metformin for > 5 years or other antidiabetic agent (control group). We assessed the number, size, and histopathology examination of proliferative lesions detected on colonoscopy. Results: We included 401 patients aged 69 ± 9 years, 57% males, divided into two groups: treated with metformin (n = 260) and without (n = 141). The number of polyps detected was significantly lower in patients under metformin (p = 0.014). There was a nonsignificant trend towards lower polyp detection rates in the metformin compared to the control group both in unadjusted analysis (50% vs 60%, p = 0.058) and multivariable adjusted analysis (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.43–1.09, p = 0.111). In the latter, we identified male gender (OR 2.24, 95%CI 1.44–3.49, p < 0.001), age (OR 1.35 for every 10 years, 95%CI 1.07–1.71, p = 0.012), glycated hemoglobin value (OR 1.20 for every 1% increase, 95%CI 1.06–1.37, p = 0.005), and hypertension (OR 1.76, 95%CI 1.01–3.08, p = 0.046) as factors associated with a higher prevalence of polyps. We saw no statistically significant differences regarding adenoma (p = 0.231), high-risk adenoma (p = 0.810), and CRC (p = 0.705) diagnoses between groups. Conclusion: In our study, metformin was associated with less colorectal polyps in diabetic patients compared to other treatment modalities. We observed a nonsignificant trend towards lower polyp detection rates in the metformin group both in unadjusted and adjusted analyses. [ABSTRACT FROM AUTHOR]

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The prevalence of colorectal cancer, primarily emerging from polyps, underscores the importance of their early detection in colonoscopy images. Due to the inherent complexity and variability of polyp appearances, the task stands difficult despite recent advances in medical technology. To tackle these challenges, a deep learning model featuring a customized U-Net architecture, AdaptUNet is proposed. Attention mechanisms and skip connections facilitate the effective combination of low-level details and high-level contextual information for accurate polyp segmentation. Further, wavelet transformations are used to extract useful features overlooked in conventional image processing. The model achieves benchmark results with a Dice coefficient of 0.9104, an Intersection over Union (IoU) coefficient of 0.8368, and a Balanced Accuracy of 0.9880 on the CVC-300 dataset. Additionally, it shows exceptional performance on other datasets, including Kvasir-SEG and Etis-LaribDB. Training was performed using the Hyper Kvasir segmented images dataset, further evidencing the model's ability to handle diverse data inputs. The proposed method offers a comprehensive and efficient implementation for polyp detection without compromising performance, thus promising an improved precision and reduction in manual labour for colorectal polyp detection.

BackgroundLimited research has explored the association between dietary soy products and colorectal polyps and adenomas, with insufficient attention given to cooking methods and subtypes of polyps. This study aimed to comprehensively assess the relationship between soy intake, its cooking methods, and the risk of colorectal polyps and adenomas within a high-incidence population of colorectal cancer (CRC) in China.MethodsData were derived from 14,903 participants aged 40–80 years, enrolled in the extended Lanxi Pre-colorectal Cancer Cohort (LP3C) between March 2018 and December 2022. This cross-sectional study is based on the participants’ baseline information. Long-term dietary information was collected through a validated food frequency questionnaire (FFQ), and colorectal polyps and adenomas were identified through electronic colonoscopy. Employing multivariate logistic regression, results were expressed as odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs).Results4,942 cases of colorectal polyps and 2,678 cases of adenomas were ascertained. A significant positive association was found between total soy intake and the occurrence of polyps/adenomas. Considering cooking methods, a notable increase in polyp risk was associated with the consumption of fried soys while no association was detected for boiled or marinated soys. Furthermore, total soy intake demonstrated associations with large and multiple polyps, polyps Yamade-typed less than II, and polyps across all anatomical subsites.ConclusionWithin the high-risk CRC population in China, increased soy product intake was linked to a higher risk of polyps, primarily attributed to the consumption of fried soys. This suggests that modifying cooking methods to avoid fried soys may serve as a preventive strategy for colorectal polyps.

Relevance. Adenomatous colorectal polyps are associated with a high risk of developing a malignant tumor. They are considered precancerous conditions and can lead to the development of colorectal cancer. To date, colorectal cancer ranks third in the world in frequency of occurrence among all malignant neoplasms.Objective. Improving the results of diagnosis and surgical treatment of patients with colorectal adenomatous neoplasms by identifying development factors and identifying risk groups for this nosology.Materials and methods. Analysis of literary data.Results. Among the factors leading to the development of colorectal polyps, it is worth noting a genetic predisposition, so by immunoblotting, PCR sequencing of the entire exome in cases of patients with familial dentate polyposis, rare variants of the germ line in the WNK2 gene were identified. Functional studies have shown that variants of the WINK2 germ line affect protein function in the context of the MAPK pathway, a molecular trait of this disease. Also, in the course of many domestic and foreign randomized clinical trials, the following modifiable factors for the development of adenomatous colorectal polyps were identified.Conclusion. The study revealed the factors of development and recurrence of colorectal neoplasms and identified risk groups for this nosology. The study revealed low compliance of patients with respect to changes in certain living conditions (the use of ethyl alcohol and products containing it, tobacco smoking, both active and passive, the fight against obesity and inactivity), which leads to recurrence and increases the risks of malignancy of colorectal polyps.

ndoscopic mucosal resection (EMR) is a therapeutic technique developed for the resectioning of sessile and flat lesions localized in the mucosa of any part of the gastrointestinal tract. It is easy to learn and allows the resection of large polyps that would otherwise require radical surgery. For early detection of neoplasia of the gastrointestinal tract, the screening program for colorectal cancer proved to be the most important, and its wide acceptance led to a decrease in the incidence and mortality rate. This article reviews EMR techniques and focuses on large colorectal polyps, representing the most common indication for EMR. Before starting resection, the endoscopist should carefully and thoroughly examine the lesion and differentiate between resectable lesions and those potentially affected by the submucosal invasion. There are different methods of evaluating polyps; more recently advanced techniques are also used. The characteristics of colorectal lesions, including location, size, morphology, and histology, influence the choice of the optimal method of removal. The EMR removes part of the wall of the colorectum that contains the mucosa, the muscularis mucosa and partially or completely, the submucosal layer. In addition to removing benign adenomas of varying degrees of atypia, mucosectomy enables the treatment of early colorectal cancer where the risk of metastasis to the lymph glands is minimal. The primary goal of EMR is the complete and safe removal of colorectal lesions and the complete prevention of CRC. Techniques for performing EMR include conventional EMR with submucosal solution injection, hot loop, and electrocautery removal of colorectal lesions, as well as alternative EMR techniques such as cold loop EMR and "underwater" EMR. Major adverse events associated with EMR include bleeding and perforation after mucosectomy. Because of the risk of polyp recurrence regardless of the EMR technique, as well as the risk of metachronous polyps, control colonoscopies are necessary, especially in patients with the highest risk of recurrence.

Background: The World Health Organization introduced the entities of sessile serrated adenoma and traditional serrated adenoma, and hyperplastic polyps (HPs) under the serrated lesions category in 2010. Indian studies on demographic, clinical, and histopathological characteristics of colorectal polyps, especially on serrated lesions, are limited. Our study aimed to study the morphology of the colorectal polyps and estimate the percentage of serrated lesions in the polyps studied. Methodology: A cross-sectional hospital-based study was conducted on colorectal polyps received for routine histopathological examination from July 2013 to August 2015. The polyps were classified according to the WHO 2010 colon and rectum tumors classification. Data were compiled and analyzed using IBM SPSS statistics version 20.0. The interpretation was done in frequencies and percentages. Results: We studied a total of 200 colorectal polyps. The polyps were mostly seen in the descending colon (41%). Histologically, the majority of the colorectal polyps were adenomatous in nature (59%). The serrated lesions accounted for 29% of all colorectal polyps. The polyps were mostly seen in patients who were more than 40 years old. Conclusion: Adenomas were the most prevalent type of colorectal polyps, seen more in males, at a higher age, and distally located. Serrated lesions predominantly included HPs, mostly

Colorectal polyps, precursors to colorectal cancer (CRC), require precise identification for appropriate diagnosis and therapy. This study aims to investigate the differences in hematological and inflammatory markers, specifically the CALLY index, HALP score, and immuno-inflammatory indexes, between neoplastic and nonneoplastic polyps. A retrospective cross-sectional study was conducted on 758 patients aged 61.0 ± 11.8 who underwent polypectomy between June 2021 and May 2024. Patients with colorectal adenocarcinoma (n = 22) were excluded. The polyps were classified into neoplastic and nonneoplastic categories based on histopathological evaluation. The study compared the CALLY index, HALP score, and various inflammatory indexes between neoplastic and nonneoplastic polyps. Out of 758 polyps analyzed, 514 were neoplastic, and 244 were nonneoplastic. Neoplastic polyps exhibited significantly lower CALLY and HALP scores (p < 0.05) and higher immuno-inflammatory indexes (p < 0.05) compared to nonneoplastic polyps. Dysplasia status, polyp diameter, and sigmoid colon localization were significant factors in determining neoplastic growth potential. No significant differences were observed in polyp localization in the proximal and distal colon segments or in solitary versus multiple polyps. The CALLY and HALP scores and immuno-inflammatory indexes can serve as valuable markers for distinguishing neoplastic from nonneoplastic polyps. These indexes reflect underlying inflammatory and immune responses, highlighting their potential utility in the early detection and risk stratification of colorectal polyps. Integrating these markers into clinical practice may enhance diagnostic accuracy and improve patient management, leading to timely interventions and better outcomes for individuals at risk of CRC.

Introduction: colorectal cancer is the third most common cancer worldwide. Most colorectal cancers arise from adenomatous polyps. Targeted biopsies of polyps and referral for histopathological processing require a significantly longer period to obtain a final diagnosis, and the procedure itself entails significant material costs. On the other hand, "in vivo" histology employs established classification schemes to reduce or eliminate the need for "ex vivo" pathological analysis. Aim: to assess the reliability of the NICE classification using NBI technology in characterizing and predicting the histopathological structure of small and intermediate colorectal polyps. Materials and Methods: the study was conducted as a clinical, prospective, longitudinal study at the Clinic of Gastroenterohepatology of the Clinical Center University of Sarajevo. The target population in this study included patients of both sexes who underwent colonoscopy. The final sample included 68 patients and 100 polyps. Results: in the case of small polyps, Cramer's V coefficient indicates a strong, the contingency coefficient a moderately strong, and the polychoric correlation coefficient a very strong relationship between NICE type and histopathological categorization of colorectal polyps. For intermediate polyps, Cramer's V and the contingency coefficient indicate a strong, and the polychoric correlation coefficient a very strong relationship between NICE type and histopathological categorization of colorectal polyps. The area under the ROC curve is 0.834 and statistically significant, implying that the NICE classification has very good to excellent predictive power in identifying the malignant nature of small and intermediate colorectal polyps. Conclusion: this study suggests the possibility of reliable endoscopic "in vivo" assessment of the biological potential of colorectal polyps. [ABSTRACT FROM AUTHOR]

Background and Aim: A hemostatic gel, PuraStat (3‐D Matrix, Tokyo, Japan), is used for various gastrointestinal hemostasis. In this study, we analyzed the efficacy of PuraStat for perioperative bleeding (POB) and prevention of delayed bleeding (DB) to colorectal cold snare polypectomy (CSP) with continuous anticoagulant. Methods: This was a single‐center, retrospective study. Subjects were lesions of 2–9 mm under continuous anticoagulant from 2021 to 2023 and treated with PuraStat for POB. The definition of POB was bleeding which did not stop spontaneously by 1.0–1.5 min after resection and needed hemostasis. Successful hemostasis was defined as cessation of bleeding within 1.0–1.5 min after spraying PuraStat and the rate of it and risk factors of POB were analyzed. For comparison, cases receiving previous CSP without PuraStat were extracted from all cases with CSP (2018‐2021), and POB and DB rate (DBR) were analyzed after propensity score matching. Results: One hundred twenty‐two lesions (91: direct oral anticoagulant (DOAC), 31: warfarin) with anticoagulant were analyzed and the rate of successful hemostasis with PuraStat was 92.6% (DOAC/warfarin: 93.4%/80.6%, P = 0.01). The rate of DB was 0.0%. Multivariate analysis showed that significant risk factors about unsuccessful hemostasis for POB with PuraStat were lesion size 8–9 mm (P < 0.01), warfarin (P = 0.01), and combination of antiplatelet (P = 0.01). Regarding the comparison about CSP with/without PuraStat, the clipping rate and DBR were 8.5%/94.9% (P < 0.01) and 0%/1.7% (P = 1.0). Conclusion: The effects of PuraStat for POB and DB in colorectal CSP with continuous anticoagulant were acceptable. [ABSTRACT FROM AUTHOR]

Colorectal endoscopic mucosal resection (EMR) is associated with the risk of postoperative wound infections, prompting investigations into effective prophylactic measures. This meta‐analysis aimed to evaluate the efficacy of various prophylactic interventions in reducing the incidence of wound infections following EMR. Adhering to PRISMA guidelines, we conducted a comprehensive search across multiple databases for randomized controlled trials (RCTs) and cohort studies from 2015 to 2022. We included studies that compared the efficacy of antibiotic prophylaxis and antiseptic measures, with clear data on post‐procedure infection rates. Eight studies met our inclusion criteria, and data were extracted for meta‐analysis. The risk of bias was assessed using the Cochrane Collaboration tool and the Newcastle‐Ottawa Scale. The meta‐analysis included 3765 patients from eight RCTs. Prophylactic antibiotics (cefixime and cefuroxime) showed moderate to high efficacy, with infection rates as low as 0% and 0.76%. Prophylactic endoscopic closure and clipping showed the highest efficacy, with zero reported infections. The standardized surgical site infection prevention bundle had lower effectiveness, with an infection incidence of 3.83%. The risk of bias assessment indicated potential performance bias due to lack of blinding, but overall evidence quality was upheld by proper random sequence generation and diligent outcome data monitoring. The effectiveness of specific prophylactic measures, notably prophylactic antibiotics and mechanical closure techniques, has been shown in significantly reducing the risk of wound infections following colorectal EMR. [ABSTRACT FROM AUTHOR]

Background: Recent studies showed contrasting associations between Helicobacter pylori infection and organic bowel disorders, where positive associations were reported in colorectal carcinoma (CRC) and colorectal polyp. In contrast, a protective association was observed in patients with inflammatory bowel diseases (IBD). We aim to determine the association between H. pylori infection and CRC, colorectal polyps, and IBD in Indonesian tertiary Hospitals. Method: We retrospectively collected electronic medical record data from patients referred to Dr. Cipto Mangunkusumo General National Hospital from 2010 to 2021 who underwent endoscopies and H. pylori tests. We performed a chi-square analysis with a significant p-value of < 0.05. Results: Three hundred and fourteen patients were enrolled. Overall, the prevalence of H. pylori infection in organic bowel disease was 61.7% (n = 194), with 9.9% (n = 31) of them having CRC, 20.3% having colorectal polyps (n = 64), and 31.5% (n = 99) having IBD. A significant association between H. pylori infection and IBD was observed (RR = 0.36; 95% CI: 0.18-0.70; p = 0.000). However, no significant association was found between H. pylori infection and CRC (RR = 0.60; 95% CI: 0.22-1.66; p = 0.31) and colon polyps (RR = 0.59; 95% CI: 0.30-1.15; p = 0.10). Conclusion: This study showed H. pylori infection lowers the risk of IBD (RR = 0.36; 95% CI: 0.18-0.70; p = 0.000). However, insignificant association was observed between H. pylori infection, CRC, and colorectal polyps. [ABSTRACT FROM AUTHOR]

BackgroundPolyDeep is a computer-aided detection and classification (CADe/x) system trained to detect and classify polyps. During colonoscopy, CADe/x systems help endoscopists to predict the histology of colonic lesions.ObjectiveTo compare the diagnostic performance of PolyDeep and expert endoscopists for the optical diagnosis of colorectal polyps on still images.MethodsPolyDeep Image Classification (PIC) is an in vitro diagnostic test study. The PIC database contains NBI images of 491 colorectal polyps with histological diagnosis. We evaluated the diagnostic performance of PolyDeep and four expert endoscopists for neoplasia (adenoma, sessile serrated lesion, traditional serrated adenoma) and adenoma characterization and compared them with the McNemar test. Receiver operating characteristic curves were constructed to assess the overall discriminatory ability, comparing the area under the curve of endoscopists and PolyDeep with the chi- square homogeneity areas test.ResultsThe diagnostic performance of the endoscopists and PolyDeep in the characterization of neoplasia is similar in terms of sensitivity (PolyDeep: 89.05%; E1: 91.23%, p=0.5; E2: 96.11%, p

ABSTRACT Background: Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is recognized as a risk factor for interval cancer. Objective: The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. Methods: We prospectively evaluated 479 polyps 30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. Conclusion: CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.

Abstract Objective To investigate the correlation between colorectal polyps (CRP) and Helicobacter pylori (H. pylori) infection, and the correlation between CRP and the expression of phosphorylated ribosomal protein S6 kinase (p-S6K1). Besides, its related influencing factors were determined in the present study. Methods A total of 191 subjects who underwent colonoscopy in our hospital from January 2020 to February 2022 were selected for this study. Among them, 141 patients were diagnosed with CRP, and the other 50 subjects were no significant colorectal abnormalities. 141 CRP patients were divided into H. pylori-positive group (n = 89) and H. pylori-negative group (n = 52) according to the results of the H. pylori test. The expression of p-S6K1 in CRP tissue was detected. The relationship between the p-S6K1 expression and the clinicopathological characteristics of CRP patients was analyzed. The logistic analysis of factors influencing the occurrence of CRP was performed. Results There were significant differences in pathological type, site of disease, the number and size of polyps between the H. pylori negative group and the H. pylori positive group (P

Background: Colorectal Polyps are the main source of precancerous lesions in colorectal cancer. To increase the early diagnosis of tumors and improve their screening, we aimed to develop a simple and non-invasive diagnostic prediction model for colorectal polyps based on machine learning (ML) and using accessible health examination records. Methods: We conducted a single-center observational retrospective study in China. The derivation cohort, consisting of 5426 individuals who underwent colonoscopy screening from January 2021 to January 2024, was separated for training (cohort 1) and validation (cohort 2). The variables considered in this study included demographic data, vital signs, and laboratory results recorded by health examination records. With features selected by univariate analysis and Lasso regression analysis, nine machine learning methods were utilized to develop a colorectal polyp diagnostic model. Several evaluation indexes, including the area under the receiver-operating-characteristic curve (AUC), were used to compare the predictive performance. The SHapley additive explanation method (SHAP) was used to rank the feature importance and explain the final model. Results: 14 independent predictors were identified as the most valuable features to establish the models. The adaptive boosting machine (AdaBoost) model exhibited the best performance among the 9 ML models in cohort 1, with accuracy, sensitivity, specificity, positive predictive value, negative predictive value, F1 score, and AUC (95% CI) of 0.632 (0.618–0.646), 0.635 (0.550–0.721), 0.674 (0.591–0.758), 0.593 (0.576–0.611), 0.673 (0.654–0.691), 0.608 (0.560–0.655) and 0.687 (0.626–0.749), respectively. The final model gave an AUC of 0.675 in cohort 2. Additionally, the precision recall (PR) curve for the AdaBoost model reached the highest AUPR of 0.648, positioning it nearest to the upper right corner. SHAP analysis provided visualized explanations, reaffirming the critical factors associated with the risk of colorectal polyps in the asymptomatic population. Conclusions: This study integrated the clinical and laboratory indicators with machine learning techniques to establish the predictive model for colorectal polyps, providing non-invasive, cost-effective screening strategies for asymptomatic individuals and guiding decisions for further examination and treatment.