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Wang X, Cao L, Song X, Zhu G, Ni B, Ma X, Li J. Is flexible sigmoidoscopy screening associated with reducing colorectal cancer incidence and mortality? a meta-analysis and systematic review. Front Oncol 2023; 13:1288086. [PMID: 38162502 PMCID: PMC10757863 DOI: 10.3389/fonc.2023.1288086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
Background The question of whether flexible sigmoidoscopy (FS) for colorectal cancer (CRC) affects incidence or mortality remains unclear. In this study, we conducted a meta-analysis and systematic review to explore this issue. Methods A systematic search of PubMed, EMBASE, and ClinicalTrials.gov was performed for cohort studies (CS), case-control studies, and randomized controlled trials (RCTs) of people who underwent FS and reported mortality or incidence of CRC until 11 December 2022. Relative risk (RR) was applied as an estimate of the effect of interest. To combine the RRs and 95% confidence intervals, a random-effects model was used. The quality of the included studies and evidence was assessed by the Newcastle-Ottawa quality assessment scale, the Jadad scale, and the "Grading of Recommendations Assessment, Development and Evaluation System." Results There were a total of six RCTs and one CS, comprising 702,275 individuals. FS was found to be associated with a 26% RR reduction in CRC incidence (RR, 0.74; 95% CI, 0.66-0.84) and a 30% RR reduction in CRC mortality (RR, 0.70; 95% CI, 0.58-0.85). In the incidence subgroup analysis, FS significantly reduced the incidence of CRC compared with non-screening, usual care, and fecal immunochemical testing. Significance was also shown in men, women, distal site, stages III-IV, ages 55-59, and age over 60. In terms of the mortality subgroup analysis, the results were roughly the same as those of incidence. Conclusion According to this study, FS might reduce the incidence and mortality of CRC. To confirm this finding, further prospective clinical studies should be conducted based on a larger-scale population. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42023388925.
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Affiliation(s)
- Xinmiao Wang
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Luchang Cao
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaotong Song
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanghui Zhu
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Baoyi Ni
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyi Ma
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Li
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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2
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Yang H, Deng HM, Chen HY, Tang SH, Deng F, Lu YG, Song JC. The Impact of Age on Propofol Requirement for Inducing Loss of Consciousness in Elderly Surgical Patients. Front Pharmacol 2022; 13:739552. [PMID: 35418861 PMCID: PMC8996377 DOI: 10.3389/fphar.2022.739552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
It is generally accepted that geriatric patients are more sensitive to propofol than adults; thus, a dose-adjusted propofol is recommended for these patients during the induction of anesthesia. However, for patients aged 75 years and over, established guidelines for propofol induction doses do not provide dose references. To this end, we observed 80 surgical patients (female 39, male 41, American Society of Anesthesiologists physical status score I ∼ II) to access the appropriate dose of propofol for inducing loss of consciousness (LOC). Accordingly, patients were subdivided into group A (20 patients, 45–64 years), group B (20 patients, 65–74 years), group C (20 patients, 75–84 years), and group D (20 patients, ≥ 85 years). All patients received propofol (at a rate of 0.3 mg/kg/min) alone for inducing LOC, which was defined by loss of both eyelash reflex and verbal response. Compared with group A, the propofol requirement for LOC in Group B, C and D decreased by 14.8, 25.2 and 38.5%, respectively. Bivariate linear correlation analysis showed that propofol requirement was negatively correlated with age. After adjusting for potential confounders, age was still an independent factor affecting propofol requirement. In conclusion, the propofol requirement for inducing LOC decreased significantly in elderly patients. We demonstrated that age was an independent factor impacting propofol requirement for LOC during the induction of general anesthesia, implying that the propofol dose for anesthesia induction should be further reduced in elderly surgical patients, especially those aged 75 years and over.
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Affiliation(s)
- Hua Yang
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Hui-Min Deng
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai-Yan Chen
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Shu-Heng Tang
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Fang Deng
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Yu-Gang Lu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Chao Song
- Department of Anesthesiology, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
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3
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Chae H, Yang HJ, Park SK, Jung YS, Park JH, Park DI, Sohn CI. Metabolically Healthy Obesity Is Associated with an Increased Risk of Colorectal Adenoma Occurrence Diagnosed by Surveillance Colonoscopy. Gut Liver 2021; 15:383-390. [PMID: 32616681 PMCID: PMC8129661 DOI: 10.5009/gnl20084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/30/2020] [Accepted: 05/25/2020] [Indexed: 12/24/2022] Open
Abstract
Background/Aims The risk of recurrence of colorectal adenoma among obese individuals without metabolic abnormalities or in those with metabolically healthy obesity is largely unexplored. Therefore, we longitudinally investigated the risk of adenoma occurrence in individuals undergoing surveillance colonoscopy according to metabolic status and obesity. Methods This retrospective cohort study included 16,872 Korean adults who underwent their first screening colonoscopy between 2003 and 2012 and who then underwent follow-up colonoscopy until 2017. Participants were categorized into a metabolically healthy nonobese group (reference group), a metabolically healthy obese group, a metabolically abnormal nonobese group, and a metabolically abnormal obese group. Hazard ratios (HRs) for adenoma recurrence compared to the reference group were calculated in each group. Results During a median follow-up duration of 47.3 months (interquartile range, 35.6 to 58.9 months), 3,673 (21.8%) and 292 (1.73%) participants developed adenoma and advanced adenoma, respectively. When age, sex, smoking, alcohol consumption, family history of colorectal cancer, and baseline adenoma risk were adjusted, the risk of adenoma recurrence was increased in metabolically healthy obese individuals (HR, 1.33; 95% confidence interval [CI], 1.12 to 1.57) and metabolically abnormal obese individuals (HR, 1.18; 95% CI, 1.08 to 1.30) but not in metabolically abnormal nonobese individuals (HR, 1.03; 95% CI, 0.94 to 1.13). Conclusions In this study, metabolically healthy obese individuals and metabolically abnormal obese individuals exhibited increased risks of occurrence of colorectal adenoma diagnosed by surveillance colonoscopy. This finding implies that obesity itself, even without metabolic abnormalities, is associated with an increased risk of adenoma recurrence. (Gut Liver 2021;15-390)
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Affiliation(s)
- Hyunbeom Chae
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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4
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Bhandari P, Longcroft-Wheaton G, Libanio D, Pimentel-Nunes P, Albeniz E, Pioche M, Sidhu R, Spada C, Anderloni A, Repici A, Haidry R, Barthet M, Neumann H, Antonelli G, Testoni A, Ponchon T, Siersema PD, Fuccio L, Hassan C, Dinis-Ribeiro M. Revising the European Society of Gastrointestinal Endoscopy (ESGE) research priorities: a research progress update. Endoscopy 2021; 53:535-554. [PMID: 33822332 DOI: 10.1055/a-1397-3005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. METHODS As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinical practice); (2) remains a priority (i. e. the above criterion was not met); (3) redefine the existing priority (i. e. the priority was too vague with the research question not clearly defined). RESULTS The previous ESGE research priorities document published in 2016 had 26 research priorities under seven domains. Our review of these priorities has resulted in seven priorities being removed from the list, one priority being partially removed, another seven being redefined to make them more precise, with eleven priorities remaining unchanged. This is a reflection of a rapid surge in endoscopic research, resulting in 27 % of research questions having already been answered and another 27 % requiring redefinition. CONCLUSIONS Our extensive review process has led to the removal of seven research priorities from the previous (2016) list, leaving 19 research priorities that have been redefined to make them more precise and relevant for researchers and funding bodies to target.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | | | - Diogo Libanio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Eduardo Albeniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed-UPNA-IdiSNA, Pamplona, Spain
| | - Mathieu Pioche
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Digestive Endoscopy Unit, IRCSS Humanitas Research Hospital, Milan, Italy
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany.,GastroZentrum Lippe, Bad Salzuflen, Germany
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy.,Nuovo Regina Margherita Hospital, Rome, Italy.,Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Mario Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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5
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Yoo KM, Yang HJ, Park SK, Jung YS, Park JH, Park DI, Sohn CI. Skeletal muscle mass and risk of advanced adenoma in surveillance colonoscopy. J Gastroenterol Hepatol 2020; 35:2088-2095. [PMID: 32350914 DOI: 10.1111/jgh.15082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Sarcopenia has been suggested to be associated with chronic inflammation and insulin resistance. This study aimed to evaluate whether low muscle mass is associated with the incidence and recurrence of advanced colorectal adenoma. METHODS We conducted a cohort study including 14 701 participants who underwent first-time screening colonoscopy between 2003 and 2012 and follow-up colonoscopy until 2017. Skeletal muscle mass was measured using a bioelectrical impedance analyzer and divided by body weight to calculate the skeletal muscle mass index (SMI). RESULTS During a median 47 (interquartile range, 35-58) months of follow-up, overall and advanced adenoma developed in 2988 (20.3%) and 207 (1.41%) participants, respectively. In multivariate analysis using models adjusted for baseline adenoma risk, lifestyle factors, markers for insulin resistance and chronic inflammation, and metabolic syndrome, decreasing SMI quartiles were associated with increased risk of occurrence of advanced adenoma and overall adenoma. The adjusted hazard ratios (95% confidence intervals) comparing SMI quartiles 3, 2, and 1 to quartile 4 were 1.57 (1.03-2.41), 1.22 (0.78-1.92), and 1.77 (1.13-2.76), respectively, for advanced adenoma (P for trend = 0.049) and 1.05 (0.95-1.17), 1.09 (0.98-1.21), and 1.26 (1.13-1.41), respectively, for overall adenoma (P for trend < 0.001). CONCLUSIONS In this large cohort with long-term colonoscopy follow-up, low relative muscle mass was associated with increased risk of occurrence of advanced adenoma and overall adenoma at follow-up colonoscopy, independent of metabolic and inflammatory markers. Timely and thorough surveillance colonoscopy may be emphasized in such populations.
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Affiliation(s)
- Kyung Mo Yoo
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-Joon Yang
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Suk Jung
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Ho Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Il Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chong Il Sohn
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hao Y, Wang Y, Qi M, He X, Zhu Y, Hong J. Risk Factors for Recurrent Colorectal Polyps. Gut Liver 2020; 14:399-411. [PMID: 31547641 PMCID: PMC7366149 DOI: 10.5009/gnl19097] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/22/2019] [Accepted: 06/05/2019] [Indexed: 12/12/2022] Open
Abstract
The recurrence of colorectal polyps is caused by various factors and leads to the carcinogenesis of colorectal cancer, which ranks third in incidence and fourth in mortality among cancers worldwide. The potential risk factors for colorectal polyp recurrence have been demonstrated in multiple trials. However, an article that pools and summarizes the various results is needed. This review enumerates and analyzes some risk factors in terms of patient characteristics, procedural operations, polyp characteristics, and dietary aspects to propose some effective prophylactic measures. This review aimed to provide a reference for clinical application and guide patients to prevent colorectal polyp recurrence in a more effective manner.
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Affiliation(s)
- Yuanzhen Hao
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Joint Programme of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Yining Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Joint Programme of Nanchang University and Queen Mary University of London, Nanchang, China.,Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shangha
| | - Miao Qi
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.,Joint Programme of Nanchang University and Queen Mary University of London, Nanchang, China
| | - Xin He
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ying Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Junbo Hong
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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7
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Raju GS, Lum P, Abu-Sbeih H, Ross WA, Thirumurthi S, Miller E, Lynch P, Lee J, Bhutani MS, Shafi M, Weston B, Rashid A, Wang Y, Chang GJ, Carlson R, Hagan K, Davila M, Stroehlein J. Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate. Endosc Int Open 2020; 8:E115-E121. [PMID: 32010742 PMCID: PMC6976333 DOI: 10.1055/a-1012-1811] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patients and methods This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence. Results Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30-45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site. Conclusions We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study.
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Affiliation(s)
- Gottumukkala S. Raju
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Phillip Lum
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - William A. Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Selvi Thirumurthi
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ethan Miller
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Patrick Lynch
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jeffrey Lee
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Mehnaz Shafi
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Brian Weston
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - George J. Chang
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Richard Carlson
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Katherine Hagan
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Marta Davila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - John Stroehlein
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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8
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Oh DM, Lee JK, Kim H, Park CK, Jung JK, Kim DJ, Chung YJ, Kim TH, Park MI, Park JP. Local Recurrence and Its Risk Factor after Incomplete Resection of Colorectal Advanced Adenomas: A Single Center, Retrospective Study. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017; 70:33-38. [PMID: 28728314 DOI: 10.4166/kjg.2017.70.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background/Aims Colonoscopy can detect precancerous lesions, which can subsequently be removed and reduce incidences of and mortality from colorectal cancer (CRC). However, recently published data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons, incomplete resection has been considered as a significant contributor. However, to date, there have only been a few studies regarding incompletely resected polyps, especially advanced colorectal adenoma (ACA). Hence, we aimed to evaluate the prognosis of incompletely resected ACA. Methods We retrospectively reviewed the medical records of patients with ACA who had underwent endoscopic treatment with incomplete resection. The primary outcomes were (1) the incomplete resection rate of ACA, as determined by a histopathologic examination and (2) the recurrence rate of incompletely resected ACA. We also investigated the probable contributing factors that may have led to a relapse of incompletely resected ACA. Results A total of 7,105 patients had their colorectal polyps resected by endoscopic treatment, and 2,233 of these were considered as ACA. Of these, 354 polyps (15.8%) were resected incompletely, and only 163 patients were followed-up. Of those followed-up, 31 patients (19.0%) experienced local recurrence. The risk factors for recurrence after incomplete resection were evaluated; age, morphology of adenoma, and use of rescue therapy, such as argon plasma coagulation, were found to be associated with adenoma recurrence. Conclusions Incompletely resected ACA in older patients or in patients with sessile-type adenomas should be monitored strictly, and if incomplete resection is suspected, rescue therapy must be considered.
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Affiliation(s)
- Dae Myung Oh
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jae Kwang Lee
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Hyunsoo Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Chang Keun Park
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jae Kwon Jung
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Jin Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Yun Jin Chung
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Tae Hoon Kim
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Myung Il Park
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Jong Pil Park
- Division of Gastroenterology, Department of Internal Medicine, Daegu Fatima Hospital, Daegu, Korea
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9
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Pontone S, Palma R, Panetta C, Pironi D, Eberspacher C, Angelini R, Pontone P, Catania A, Filippini A, Sorrenti S. Endoscopic mucosal resection in elderly patients. Aging Clin Exp Res 2017; 29:109-113. [PMID: 27837459 DOI: 10.1007/s40520-016-0661-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/18/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) of early superficial colorectal carcinomas is nowadays accepted as the gold standard treatment for this type of neoplasia. AIM This study aims to evaluate the efficacy and safety of mucosectomy in elderly patients considering the predictive value of submucosal infiltration. METHODS A retrospective study of all patients referred for EMR of sessile colorectal polyps classified IIa by the Paris classification between April 2013 and April 2015. A total of 50 patients (30 males (60 %); age range = 44-86; mean age = 67.7) were enrolled. Patients were divided in two groups considering 65 years as cutoff to individuate the elderly patients. RESULTS EMR was performed in 53 lesions: 39 were performed en bloc and 14 by piecemeal technique. 30 % of lesions were in the rectum; 11 % in the sigmoid colon; 15 % in the descending colon; 6 % in the transverse colon; 24 % in the ascendant colon; and 14 % in the cecum. The mean size of the resected specimens was 20 mm (range 8-80 mm). The rate of complete resection was 79.2 %, incomplete 13.2 %, not estimable 7 %. Ten patients underwent surgery because of an incomplete resection and/or histological evaluation. CONCLUSIONS Colon EMR is safe and effective in elderly patients. Endoscopy is still helped in the correct indication for surgery in high-risk surgical patients.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy.
| | - Rossella Palma
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Daniele Pironi
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Chiara Eberspacher
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Rita Angelini
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Paolo Pontone
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Antonio Catania
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Angelo Filippini
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, "Sapienza" University of Rome, V.le Regina Elena n°324, 00161, Rome, Italy
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Pommergaard HC, Burcharth J, Rosenberg J, Raskov H. The association between location, age and advanced colorectal adenoma characteristics: a propensity-matched analysis. Scand J Gastroenterol 2017; 52:1-4. [PMID: 27686516 DOI: 10.1080/00365521.2016.1218929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Evidence supports an association between certain colorectal adenoma characteristics and predisposition to cancer. The association between anatomical location of colorectal adenoma, age and advanced adenomas needs attention. The objective of this study was to evaluate the possible association between occurrence of sporadic advanced adenomas with location and age. MATERIALS AND METHODS A cross-sectional study using baseline data from index colonoscopy from a randomized controlled trial evaluating chemopreventive treatment against recurrence of colorectal adenomas was performed. Inclusion criteria for patients were one adenoma of >1 cm in diameter or multiple adenomas of any size, or an adenoma of any size and familial disposition for colorectal cancer. Multivariate regression and propensity score-matched analyses were used to correlate location of adenomas and age with advanced adenoma features. RESULTS In this study, 2149 adenomas were removed in 1215 patients. Advanced colorectal adenomas primarily occurred in the anal part of the colon. Older age was associated with more adenomas and more oral occurrence of adenomas, as well as a higher risk of advanced adenomas. Surprisingly, specifically for the oral adenomas the risk of advanced adenoma seems to be lower for older patients compared with younger. CONCLUSIONS This study presents new results with regard to association between age, location of adenomas and risk of advanced adenomas. The results indicate that sigmoidoscopy for screening purposes may be obsolete, and add to the existing literature on which future guidelines for screening may be based.
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Affiliation(s)
| | - Jakob Burcharth
- b Department of Surgery , Zealand University Hospital - University of Copenhagen , Køge , Denmark
| | - Jacob Rosenberg
- c Department of Surgery , Herlev Hospital - University of Copenhagen , Herlev , Denmark
| | - Hans Raskov
- d Speciallægecentret ved Diakonissestiftelsen , Frederiksberg , Denmark
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11
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Lu HY, Lin RT, Zhou GX, Yu TM, Liu ZJ. Critical Role of p53 and K-ras in the Diagnosis of Early Colorectal Cancer: a One-year, Single-center Analysis. Int J Med Sci 2017; 14:1154-1162. [PMID: 29104470 PMCID: PMC5666547 DOI: 10.7150/ijms.20538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/07/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Colorectal cancer (CRC) is strongly associated with colorectal polyps, which has become the third most common cancer in China. In the present study, we revealed the susceptible population and risk factors of colorectal polyps, and analyzed the expression of Ki-67, p53 and K-ras in the intestinal mucosa of patients with colorectal polyps in order to explore their significance in the detection and prognosis of CRC at an early stage. Materials and Methods: Total 801 cases of colorectal polyps were collected during endoscopic resection including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Expression of Ki-67, p53 and K-ras in the intestinal mucosa was detected by immunohistochemistry and quantitative real-time polymerase chain reaction (qRT-PCR), respectively. Histological analysis was performed by Hematoxylin and eosin (HE) staining. Categorical variables were compared by one-way ANOVA, Pearson test, Spearman test, Kruskal-Wallis test and analysis of regression. Results: Of all patients with colorectal polyps, 90.76% of patients (n = 727) were ≥ 50 years old. 530 cases (66.17%) were males compared with 271 females (33.83%) in all 801 cases. More importantly, 1.03% patients (n = 7) underwent polypectomy and histological examination was confirmed to be the early stage of CRC. The expression of p53 was found to be significantly decreased, while K-ras was increased in tumor tissues of CRC compared with that in hyperplastic polyps and healthy controls. Conclusions: 1.03% patients (n = 7) underwent polypectomy was confirmed to be the early stage of CRC. Histological analysis for expression of p53 and K-ras can guarantee to screen the early stage of CRC.
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Affiliation(s)
- Hui-Ying Lu
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Ri-Tian Lin
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Guang-Xi Zhou
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Tian-Ming Yu
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Zhan-Ju Liu
- Department of Gastroenterology, The Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
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Kim NH, Park JH, Park DI, Sohn CI, Choi K, Jung YS. Metabolic syndrome is a risk factor for adenoma occurrence at surveillance colonoscopy: A single-center experience in Korea. Medicine (Baltimore) 2016; 95:e4454. [PMID: 27512862 PMCID: PMC4985317 DOI: 10.1097/md.0000000000004454] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 12/13/2022] Open
Abstract
We investigated the risk factors for adenoma occurrence at surveillance colonoscopy, especially focusing on patient characteristics, including metabolic factors.Surveillance colonoscopy intervals depend on baseline adenoma characteristics. However, patients' characteristics may also influence the occurrence of adenomas.Of 62,171 asymptomatic subjects who underwent colonoscopy for a health check-up between 2010 and 2011, 4869 subjects who underwent follow-up colonoscopy between 2012 and 2013 were included in this longitudinal study. The risk of adenoma occurrence was assessed using Cox proportional hazards modeling.Of 4869 subjects, 2827 (58.1%), 1619 (33.3%), and 423 (8.7%) were assigned to the normal, low-risk, and high-risk groups, respectively, according to baseline adenoma characteristics. The mean interval between initial and follow-up colonoscopy was 2.2 ± 0.6 years. Certain patient factors, including older age (≥50 years; adjusted hazard ratio [aHR], 2.08; 95% CI, 1.73-2.49), male sex (aHR, 1.69; 95% CI, 1.30-2.19), metabolic syndrome (MetS) (aHR, 1.28; 95% CI, 1.09-1.51), obesity (aHR, 1.17; 95% CI, 1.02-1.34), elevated fasting blood glucose levels (aHR, 1.37; 95% CI, 1.19-1.58), and elevated triglyceride levels (aHR, 1.19; 95% CI, 1.03-1.37), as well as baseline adenoma characteristics, were associated with a higher risk of adenoma occurrence at follow-up colonoscopy. The cumulative incidence of adenoma occurrence in the high-risk group was higher than that in the low-risk group, whereas the incidence in the high-risk group without MetS was comparable with that in the low-risk group with MetS.Patient characteristics, such as MetS, obesity, older age, and male sex, in addition to adenoma characteristics, were independent risk factors for adenoma occurrence at surveillance colonoscopy. These patient characteristics may be considered in surveillance colonoscopy intervals.
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