Prevalence and predictive factors of the need for surgery for advanced colorectal adenoma

Effect of implementing a regional referral network on surgical referral rate of benign polyps found during a colorectal cancer screening program: A population-based study

INTRODUCTION

Surgical management is too often performed as the first-line treatment for large, benign colorectal polyps. We report the management of benign lesions detected by organised colorectal cancer (CRC) screening.

METHODS

Population-based study in 2012, 2016, and 2017, analyzing the evolution of surgical management of benign polyps of≥2cm diameter discovered in the context of organised CRC screening after the implementation of a regional referral network for the management of superficial colorectal lesions.

RESULTS

A total of 1571 patients underwent colonoscopy following a positive test during the study period, among which 981 colonoscopies yielded at least one lesion. The adenoma detection rate was lower in 2012 (Guaiac test) than in 2016 and 2017 (fecal immunochemical test) (40% vs. 60% vs. 57%, P<0.0001). The surgery rate for benign lesions decreased from 14.6% in 2012 to 7.7% in 2016 and 5% in 2017 (P=0.017). The risk factors for surgery for benign lesions were year 2012 (odds ratio [OR]=3.35, P=0.022), high-grade dysplasia (OR=2.49, P=0.04), in situ carcinoma (OR=5, P=0.003), size≥20mm (OR=17.39, P<0.0001), and private sector (OR=6.6, P=0.0002). The morbidity rate of surgery for benign polyp≥2cm was 20.4% at 1month and its cost was sixfold higher than that of endoscopy.

CONCLUSION

The establishment of a regional referral network for the management of large colorectal polyps reduces the rate of surgical management of such lesions.

Changes in Weight and Health-Related Behavior Using Smartphone Applications in Patients With Colorectal Polyps

OBJECTIVE

To assess the effectiveness of using a smartphone application for weight loss as well as a change in health-related behavior in patients with colorectal polyps over 3 months.

DESIGN

Randomized, controlled pilot trial.

SETTING

The Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.

PARTICIPANTS

Adults aged 25-65 years who were diagnosed with colorectal polyps.

INTERVENTIONS

A comparison of smartphone application data, with exercise and food intake diary data over 3 months.

MAIN OUTCOME MEASURES

Primary outcomes were weight reduction and an increase in physical activity. Secondary outcomes included changes in dietary intake, such as that of vegetables, fruits, and fatty food.

ANALYSIS

Student t test was used for continuous variables, and chi-square test for categorical variables.

RESULTS

Participants using the smartphone application experienced significant weight reduction compared with participants in the control group (mean change = -1.25 vs -0.42 kg; SD = 0.42 vs 1.23 kg). Moreover, use of the application and strict adherence to it significantly increased the level of physical activity (mean change = 1.57 vs 0.71 strenuous exercises/wk; SD = 1.09 vs 0.96 strenuous exercise/wk).

CONCLUSIONS AND IMPLICATIONS

Smartphone applications could be potential tools for weight control and physical activity in patients with colorectal polyps. Future larger randomized, controlled trials over a prolonged period are warranted to confirm these findings.

Decentralized colonoscopic surveillance with high patient compliance prevents hereditary and familial colorectal cancer

Although colonoscopic surveillance is recommended both for individuals with known hereditary colorectal cancer (HCRC) syndromes and those with a more moderate familial colorectal cancer (FCRC) history, the evidence for the benefits of surveillance is limited and surveillance practices vary. This study evaluates the preventive effect for individuals with a family history of CRC of decentralized colonoscopic surveillance with the guidance of a cancer prevention clinic. We performed a population based prospective study of 261 patients with HCRC or FCRC, recorded in the colonoscopic surveillance registry at the Cancer genetics clinic, University Hospital of Umeå, Sweden. Colonoscopic surveillance was conducted every second (HCRC) or fifth (FCRC) year at local hospitals in Northern Sweden. Main outcome measures were findings of high-risk adenomas (HRA) or CRC, and patient compliance to surveillance. Estimations of the expected numbers of CRC without surveillance were made. During a total of 1256 person years of follow-up, one case of CRC was found. The expected numbers of cancers in the absence of surveillance was between 9.5 and 10.5, resulting in a standardized incidence ratio, observed versus expected cases of CRC, between 0.10 (CI 95 % 0.0012-0.5299) and 0.11 (CI 95 % 0.0014-0.5857). No CRC mortality was reported, but three patients needed surgical intervention. HRA were found in 5.9 % (14/237) of the initial and in 3.4 % (12/356) of the follow-up colonoscopies. Patient compliance to the surveillance program was 90 % as 597 of the planned 662 colonoscopies were performed. The study concludes that colonoscopic surveillance with high patient compliance to the program is effective in preventing CRC when using a decentralized method for colonoscopy surveillance with the guidance of a cancer prevention clinic.

Expert opinions and scientific evidence for colonoscopy key performance indicators

Colonoscopy is a widely performed procedure with procedural volumes increasing annually throughout the world. Many procedures are now performed as part of colorectal cancer screening programmes. Colonoscopy should be of high quality and measures of this quality should be evidence based. New UK key performance indicators and quality assurance standards have been developed by a working group with consensus agreement on each standard reached. This paper reviews the scientific basis for each of the quality measures published in the UK standards.

The association between coronary calcification and adenomatous polyps of colon in Korean adults

BACKGROUND AND OBJECTIVE

Adenomatous polyps of colon is a precancerous lesion. Many studies have shown that the adenomatous polyps of colon and cardiovascular disease share several common risk factors. This cross-sectional study aimed to investigate whether coronary calcification is associated with the adenomatous polyps of colon.

METHODS

Among 1637 Korean adults, we examined the association between coronary calcium score (CCS) as a measurement of coronary calcification and the presence of adenomatous polyps of colon via multi-detected row computed tomography (MDCT) and colonoscopy, respectively. CCS values were categorized as follows: 0, 1-17, 18-105, or≥106. The odds ratios (ORs) and 95% confidence intervals (CIs) for the presence of adenomatous polyps of colon were calculated across CCS groups.

RESULTS AND CONCLUSIONS

After adjusting for confounding variables, the adjusted ORs (95% CIs) for the presence of adenomatous polyps of colon in each of the four CCS groups were 1.00 (reference), 1.44 (0.91-2.33), 1.88 (1.15-3.01) and 3.61 (2.23-5.74). And higher CCS values were associated with multiple polyps (P≤0.001), villous histologic features or high-grade dysplasia (P=0.02), and advanced adenomatous polyps (P≤0.001). A higher level of CCS was found to be strongly and independently associated with the presence of adenomatous polyps of colon in Korean adults. This finding suggests that people at high risk for coronary atherosclerosis through MDCT should be considered for further evaluation of adenomatous polyps.