Analysis of 234 cases of colorectal polyps treated by endoscopic mucosal resection

Prediction of recurrence of early gastric carcinoma after endoscopic submucosal dissection

Background

The aim of this retrospective study was to predict the post-endoscopic submucosal dissection (ESD) recurrence risk of early gastric carcinoma (EGC) using a nomogram model, and to provide valuable evidence for preventing the recurrence.

Methods

The patients with EGC receiving ESD between March 2010 and February 2018 were enrolled. They were followed up once every three months after ESD. At the end of follow-up, they were assigned into recurrence and non-recurrence groups. The independent risk factors for post-ESD recurrence were identified using Cox regression analysis. A nomogram prediction model was established, and its predictive efficiency was assessed by plotting receiver operating characteristic (ROC) curve.

Results

Helicobacter pylori (HP) infection, number of positive lymph nodes >3 and a large amount of intraoperative hemorrhage were risk factors for post-ESD recurrence. According to multivariate Cox regression analysis, HP infection and number of positive lymph nodes >3 were independent predictors. The nomogram model had a good fitting effect, and the area under ROC curve was 0.933 (95% confidence interval: 0.919-0.947), suggesting a high predictive efficiency.

Conclusion

Positive lymph nodes and HP infection are closely correlated with the recurrence risk after ESD in EGC patients. The established model is a quantitative tool for predicting recurrence to improve the prognosis.

Diagnostic value of a novel endoscopic optical staining technique for colorectal polyps less than 2 cm in diameter

BACKGROUND

The detection and treatment of early and small colorectal polyps are the key to preventing colorectal cancer. Spectral focused imaging (SFI) and variable intelligent staining technology (VIST), a novel optical staining technology of domestic endoscop, have high clinical value in the setting of adjuvant therapy.

AIM

To investigate the diagnostic value of SFI and VIST for colorectal polyps less than 2 cm in diameter.

METHODS

A total of 200 cases of colorectal polyps diagnosed at our hospital from January 2022 to October 2022 were selected. White light mode and SFI and VIST technology were used to observe the morphology of intestinal polyps, glandular duct opening type, and capillary morphology, and resolution scoring was made. Using pathological diagnosis as the golden standard, the diagnostic value of the novel optical staining technique for colorectal polyps less than 2 cm in diameter was evaluated.

RESULTS

There were 78 (38%) type 1, 114 (55%) type 2, and 16 (8%) type 3 polypoid lesions. Pathological results showed that there were 76 non-adenomatous polyps (37%) and 132 adenomatous polyps (64%). Compared with white light mode, the diagnostic sensitivity, specificity, and accuracy of the novel optical staining mode were significantly higher (P < 0.05). The sensitivity and specificity of the novel optical staining mode for adenomatous polyps with diameters smaller than 1 cm and 1 cm to 2 cm were 92.69% and 92.21%, and 86.34 and 91.40%, respectively, and the accuracy was 90.60% and 92.02%, respectively. For colorectal polyp lesions with different diameters, the Kappa values between the diagnosis results based on conventional white light mode and novel staining technology and pathological diagnosis were 0.789 and 0.831, respectively.

CONCLUSION

Compared with the conventional white light mode of colonoscopy, the detection rate for colorectal polyps and the success rate for diagnosis of adenomatous polyps can be improved by the novel optical staining technique of domestic endoscopy. The novel optical staining technique is of high value in the observation and diagnosis of colorectal adenomatous polyps with a diameter less than 2 cm.

The value of colorectal filling contrast ultrasonography in diagnosing pediatric juvenile polyps

OBJECTIVES

To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and explore its value in the diagnosis of pediatric juvenile polyps.

METHODS

One hundred and eleven children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS) and CFCUS prior to undergoing colonoscopy. Pathologic findings were used as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis.

RESULTS

Forty-five children with fifty-two colorectal polyps were confirmed via pathological examination. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs. CTUS were 92.3% versus 80.7%, 100% versus 100%, 100% versus 100%, and 93.3% versus 84.8%, respectively. The missed polyps were significantly smaller than the polyps detected in diameter (7.50 ± 2.12 mm vs. 19.62 ± 7.89 mm, p < 0.0001) by CTUS. A significant difference between CTUS and CFCUS was observed in the detection rate of polyps with a diameter < 1 cm (p = 0.031) and pedicles (p < 0.001). The kappa values for the assessment of Yamada's classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Moreover, CFCUS incidentally revealed a punctate hyperechoic area on the surface of colonic polyps in six cases, which may be suggestive of a correlation with erosion and bleeding findings.

CONCLUSION

CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada's classification, providing useful preoperative information for colonoscopy.