Comparison of the detection of colorectal lesions in different endoscopic modalities: A network meta-analysis and systematic review

The role of BMI, serum lipid profile molecules and their derivative indexes in colorectal polyps

Objectives

To investigate the role of body mass index (BMI), serum lipid profile molecules and their derivative indexes in colorectal polyps.

Methods

A total of 352 individuals who underwent colonoscopy at our center were included in this retrospective analysis. Of these, 247 patients without evident abnormalities (control group), while 105 patients diagnosed with colorectal polyps (patient group). Serum lipid profile molecules and their derivative indexes were then compared between the two groups.

Results

The patient group exhibited significantly higher levels of total cholesterol (TC) and apolipoprotein B (ApoB) compared to the control group (p<0.05). In males, the patient group displayed elevated levels of ApoB and ApoB/ApoA1 ratio compared to the control group (p<0.05). Additionally, the triglycerides (TG) and TG/high-density lipoprotein-cholesterol (HDL-C) ratios were significantly higher in the multiple polyps group than in the single polyp group (p<0.05). Furthermore, the HDL-C and HDL-C/ApoA1 ratio levels were higher in the adenomatous polyp group when compared to the non-adenomatous polyp group (p<0.05). Multiple logistic regression analysis indicated that total cholesterol (TC), TG, low-density lipoprotein-cholesterol (LDL-C), TC/HDL-C ratio, TG/HDL-C ratio and LDL-C/HDL-C ratio were risk factors for the occurrence of colorectal polyps (p<0.05). ROC curve analyses revealed that TC, ApoB, and ApoB/ApoA1 ratio were associated with colorectal polyps. No significant difference in BMI between the two groups (p>0.05).

Conclusions

The incidence and progression of colorectal polyps are linked to serum lipid molecules and their derivative indexes. Dyslipidemia may increase the risk of colorectal polyps, potentially leading to colorectal cancer (CRC).

El papel del IMC, las moléculas del perfil lipídico sérico y sus índices derivados en los pólipos colorrectales

Objetivos

Investigar el papel del IMC, las moléculas del perfil lipídico en suero y los cocientes lipoproteicos en los pólipos colorrectales.

Métodos

En un análisis retrospectivo, se incluyó a 352 sujetos sometidos a una colonoscopia en nuestro centro, de los cuales 247 no mostraron ninguna alteración evidente (grupo control), mientras que 105 recibieron un diagnóstico de uno o múltiples pólipos (grupo de pacientes). Se compararon las moléculas del perfil lipídico sérico y los cocientes lipoproteicos de los dos grupos.

Resultados

El grupo de pacientes mostró niveles significativamente mayores de colesterol total (CT) y apolipoproteína B (ApoB) que el grupo de control (p<0,05). Entre los hombres, el grupo de pacientes mostró niveles de ApoB y una relación ApoB/ApoA1 superiores a los del grupo de control (p<0,05). Así mismo, los niveles de triglicéridos (TG) y la relación TG/C-HDL (colesterol de lipoproteínas de alta densidad) fueron significativamente más elevados en el grupo de pólipos múltiples que en el de un solo pólipo (p<0,05). Además, los niveles de C-HDL y la relación C-HDL/ApoA1 fueron más altos en el grupo con pólipos adenomatosos que en el de no adenomatosos (p<0,05). El análisis de regresión logística múltiple identificó al CT, TG, LDL-C y a los cocientes CT/C-HDL, TG/C-HDL y C-LDL/C-HDL como factores de riesgo para el desarrollo de pólipos colorrectales (p<0,05). Los análisis de la curva ROC revelaron una asociación entre el CT, la ApoB, y la relación ApoB/ApoA1 y los pólipos colorrectales. Por otro lado, no se observaron diferencias estadísticamente significativas en el IMC entre los dos grupos (p>0,05).

Conclusiones

La incidencia y evolución de los pólipos colorrectales están relacionados con las moléculas del perfil lipídico en suero y los cocientes lipoproteicos de las mismas. La dislipidemia podría incrementar el riesgo de desarrollar pólipos colorrectales, pudiendo derivar posteriormente en el desarrollo de cáncer colorrectal (CRC).

Factors Associated with Polyp Detection Rate in European Colonoscopy Practice: Findings of The European Colonoscopy Quality Investigation (ECQI) Group

Background: The European Colonoscopy Quality Investigation (ECQI) Group aims to raise awareness for improvement in colonoscopy standards across Europe. We analysed data collected on a sample of procedures conducted across Europe to evaluate the achievement of the polyp detection rate (PDR) target. We also investigated factors associated with PDR, in the hope of establishing areas that could lead to a quality improvement. Methods: 6445 form completions from 12 countries between 2 June 2016 and 30 April 2018 were considered for this analysis. We performed an exploratory analysis looking at PDR according to European Society of Gastrointestinal Endoscopy (ESGE) definition. Stepwise multivariable logistic regression analysis was conducted to determine the most influential associated factors after adjusting for the other pre-specified variables. Results: In our sample there were 3365 screening and diagnostic procedures performed in those over 50 years. The PDR was 40.5%, which is comparable with the ESGE minimum standard of 40%. The variables found to be associated with PDR were in descending order: use of high-definition equipment, body mass index (BMI), patient gender, age group, and the reason for the procedure. Use of HD equipment was associated with a significant increase in the reporting of flat lesions (14.3% vs. 5.7%, p < 0.0001) and protruded lesions (34.7% vs. 25.4%, p < 0.0001). Conclusions: On average, the sample of European practice captured by the ECQI survey meets the minimum PDR standard set by the ESGE. Our findings support the ESGE recommendation for routine use of HD colonoscopy.

Electronic chromo-endoscopy: technical details and a clinical perspective

Precise endoscopic assessment is necessary to detect neoplastic changes in an early stage. Electronic or virtual chromo-endoscopy (ECE) is an alternative to conventional dye-based chromo-endoscopy which markedly improves capillary pattern and hence can detect micro-vessel morphological changes of early neoplasia to target biopsies and aid in diagnosis. The clinical significance increased after the advent of endoscopic treatment modalities like ESD/EMR which requires precise delineation of extent and depth of lesion. Most of the studies have used narrow-band imaging (NBI) (Olympus Medical Systems Tokyo, Japan), although data from i-SCAN (PENTAX Endoscopy, Tokyo, Japan) and flexible spectral imaging color enhancement (FICE) (Fujinon, Fujifilm Medical Co, Saitama, Japan) are emerging. Electronic chromo-endoscopy is convenient compared to dye-based chromo-endoscopy in the sense that it is available at the push of a button in endoscope and reduces procedure time substantially with comparable efficacy. Scope of this review is to discuss available electronic chromo-endoscopy modalities and their role in the diagnosis, surveillance, and management of early GI neoplasia.