BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationsh...BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.展开更多
AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these gen...AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.展开更多
BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and ar...BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and are prone to complications.Endoscopic mucosal ablation(EMA)is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions.CASE SUMMARY In this case series we report the successful treatment of three flat colonic polyps using the EMA technique.Two lesions were treatment naïve and 1 was a recurrence after an endoscopic mucosal resection.The sizes ranged from 2 to 4 cm.All three polyps were ablated successfully with no immediate or delayed complications.The recurrence rate at 1 year of follow up was 0%.CONCLUSION Based on this initial experience,we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.展开更多
The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer g...The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer growth.Endoscopy is the conventional technique for detecting colon polyps,and considerable research has proved that automated diagnosis of image regions that might have polyps within the colon might be used to help experts for decreasing the polyp miss rate.The automated diagnosis of polyps in a computer-aided diagnosis(CAD)method is implemented using statistical analysis.Nowadays,Deep Learning,particularly throughConvolution Neural networks(CNN),is broadly employed to allowthe extraction of representative features.This manuscript devises a new Northern Goshawk Optimization with Transfer Learning Model for Colonic Polyp Detection and Classification(NGOTL-CPDC)model.The NGOTL-CPDC technique aims to investigate endoscopic images for automated colonic polyp detection.To accomplish this,the NGOTL-CPDC technique comprises of adaptive bilateral filtering(ABF)technique as a noise removal process and image pre-processing step.Besides,the NGOTL-CPDC model applies the Faster SqueezeNet model for feature extraction purposes in which the hyperparameter tuning process is performed using the NGO optimizer.Finally,the fuzzy Hopfield neural network(FHNN)method can be employed for colonic poly detection and classification.A widespread simulation analysis is carried out to ensure the improved outcomes of the NGOTL-CPDC model.The comparison study demonstrates the enhancements of the NGOTL-CPDC model on the colonic polyp classification process on medical test images.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EM...BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EMR)is preferred is still debatable.AIM To compare the surgical,histological,and oncological outcomes between ESD and EMR in the treatment of colorectal polyps,with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc,complete resection,margin involvement,resection time,need for additional surgery,complications,and recurrence rate of ESD with EMR.RESULTS Of 281344 colorectal polyps from 21 studies were included.When compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and recurrence.ESD led to increased procedural time,need for additional surgery,and perforation risk.No significant difference in bleeding risk was found between the two groups.Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD.Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and recurrence.In subgroup analysis,Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4%and 0.0002%,respectively,as compared to perforation risk of 8%and 1%,respectively,in reports coming from rest of the world.CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR.With appropriate training,ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps,without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.展开更多
BACKGROUND It was shown in previous studies that high definition endoscopy, high magnification endoscopy and image enhancement technologies, such as chromoendoscopy and digital chromoendoscopy [narrow-band imaging(NBI...BACKGROUND It was shown in previous studies that high definition endoscopy, high magnification endoscopy and image enhancement technologies, such as chromoendoscopy and digital chromoendoscopy [narrow-band imaging(NBI), iScan] facilitate the detection and classification of colonic polyps during endoscopic sessions. However, there are no comprehensive studies so far that analyze which endoscopic imaging modalities facilitate the automated classification of colonic polyps. In this work, we investigate the impact of endoscopic imaging modalities on the results of computer-assisted diagnosis systems for colonic polyp staging.AIM To assess which endoscopic imaging modalities are best suited for the computerassisted staging of colonic polyps.METHODS In our experiments, we apply twelve state-of-the-art feature extraction methods for the classification of colonic polyps to five endoscopic image databases of colonic lesions. For this purpose, we employ a specifically designed experimental setup to avoid biases in the outcomes caused by differing numbers of images per image database. The image databases were obtained using different imaging modalities. Two databases were obtained by high-definition endoscopy in combination with i-Scan technology(one with chromoendoscopy and one without chromoendoscopy). Three databases were obtained by highmagnification endoscopy(two databases using narrow band imaging and one using chromoendoscopy). The lesions are categorized into non-neoplastic and neoplastic according to the histological diagnosis.RESULTS Generally, it is feature-dependent which imaging modalities achieve high results and which do not. For the high-definition image databases, we achieved overall classification rates of up to 79.2% with chromoendoscopy and 88.9% without chromoendoscopy. In the case of the database obtained by high-magnification chromoendoscopy, the classification rates were up to 81.4%. For the combination of high-magnification endoscopy with NBI, results of up to 97.4% for one database and up to 84% for the other were achieved. Non-neoplastic lesions were classified more accurately in general than non-neoplastic lesions. It was shown that the image recording conditions highly affect the performance of automated diagnosis systems and partly contribute to a stronger effect on the staging results than the used imaging modality.CONCLUSION Chromoendoscopy has a negative impact on the results of the methods. NBI is better suited than chromoendoscopy. High-definition and high-magnification endoscopy are equally suited.展开更多
BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the ris...BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.展开更多
BACKGROUND Post-polypectomy electrocoagulation syndrome(PPES)can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis.Nevertheless,there can be cases with complications ...BACKGROUND Post-polypectomy electrocoagulation syndrome(PPES)can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis.Nevertheless,there can be cases with complications developing.CASE SUMMARY A 58-year-old woman,who had no previous medical history,visited the Emergency Department of another hospital with symptoms of abdominal pain and fever,1 d after multiple colonoscopic polypectomies.An abdominopelvic computed tomography(CT)scan demonstrated colo-colonic intussusception,and she was transferred to our hospital to consider an operation.CT showed colocolonic intussusception with PPES and no evidence of obstruction.The physical examination showed localized mild tenderness on the right sided abdomen.The patient fasted and was admitted for treatment with intravenous antibiotics(piperacillin/tazobactam 4.5 g each 8 h,ornidazole 500 mg each 12 h).After admission,the symptoms got better and a follow-up CT scan demonstrated resolution of the PPES and intussusception.The patient was discharged on hospital day 9.CONCLUSION Colo-colic intussusception can occur with PPES,and it can be properly treated conservatively.展开更多
BACKGROUND The role of oxidative stress in the pathogenesis of colorectal carcinoma(CRC)has garnered considerable interest recently.Specific oxidative factors have been implicated in the pathogenesis of adenomatous po...BACKGROUND The role of oxidative stress in the pathogenesis of colorectal carcinoma(CRC)has garnered considerable interest recently.Specific oxidative factors have been implicated in the pathogenesis of adenomatous polyps and ultimately adenocarcinoma.AIM To evaluate the effect of oxidative imbalance as quantified by specific serological markers in the development of sporadic colon adenocarcinoma.METHODS A total of 170 patients that underwent endoscopy of the lower gastrointestinal tract in a tertiary center within 3 years were included in the study.They were allocated in three groups;those with sporadic colon adenocarcinoma(n=56,32.9%),those with colonic polyps(n=33,19.4%)and healthy controls(n=81,47.7%).All patients were evaluated for oxidant activity and antioxidant capacity with serum measurements of specific markers such as vitamins A,25(OH)D3,E,C,B12,folic acid,glutathione,selenium(Se),zinc(Zn),free iron(Fe^(2+)),and malondialdehyde and results were compared between groups.RESULTS Serum levels of vitamins C,E,D,Se,Zn,vitamin B12 and total antioxidant capacity were significantly lower in the combined neoplasia/polyp group than in the control group(P=0.002,P=0.009,P<0.001,P<0.001,P<0.001,P=0.020 and P<0.001,correspondingly).Increased levels of vitamin E(P=0.004),vitamin D(P<0.001),Se(P<0.001)and Zn(P<0.001)seem to bestow a protective effect on the development of CRC.For vitamin D(P<0.001)and Zn(P=0.036),this effect seems to extend to the development of colon polyps as well.On the other hand,elevated serum levels of malondialdehyde are associated with a higher risk of CRC(OR=2.09 compared to controls,P=0.004).Regarding colonic polyp development,increased concentrations of vitaminΑand Fe^(2+) are associated with a higher risk,whereas lower levels of malondialdehyde with a lower risk.CONCLUSION Increased oxidative stress may play an important role in the pathogenesis and progression of CRC.Antioxidants’presence may exert a protective effect in the very early stages of colon carcinogenesis.展开更多
Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the i...Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality.Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps.Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps.Polyp size,location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability.Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically.When compared to surgery,endoscopic resection is associated with lower morbidity,mortality,and higher patient quality of life.Conversely,malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery.From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics,but also on local resources and expertise availability.In this review,we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.展开更多
The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA...The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA should be determined for a further large number of studies.EMA should be used with caution for larger lesions.展开更多
Colonoscopy has been shown to be an effective modality to prevent colorectal cancer(CRC)development.CRC reduction is achieved by detecting and removing adenomas,which are precursors of CRC.Most colorectal polyps are s...Colonoscopy has been shown to be an effective modality to prevent colorectal cancer(CRC)development.CRC reduction is achieved by detecting and removing adenomas,which are precursors of CRC.Most colorectal polyps are small and do not pose a significant challenge for trained and skilled endoscopists.However,up to 15%of polyps are considered“difficult”,potentially causing life-threatening complications.A difficult polyp is defined as any polyp that is challenging for the endoscopist to remove owing to its size,shape,or location.Advanced polypectomy techniques and skills are required to resect difficult colorectal polyps.There were various polypectomy techniques for difficult polyps such as endoscopic mucosal resection(EMR),underwater EMR,Tip-in EMR,endoscopic submucosal dissection(ESD),or endoscopic full-thickness resection.The selection of the appropriate modality depends on the morphology and endoscopic diagnosis.Several technologies have been developed to aid endoscopists in performing safe and effective polypectomies,especially complex procedures such as ESD.These advances include video endoscopy system,equipment assisting in advanced polypectomy,and closure devices/techniques for complication management.Endoscopists should know how to use these devices and their availability in practice to enhance polypectomy performance.This review describes several useful strategies and tips for managing difficult colorectal polyps.We also propose the stepwise approach for difficult colorectal polyps.展开更多
BACKGROUND Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy.We present an uncommon colonoscopy findi...BACKGROUND Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy.We present an uncommon colonoscopy finding of a healed diverticular perforation,mimicking a polyp,6 wk post-diverticulitis-something that has not been reported in literature.We aim to shed light on the likely process that resulted in the trompe l'oeil after diverticulitis.This also introduces the possibility of more targeted colonic resection in the event of a similar recurrence.CASE SUMMARY A middle-aged Chinese female presented with a 3-d history of non-colicky left iliac fossa pain.It was associated with fever(Tmax 37.6℃),non-bloody diarrhoea and non-bloody,non-bilious vomiting.She had a history of Type 2 diabetes mellitus,well controlled on metformin.Tenderness was noted on the left iliac fossa region with no guarding or mass.Total white cell count(11.45×10^(9)/L)and C-reactive protein levels(213.9 mg/L)were elevated.Computed tomography imaging of the abdomen revealed pericolonic fat stranding and extraluminal air pockets fluid density with peritoneal thickening at the sigmoid colon,likely representing a sealed perforation.Six weeks after the episode,she underwent a follow-up colonoscopy.An exophytic polypoid lesion closely associated with a diverticulum was seen in the sigmoid colon.The lesion was easily“pinched”off without much effort using endoscopic forceps and sent for histology which revealed granulation tissue suggesting a healed diverticular perforation.CONCLUSION Granulation tissue associated with healed diverticular perforations resemble polyps.Tattooing around these sites may allow for future targeted colonic resections.展开更多
BACKGROUND Music has been used to reduce stress and improve task performance during medical therapy.AIM To assess the effects of music on colonoscopy performance outcomes.METHODS We retrospectively reviewed patients w...BACKGROUND Music has been used to reduce stress and improve task performance during medical therapy.AIM To assess the effects of music on colonoscopy performance outcomes.METHODS We retrospectively reviewed patients who underwent colonoscopy performed by four endoscopists with popular music.Colonoscopy performance outcomes,such as insertion time,adenoma detection rate(ADR),and polyp detection rate(PDR),were compared between the music and non-music groups.To reduce selection bias,propensity score matching was used.RESULTS After one-to-one propensity score matching,169 colonoscopies were selected from each group.No significant differences in insertion time(4.97 vs 5.17 min,P=0.795)and ADR(39.1%vs 46.2%,P=0.226)were found between the two groups.Subgroup analysis showed that the insertion time(3.6 vs 3.8 min,P=0.852)and ADR(51.1%vs 44.7%,P=0.488)did not significantly differ between the two groups in experts.However,in trainees,PDR(46.9%vs 66.7%,P=0.016)and ADR(25.9%vs 47.6%,P=0.006)were significantly lower in the music than in the nonmusic group.CONCLUSION The current study found that listening to music during colonoscopy did not affect procedure performance.Moreover,it suggested that music may distract trainees from appropriately detecting adenomas and polyps.展开更多
AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to Febr...AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not signif icantly different from SC in term of cecal intubation time and polyp detection rate.展开更多
Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,c...Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,cost-effectiveness,follow-up strategy,and extracolonic findings. In summary,CTC technique is still evolving,and further research is needed to clarify the role of automated colonic insufflation,smooth-muscle relaxants,intravenous and oral contrast,soft-ware rendering,and patient positioning. Currently,full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%,with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy,especially in patients who have never undergone either procedure. CTC is generally safe,although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness,most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present,the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today,in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue,with multi-detector row CT scanners allowing thinner collimation and higher reso-lution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.展开更多
Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative t...Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative to optical colonoscopy(OC).Hastened by the coronavirus disease 2019 pandemic,CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics.A wider adoption of CCE would be bolstered by positive patient experience,as it offers a diagnostic investigation that is not inferior to other modalities.The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps.Solving this issue would improve the stratification of patients for polyp removal.Artificial intelligence(AI)has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations.Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs.With this letter,we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.展开更多
Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,a...Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,and the majority of post-colonoscopy colorectal cancers are thought to arise from these.Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa.However,these topographic features are not enhanced by white light colonoscopy,and the endoscopist must infer these from two-dimensional cues.This may contribute to the number of missed lesions.A variety of optical imaging technologies have been developed commercially to enhance surface topography.However,existing techniques enhance surface topography indirectly,and in two dimensions,and the evidence does not wholly support their use in routine clinical practice.In this narrative review,co-authored by gastroenterologists and engineers,we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate,and review the development of photometric stereo(PS)for colonoscopy.PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography.This imaging technique has several potential clinical applications in colonoscopy,including adenoma detection,polyp classification,and facilitating polypectomy,an inherently three-dimensional task.However,the development of PS for colonoscopy is at an early stage.We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.展开更多
Colorectal cancer(CRC)is a heterogeneous illness characterized by various epigenetic and microenvironmental changes and is the third-highest cause of cancer-related death in the US.Artificial intelligence(AI)with its ...Colorectal cancer(CRC)is a heterogeneous illness characterized by various epigenetic and microenvironmental changes and is the third-highest cause of cancer-related death in the US.Artificial intelligence(AI)with its ability to allow automatic learning and improvement from experiences using statistical methods and Deep learning has made a distinctive contribution to the diagnosis and treatment of several cancer types.This review discusses the uses and application of AI in CRC screening using automated polyp detection assistance technologies to the development of computer-assisted diagnostic algorithms capable of accurately detecting polyps during colonoscopy and classifying them.Furthermore,we summarize the current research initiatives geared towards building computer-assisted diagnostic algorithms that aim at improving the diagnostic accuracy of benign from premalignant lesions.Considering the evolving transition to more personalized and tailored treatment strategies for CRC,the review also discusses the development of machine learning algorithms to understand responses to therapies and mechanisms of resistance as well as the future roles that AI applications may play in assisting in the treatment of CRC with the aim to improve disease outcomes.We also discuss the constraints and limitations of the use of AI systems.While the medical profession remains enthusiastic about the future of AI and machine learning,large-scale randomized clinical trials are needed to analyze AI algorithms before they can be used.展开更多
Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy.A variety of polypectomy techniques and de...Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy.A variety of polypectomy techniques and devices are available,and their use can vary greatly based on local availability and preferences.In general,cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps,and hot snare has been the method of choice for larger polyps.The use of hot forceps has mostly fallen out of favor.Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve.As a result,the vast majority of polyps today can be removed endoscopically.Since electrocautery is frequently used for polypectomy,endoscopists should be thoroughly familiar with the basic principles of electrosurgery as it pertains to polypectomy.Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance.The two most common post-polypectomy complications are bleeding and perforation.Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers.This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.展开更多
文摘BACKGROUND Analyzing the variations in serum bile acid(BA)profile can provide a certain biological basis for early warning and prevention of various diseases.There is currently no comprehensive study on the relationship between the serum BA profile and colonic polyps.AIM To study the serum BA profile detection results of patients with colonic polyps,and analyze the correlation between BA and colonic polyps.METHODS From January 1,2022,to June 1,2023,204 patients with colonic polyps who were diagnosed and treated at Zhongda Hospital Southeast University were chosen as the study subjects,and 135 non-polyp people who underwent physical examination were chosen as the control group.Gathering all patients'clinical information,typical biochemical indicators,and BA profile.RESULTS Compared with the control group,the serum levels of taurocholic acid,glycocholic acid,glycochenodeoxycholic acid,and taurochenodeoxycholic acid in the colonic polyp group were significantly higher than those in the control group,while the content of deoxycholic acid(DCA)was lower than that in the control group(P<0.05).When colonic polyps were analyzed as subgroups,it was shown that there was a strong correlation between changes in the BA profile and polyp diameter,location,morphology,pathological kind,etc.CONCLUSION The serum BA profile showed significant changes in patients with colonic polyps,with a significant increase in primary conjugated BA content and a decrease in secondary free bile acid DCA content.There is a certain correlation between primary free BA and pathological parameters of polyps.
基金Supported by the Special Fund for Health Research and Development,Beijing Municipal Government,China,No.2011-4001-01
文摘AIM To determine the pathogenesis and potential single nucleotide polymorphisms(SNPs) as screening sites for colonic polyps,colon cancer and ulcerative colitis,and to analyze the possible association between these genetic polymorphisms and the three diseases. METHODS We evaluated genetic polymorphisms in 144 newly diagnosed colonic polyp patients,96 colon cancer patients and 44 ulcerative colitis patients. The four SNPs genotyped were rs4809957,rs6068816,rs6091822 and rs8124792. The control group consisted of 504 East Asians enrolled in the 1000 Genomes Project. Correlations between CYP24A1 SNPs and the diseases were analyzed by Fisher's exact probability test.RESULTS CYP24A1 polymorphisms rs4809957 A/G and rs6068816 C/T showed a statistically significant association with risk of the three diseases,when both the genotypes and allele frequencies were considered. With regard to rs6091822 G/T,all three diseases were related to risk allele carriers(GT + TT) vs wild-type(GG),but the associations between the allele frequencies and the diseases were not significant. The risk of colonic polyps and colon cancer was related to the allele frequencies of rs8124792 G/A,and this association remained for genotype frequencies of this SNP. CONCLUSION Four SNPs are related to the risk of colonic polyps and colon cancer. G allele in rs6091822 G/T may play an anti-cancer role only if it is homozygous. The A allele,which is a minor component of rs8124792,may be indicated in the diagnosis of colonic polyps or colon cancer rather than ulcerative colitis.
文摘BACKGROUND Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract.However,resection techniques require extensive training,are not available in all endoscopy centers and are prone to complications.Endoscopic mucosal ablation(EMA)is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions.CASE SUMMARY In this case series we report the successful treatment of three flat colonic polyps using the EMA technique.Two lesions were treatment naïve and 1 was a recurrence after an endoscopic mucosal resection.The sizes ranged from 2 to 4 cm.All three polyps were ablated successfully with no immediate or delayed complications.The recurrence rate at 1 year of follow up was 0%.CONCLUSION Based on this initial experience,we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.
文摘The major mortality factor relevant to the intestinal tract is the growth of tumorous cells(polyps)in various parts.More specifically,colonic polyps have a high rate and are recognized as a precursor of colon cancer growth.Endoscopy is the conventional technique for detecting colon polyps,and considerable research has proved that automated diagnosis of image regions that might have polyps within the colon might be used to help experts for decreasing the polyp miss rate.The automated diagnosis of polyps in a computer-aided diagnosis(CAD)method is implemented using statistical analysis.Nowadays,Deep Learning,particularly throughConvolution Neural networks(CNN),is broadly employed to allowthe extraction of representative features.This manuscript devises a new Northern Goshawk Optimization with Transfer Learning Model for Colonic Polyp Detection and Classification(NGOTL-CPDC)model.The NGOTL-CPDC technique aims to investigate endoscopic images for automated colonic polyp detection.To accomplish this,the NGOTL-CPDC technique comprises of adaptive bilateral filtering(ABF)technique as a noise removal process and image pre-processing step.Besides,the NGOTL-CPDC model applies the Faster SqueezeNet model for feature extraction purposes in which the hyperparameter tuning process is performed using the NGO optimizer.Finally,the fuzzy Hopfield neural network(FHNN)method can be employed for colonic poly detection and classification.A widespread simulation analysis is carried out to ensure the improved outcomes of the NGOTL-CPDC model.The comparison study demonstrates the enhancements of the NGOTL-CPDC model on the colonic polyp classification process on medical test images.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has shown to be effective in management of colorectal neoplasm in the Asian countries,while its implementation in Western countries where endoscopic mucosal resection(EMR)is preferred is still debatable.AIM To compare the surgical,histological,and oncological outcomes between ESD and EMR in the treatment of colorectal polyps,with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc,complete resection,margin involvement,resection time,need for additional surgery,complications,and recurrence rate of ESD with EMR.RESULTS Of 281344 colorectal polyps from 21 studies were included.When compared to EMR,the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate,and lower lateral margin involvement and recurrence.ESD led to increased procedural time,need for additional surgery,and perforation risk.No significant difference in bleeding risk was found between the two groups.Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD.Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate,bleeding risk and recurrence.In subgroup analysis,Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4%and 0.0002%,respectively,as compared to perforation risk of 8%and 1%,respectively,in reports coming from rest of the world.CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR.With appropriate training,ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps,without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.
文摘BACKGROUND It was shown in previous studies that high definition endoscopy, high magnification endoscopy and image enhancement technologies, such as chromoendoscopy and digital chromoendoscopy [narrow-band imaging(NBI), iScan] facilitate the detection and classification of colonic polyps during endoscopic sessions. However, there are no comprehensive studies so far that analyze which endoscopic imaging modalities facilitate the automated classification of colonic polyps. In this work, we investigate the impact of endoscopic imaging modalities on the results of computer-assisted diagnosis systems for colonic polyp staging.AIM To assess which endoscopic imaging modalities are best suited for the computerassisted staging of colonic polyps.METHODS In our experiments, we apply twelve state-of-the-art feature extraction methods for the classification of colonic polyps to five endoscopic image databases of colonic lesions. For this purpose, we employ a specifically designed experimental setup to avoid biases in the outcomes caused by differing numbers of images per image database. The image databases were obtained using different imaging modalities. Two databases were obtained by high-definition endoscopy in combination with i-Scan technology(one with chromoendoscopy and one without chromoendoscopy). Three databases were obtained by highmagnification endoscopy(two databases using narrow band imaging and one using chromoendoscopy). The lesions are categorized into non-neoplastic and neoplastic according to the histological diagnosis.RESULTS Generally, it is feature-dependent which imaging modalities achieve high results and which do not. For the high-definition image databases, we achieved overall classification rates of up to 79.2% with chromoendoscopy and 88.9% without chromoendoscopy. In the case of the database obtained by high-magnification chromoendoscopy, the classification rates were up to 81.4%. For the combination of high-magnification endoscopy with NBI, results of up to 97.4% for one database and up to 84% for the other were achieved. Non-neoplastic lesions were classified more accurately in general than non-neoplastic lesions. It was shown that the image recording conditions highly affect the performance of automated diagnosis systems and partly contribute to a stronger effect on the staging results than the used imaging modality.CONCLUSION Chromoendoscopy has a negative impact on the results of the methods. NBI is better suited than chromoendoscopy. High-definition and high-magnification endoscopy are equally suited.
文摘BACKGROUND Recently,research has linked Helicobacter pylori(H.pylori)stomach infection to colonic inflammation,mediated by toxin production,potentially impacting colorectal cancer occurrence.AIM To investigate the risk factors for post-colon polyp surgery,H.pylori infection,and its correlation with pathologic type.METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen.They were then randomly split into modeling(n=56)and model validation(n=24)sets using R.The modeling cohort was divided into an H.pylori-infected group(n=37)and an H.pylori-uninfected group(n=19).Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H.pylori infection after colon polyp surgery.A roadmap prediction model was established and validated.Finally,the correlation between the different pathological types of colon polyps and the occurrence of H.pylori infection was analyzed after colon polyp surgery.RESULTS Univariate results showed that age,body mass index(BMI),literacy,alcohol consumption,polyp pathology type,high-risk adenomas,and heavy diet were all influential factors in the development of H.pylori infection after intestinal polypectomy.Binary multifactorial logistic regression analysis showed that age,BMI,and type of polyp pathology were independent predictors of the occurrence of H.pylori infection after intestinal polypectomy.The area under the receiver operating characteristic curve was 0.969[95%confidence interval(95%CI):0.928–1.000]and 0.898(95%CI:0.773–1.000)in the modeling and validation sets,respectively.The slope of the calibration curve of the graph was close to 1,and the goodness-of-fit test was P>0.05 in the two sets.The decision analysis curve showed a high rate of return in both sets.The results of the correlation analysis between different pathological types and the occurrence of H.pylori infection after colon polyp surgery showed that hyperplastic polyps,inflammatory polyps,and the occurrence of H.pylori infection were not significantly correlated.In contrast,adenomatous polyps showed a significant positive correlation with the occurrence of H.pylori infection.CONCLUSION Age,BMI,and polyps of the adenomatous type were independent predictors of H.pylori infection after intestinal polypectomy.Moreover,the further constructed column-line graph prediction model of H.pylori infection after intestinal polypectomy showed good predictive ability.
文摘BACKGROUND Post-polypectomy electrocoagulation syndrome(PPES)can occur after colonoscopic polypectomy and is usually treated conservatively with a positive prognosis.Nevertheless,there can be cases with complications developing.CASE SUMMARY A 58-year-old woman,who had no previous medical history,visited the Emergency Department of another hospital with symptoms of abdominal pain and fever,1 d after multiple colonoscopic polypectomies.An abdominopelvic computed tomography(CT)scan demonstrated colo-colonic intussusception,and she was transferred to our hospital to consider an operation.CT showed colocolonic intussusception with PPES and no evidence of obstruction.The physical examination showed localized mild tenderness on the right sided abdomen.The patient fasted and was admitted for treatment with intravenous antibiotics(piperacillin/tazobactam 4.5 g each 8 h,ornidazole 500 mg each 12 h).After admission,the symptoms got better and a follow-up CT scan demonstrated resolution of the PPES and intussusception.The patient was discharged on hospital day 9.CONCLUSION Colo-colic intussusception can occur with PPES,and it can be properly treated conservatively.
文摘BACKGROUND The role of oxidative stress in the pathogenesis of colorectal carcinoma(CRC)has garnered considerable interest recently.Specific oxidative factors have been implicated in the pathogenesis of adenomatous polyps and ultimately adenocarcinoma.AIM To evaluate the effect of oxidative imbalance as quantified by specific serological markers in the development of sporadic colon adenocarcinoma.METHODS A total of 170 patients that underwent endoscopy of the lower gastrointestinal tract in a tertiary center within 3 years were included in the study.They were allocated in three groups;those with sporadic colon adenocarcinoma(n=56,32.9%),those with colonic polyps(n=33,19.4%)and healthy controls(n=81,47.7%).All patients were evaluated for oxidant activity and antioxidant capacity with serum measurements of specific markers such as vitamins A,25(OH)D3,E,C,B12,folic acid,glutathione,selenium(Se),zinc(Zn),free iron(Fe^(2+)),and malondialdehyde and results were compared between groups.RESULTS Serum levels of vitamins C,E,D,Se,Zn,vitamin B12 and total antioxidant capacity were significantly lower in the combined neoplasia/polyp group than in the control group(P=0.002,P=0.009,P<0.001,P<0.001,P<0.001,P=0.020 and P<0.001,correspondingly).Increased levels of vitamin E(P=0.004),vitamin D(P<0.001),Se(P<0.001)and Zn(P<0.001)seem to bestow a protective effect on the development of CRC.For vitamin D(P<0.001)and Zn(P=0.036),this effect seems to extend to the development of colon polyps as well.On the other hand,elevated serum levels of malondialdehyde are associated with a higher risk of CRC(OR=2.09 compared to controls,P=0.004).Regarding colonic polyp development,increased concentrations of vitaminΑand Fe^(2+) are associated with a higher risk,whereas lower levels of malondialdehyde with a lower risk.CONCLUSION Increased oxidative stress may play an important role in the pathogenesis and progression of CRC.Antioxidants’presence may exert a protective effect in the very early stages of colon carcinogenesis.
文摘Colorectal cancer(CRC)is the third most common cancer worldwide and the second leading cause of cancer related death in the world.The early detection and removal of CRC precursor lesions has been shown to reduce the incidence of CRC and cancer-related mortality.Endoscopic resection has become the first-line treatment for the removal of most precursor benign colorectal lesions and selected malignant polyps.Detailed lesion assessment is the first critical step in the evaluation and management of colorectal polyps.Polyp size,location and both macro-and micro-features provide important information regarding histological grade and endoscopic resectability.Benign polyps and even malignant polyps with superficial submucosal invasion and favorable histological features can be adequately removed endoscopically.When compared to surgery,endoscopic resection is associated with lower morbidity,mortality,and higher patient quality of life.Conversely,malignant polyps with deep submucosal invasion and/or high risk for lymph node metastasis will require surgery.From a practical standpoint,the most appropriate strategy for each patient will need to be individualized,based not only on polyp-and patient-related characteristics,but also on local resources and expertise availability.In this review,we provide a broad overview and present a potential decision tree algorithm for the evaluation and management of colorectal polyps that can be widely adopted into clinical practice.
文摘The present letter to editor is related to endoscopic mucosal ablation(EMA).EMA is safe and effective in the treatment of colonic polyps when endoscopic resection is not possible or available,but the indication of EMA should be determined for a further large number of studies.EMA should be used with caution for larger lesions.
文摘Colonoscopy has been shown to be an effective modality to prevent colorectal cancer(CRC)development.CRC reduction is achieved by detecting and removing adenomas,which are precursors of CRC.Most colorectal polyps are small and do not pose a significant challenge for trained and skilled endoscopists.However,up to 15%of polyps are considered“difficult”,potentially causing life-threatening complications.A difficult polyp is defined as any polyp that is challenging for the endoscopist to remove owing to its size,shape,or location.Advanced polypectomy techniques and skills are required to resect difficult colorectal polyps.There were various polypectomy techniques for difficult polyps such as endoscopic mucosal resection(EMR),underwater EMR,Tip-in EMR,endoscopic submucosal dissection(ESD),or endoscopic full-thickness resection.The selection of the appropriate modality depends on the morphology and endoscopic diagnosis.Several technologies have been developed to aid endoscopists in performing safe and effective polypectomies,especially complex procedures such as ESD.These advances include video endoscopy system,equipment assisting in advanced polypectomy,and closure devices/techniques for complication management.Endoscopists should know how to use these devices and their availability in practice to enhance polypectomy performance.This review describes several useful strategies and tips for managing difficult colorectal polyps.We also propose the stepwise approach for difficult colorectal polyps.
文摘BACKGROUND Sealed perforation of colonic diverticulum is a common clinical condition and may be differentiated from an underlying malignant perforation using interval endoscopy.We present an uncommon colonoscopy finding of a healed diverticular perforation,mimicking a polyp,6 wk post-diverticulitis-something that has not been reported in literature.We aim to shed light on the likely process that resulted in the trompe l'oeil after diverticulitis.This also introduces the possibility of more targeted colonic resection in the event of a similar recurrence.CASE SUMMARY A middle-aged Chinese female presented with a 3-d history of non-colicky left iliac fossa pain.It was associated with fever(Tmax 37.6℃),non-bloody diarrhoea and non-bloody,non-bilious vomiting.She had a history of Type 2 diabetes mellitus,well controlled on metformin.Tenderness was noted on the left iliac fossa region with no guarding or mass.Total white cell count(11.45×10^(9)/L)and C-reactive protein levels(213.9 mg/L)were elevated.Computed tomography imaging of the abdomen revealed pericolonic fat stranding and extraluminal air pockets fluid density with peritoneal thickening at the sigmoid colon,likely representing a sealed perforation.Six weeks after the episode,she underwent a follow-up colonoscopy.An exophytic polypoid lesion closely associated with a diverticulum was seen in the sigmoid colon.The lesion was easily“pinched”off without much effort using endoscopic forceps and sent for histology which revealed granulation tissue suggesting a healed diverticular perforation.CONCLUSION Granulation tissue associated with healed diverticular perforations resemble polyps.Tattooing around these sites may allow for future targeted colonic resections.
文摘BACKGROUND Music has been used to reduce stress and improve task performance during medical therapy.AIM To assess the effects of music on colonoscopy performance outcomes.METHODS We retrospectively reviewed patients who underwent colonoscopy performed by four endoscopists with popular music.Colonoscopy performance outcomes,such as insertion time,adenoma detection rate(ADR),and polyp detection rate(PDR),were compared between the music and non-music groups.To reduce selection bias,propensity score matching was used.RESULTS After one-to-one propensity score matching,169 colonoscopies were selected from each group.No significant differences in insertion time(4.97 vs 5.17 min,P=0.795)and ADR(39.1%vs 46.2%,P=0.226)were found between the two groups.Subgroup analysis showed that the insertion time(3.6 vs 3.8 min,P=0.852)and ADR(51.1%vs 44.7%,P=0.488)did not significantly differ between the two groups in experts.However,in trainees,PDR(46.9%vs 66.7%,P=0.016)and ADR(25.9%vs 47.6%,P=0.006)were significantly lower in the music than in the nonmusic group.CONCLUSION The current study found that listening to music during colonoscopy did not affect procedure performance.Moreover,it suggested that music may distract trainees from appropriately detecting adenomas and polyps.
文摘AIM: To study the significance of cap-fitted colonoscopy in improving cecal intubation time and polyp detection rate. METHODS: This study was a prospective randomized controlled trial conducted from March 2008 to February 2009 in a tertiary referral hospital at Sydney. The primary end point was cecal intubation time and the secondary endpoint was polyp detection rate. Consecutive cases of total colonoscopy over a 1-year period were recruited. Randomization into either standard colonoscopy (SC) or cap-assisted colonoscopy (CAC) was performed after consent was obtained. For cases randomized to CAC, one of the three sizes of cap was used: D-201-15004 (with a diameter of 15.3 mm), D-201-14304 (14.6 mm) and D-201-12704 (13.0 mm). All of these caps were produced by Olympus Medical Systems, Japan. Independent predictors for faster cecal time and better polyp detection rate were also determined from this study. RESULTS: There were 200 cases in each group. There was no signif icant difference in terms of demographic characteristics between the two groups. CAC, when compared to the SC group, had no signif icant difference in terms of cecal intubation rate (96.0% vs 97.0%, P = 0.40) and time (9.94 ± 7.05 min vs 10.34 ± 6.82 min, P = 0.21), or polyp detection rate (32.8% vs 31.3%, P = 0.75). On the subgroup analysis, there was no significant difference in terms of cecal intubation time by trainees (88.1% vs 84.8%, P = 0.40), ileal intubation rate (82.5% vs 79.0%, P = 0.38) or total colonoscopy time (23.24 ± 13.95 min vs 22.56 ± 9.94 min, P = 0.88). On multivariate analysis, the independent determinants of faster cecal time were consultant-performed procedures (P < 0.001), male patients (P < 0.001), non-usage of hyoscine (P < 0.001) and better bowel preparation (P = 0.01). The determinants of better polyp detection rate were older age (P < 0.001), no history of previous abdominal surgery (P = 0.04), patients not having esophagogastroduodenoscopy in the same setting (P = 0.003), trainee-performed procedures (P = 0.01), usage of hyoscine (P = 0.01) and procedures performed for polyp follow-up (P = 0.01). The limitations of the study were that it was a single-center experience, no blinding was possible, and there were a large number of endoscopists. CONCLUSION: CAC did not signif icantly different from SC in term of cecal intubation time and polyp detection rate.
文摘Computed tomographic colonography (CTC) is a promising emerging technology for imaging of the colon. This concise review discusses the currently available data on CTC technique,test characteristics,acceptance,safety,cost-effectiveness,follow-up strategy,and extracolonic findings. In summary,CTC technique is still evolving,and further research is needed to clarify the role of automated colonic insufflation,smooth-muscle relaxants,intravenous and oral contrast,soft-ware rendering,and patient positioning. Currently,full bowel preparation is still required to achieve optimal results. The sensitivity for detecting large polyps (> 1 cm) can be as high as 85%,with specificity of up to 97%. These test characteristics are almost comparable to those of conventional colonoscopy. Patient acceptance of CTC is generally higher than that for colonoscopy,especially in patients who have never undergone either procedure. CTC is generally safe,although uncommon instances of colonic perforation have been documented. In terms of cost-effectiveness,most decision analyses have concluded that CTC would only be cost-effective if it were considerably cheaper than conventional colonoscopy. The proper follow-up strategy for small polyps or incidental extracolonic findings discovered during CTC is still under debate. At present,the exact clinical role of virtual colonoscopy still awaits determination. Even though widespread CTC screening is not available today,in the future there may eventually be a role for this technology. Technological advances in this area will undoubtedly continue,with multi-detector row CT scanners allowing thinner collimation and higher reso-lution images. Stool-tagging techniques are likely to evolve and may eventually allow for low-preparation CTC. Perceptual and fatigue-related reading errors can potentially be minimized with the help of computer-aided detection software. Further research will define the exact role of this promising technology in our diagnostic armamentarium.
文摘Colon capsule endoscopy(CCE)was introduced nearly two decades ago.Initially,it was limited by poor image quality and short battery time,but due to technical improvements,it has become an equal diagnostic alternative to optical colonoscopy(OC).Hastened by the coronavirus disease 2019 pandemic,CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics.A wider adoption of CCE would be bolstered by positive patient experience,as it offers a diagnostic investigation that is not inferior to other modalities.The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps.Solving this issue would improve the stratification of patients for polyp removal.Artificial intelligence(AI)has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations.Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs.With this letter,we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.
文摘Colonoscopy screening for the detection and removal of colonic adenomas is central to efforts to reduce the morbidity and mortality of colorectal cancer.However,up to a third of adenomas may be missed at colonoscopy,and the majority of post-colonoscopy colorectal cancers are thought to arise from these.Adenomas have three-dimensional surface topographic features that differentiate them from adjacent normal mucosa.However,these topographic features are not enhanced by white light colonoscopy,and the endoscopist must infer these from two-dimensional cues.This may contribute to the number of missed lesions.A variety of optical imaging technologies have been developed commercially to enhance surface topography.However,existing techniques enhance surface topography indirectly,and in two dimensions,and the evidence does not wholly support their use in routine clinical practice.In this narrative review,co-authored by gastroenterologists and engineers,we summarise the evidence for the impact of established optical imaging technologies on adenoma detection rate,and review the development of photometric stereo(PS)for colonoscopy.PS is a machine vision technique able to capture a dense array of surface normals to render three-dimensional reconstructions of surface topography.This imaging technique has several potential clinical applications in colonoscopy,including adenoma detection,polyp classification,and facilitating polypectomy,an inherently three-dimensional task.However,the development of PS for colonoscopy is at an early stage.We consider the progress that has been made with PS to date and identify the obstacles that need to be overcome prior to clinical application.
文摘Colorectal cancer(CRC)is a heterogeneous illness characterized by various epigenetic and microenvironmental changes and is the third-highest cause of cancer-related death in the US.Artificial intelligence(AI)with its ability to allow automatic learning and improvement from experiences using statistical methods and Deep learning has made a distinctive contribution to the diagnosis and treatment of several cancer types.This review discusses the uses and application of AI in CRC screening using automated polyp detection assistance technologies to the development of computer-assisted diagnostic algorithms capable of accurately detecting polyps during colonoscopy and classifying them.Furthermore,we summarize the current research initiatives geared towards building computer-assisted diagnostic algorithms that aim at improving the diagnostic accuracy of benign from premalignant lesions.Considering the evolving transition to more personalized and tailored treatment strategies for CRC,the review also discusses the development of machine learning algorithms to understand responses to therapies and mechanisms of resistance as well as the future roles that AI applications may play in assisting in the treatment of CRC with the aim to improve disease outcomes.We also discuss the constraints and limitations of the use of AI systems.While the medical profession remains enthusiastic about the future of AI and machine learning,large-scale randomized clinical trials are needed to analyze AI algorithms before they can be used.
文摘Polypectomy of colonic polyps has been shown to reduce the risk of colon cancer development and is considered a fundamental skill for all endoscopists who perform colonoscopy.A variety of polypectomy techniques and devices are available,and their use can vary greatly based on local availability and preferences.In general,cold forceps and cold snare have been the polypectomy methods of choice for smaller polyps,and hot snare has been the method of choice for larger polyps.The use of hot forceps has mostly fallen out of favor.Polypectomy for difficult to remove polyps may require the use of special devices and advanced techniques and has continued to evolve.As a result,the vast majority of polyps today can be removed endoscopically.Since electrocautery is frequently used for polypectomy,endoscopists should be thoroughly familiar with the basic principles of electrosurgery as it pertains to polypectomy.Tattooing of a polypectomy site is an important adjunct to polypectomy and can greatly facilitate future surgery or endoscopic surveillance.The two most common post-polypectomy complications are bleeding and perforation.Their incidence can be decreased with the use of meticulous polypectomy techniques and the application of some prophylactic maneuvers.This review will examine the technique of polypectomy and its complications from the perspective of the practicing gastroenterologist.
