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Risk of colorectal adenomas in super morbidly obese vs. obese and morbidly obese patients. A A Kaplan-Meier analysis of the primary outcome of colorectal polyps during the follow-up period, as a function of baseline BMI category. B A Kaplan Meier’s analysis of advanced adenomas during the follow-up period, as a function of BMI category.
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PurposeThe impact of pre-bariatric surgery BMI on the incidence of colorectal adenomas in the post-operative period is unknown. Here we aim to evaluate the incidence of colorectal adenomas after bariatric surgery and to assess super morbid obesity (SMO) as a risk factor for post-operative colorectal adenomas.Materials and Methods
An inception cohor...
Citations
... A significant decrease in the incidence rates of colorectal adenomas could not be presently demonstrated, although a trend towards less risk was appreciated. Previous reports indicate that obesity is not only associated with increased risk for adenoma formation [15], but it also exhibits a dose-dependent relationship, with super obese patients being particularly susceptible to adenoma formation [29] and the subsequent conversion to an invasive disease [30]. From this perspective, a heightened index of suspicion for colorectal neoplasias is mandated in obese individuals, and bariatric surgery may be contemplated to impede carcinogenicity [31]. ...
Background:
Obesity is a known risk factor for developing colorectal cancer (CRC) and is associated with the formation of precancerous colonic adenomas. Bariatric surgery (BRS) is considered to reduce the cancer risk in morbidly obese patients. However, the currently available literature yields contradicting results regarding the impact of bariatric surgery on the incidence of CRC.
Methods:
A systematic literature search of the Medline, Embase, CENTRAL, CINAHL, Web of Science, and clinicaltrials.gov databases was undertaken following the PRISMA guidelines. A random effects model was selected.
Results:
Twelve retrospective cohort studies, incorporating a total of 6,279,722 patients, were eligible for inclusion in the final quantitative analysis. Eight studies originated from North America, while four reported on European patients. Patients in the Bariatric Surgery group exhibited a significantly reduced risk for developing colorectal cancer (RR 0.56, 95% CI 0.4-0.8, p < 0.001), while sleeve gastrectomy was found to be significantly associated with a smaller incidence of CRC (RR 0.55, 95% CI 0.36-0.83, p < 0.001), and gastric bypass and banding did not.
Conclusions:
A significant protective effect of BRS against the development of CRC is implied. In the present analysis, the incidence rate of colorectal cancer was approximately halved amongst the obese individuals that were operated on.
... Колоректални полипи се диагностицират колоноскопски при 109 от общо 381 болни на средна възраст от 51,1±10,6 г. и със среден индекс на телесната маса от 42,2±6,2 kg/m 2 (при 28,61% от случаите) (14). Аденом в напреднал стадий се открива при 38 от тях (при 34,86% от случаите). ...
A retrospective analysis of 1695 patients, 719 males and 976 females, with colorectal tumors, hospitalized in St. Marina University Hospital of Varna during the period between January 1, 2021 and December 31, 2021 was carried out. They were examined by means of virtual colonoscopy (VCS) while 812 of them, 368 males and 444 females, were additionally examined using fibrocolonoscopy (FCS). The number of patients was greatest in 2016 (310 in VCS and 155 in FCS) but lowest in 2021 (55 in VCS and 30 in FCS). Colorectal polyps were diagnosed independently by means of VCS in a total of 308 patients (in 147 males and 161 females) (18.17%), while using FCS, they were diagnosed in a total of 203 patients (in 107 males and 96 females) (in 25.00% of the cases). With VCS, synchronous colorectal tumors, such as colorectal polyp and CRC, were diagnosed in a total of 62 patients, 34 men and 28 women. The average colorectal polyp size in VCS was 10.486 mm (between 6.4 mm and 11.6 mm), but that in FCS was 9.101 mm (between 7.3 mm and 12.75 mm). The average localization in VCS was 57.232 cm (between 39.5 cm and 72.86 cm), but that in FCS was 47.855 cm (between 33.3 and 70.0 cm). The method of VCS should be more widely applied in colorectal polyp patients in our country.
... Obesity and the metabolic syndrome are well-known risk factors for colon cancer [1][2][3]. The prevalence of serrated and conventional adenomas is higher in persons with obesity, the risk increasing with BMI [4][5][6]. In terms of colorectal cancer (CRC) screening programs, endoscopy in this population can be challenging, with adherence to the screening programs suboptimal, especially for individuals with higher BMIs [7]. ...
... Other studies challenged those results, reporting either similar or even higher incidence after surgery [10,11]. Furthermore, the rate of incident colonic adenomas after bariatric surgery and intentional weight loss is controversial [5,12]. The different distribution of diverted vs. undiverted surgery in the study groups could account for some of the conflicting results, as some pro-inflammatory and tumorigenic factors exhibit heterogeneous changes among the different surgical techniques, with gastric bypass also found to be at increased risk [13]. ...
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Background:
A fundamental understanding of the impact of bariatric surgery (BRS) on mechanisms of colorectal carcinogenesis is limited. For instance, studies report a reduced risk of colorectal cancer in females but not in males after BRS. We examined whether this sex-specific difference existed at the earlier polyp development stage.
Methods:
This retrospective cohort study included 281,417 adults from the 2012-2020 MarketScan database. We compared polyps rates on colonoscopy in four groups: post- vs. pre-BRS (treatment) to post- vs. pre-severe obesity (SO) diagnosis (control). We focused our main analysis on a propensity-matched sample that yielded a balanced distribution of covariates in our four groups (n = 9680 adults, 21.9% males). We also adjusted for important covariates.
Results:
Metabolic syndrome parameters improved after bariatric surgery and worsened after severe obesity diagnosis (p < 0.05). The rate of polyps was 46.7% at a median of 0.5 years pre-BRS and 47.9% at a median of 0.6 years pre-SO diagnosis. The polyps rate was 45.4% at a median (range) of 3.2 (1.0-8.5) years post-BRS. Conversely, 53.8% of adults had polyps at 3.0 (1.0-8.6) years post-SO. There was no change in the risk of colorectal polyps in males or females post- vs. pre-BRS. However, the risk of polyps was higher in males (OR = 1.32, 95% CI: 1.02-1.70) and females (OR = 1.29, 95% CI: 1.13-1.47) post- vs. pre-SO. When compared to the control group (SO), the odds ratios for colorectal polyps were lower for males and females after bariatric surgery (OR = 0.63, 95% CI: 0.44-0.90, and OR = 0.79, 95% CI: 0.66-0.96, respectively).
Conclusions:
Obesity is associated with an increased risk of colorectal polyps, an effect that is ameliorated after bariatric surgery. These data are relevant for studies investigating colorectal carcinogenesis mechanisms.
Purpose:
Obesity is known to be associated with colorectal adenoma (CRA) and colorectal cancer (CRC); yet colonoscopy is not considered an essential preoperative evaluation before bariatric/metabolic surgery. The aim of this study was to clarify the clinical significance of preoperative colonoscopy for obese Japanese patients.
Methods:
The subjects of this retrospective study were 114 patients who underwent screening colonoscopy before bariatric/metabolic surgery. Multivariate analyses were performed to evaluate the independent predictors of CRA/CRC among the characteristics identified as significant or nearly significant by univariate analyses.
Results:
Colonoscopy revealed abnormal findings indicating the need for biopsy or polypectomy in 20 of the 114 patients (17.5%), and CRA was diagnosed in 13 patients (11.4%). Three patients (2.6%), who were all ≥ 56 years old, had a CRA ≥ 10 mm in diameter. The multivariate analysis showed that older age and male sex were significant predictors of CRA/CRC, which was identified in 46.2% of the male patients aged ≥ 46 years.
Conclusion:
Our findings suggest that older age and male sex may be risk factors for CRA/CRC in obese Japanese candidates for bariatric/metabolic surgery; thus, preoperative colonoscopy should be considered for these high-risk patients.
